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Assessment And Management Of Ankle SprainsSteven Schepens M.D.2020/12/101Assessment And Management Of AAnkle SprainsnMost common athletic injurynMost caused by excessive inversionInjury to lateral supporting ligamentnMost treated nonoperatively2020/12/102Ankle SprainsMost common athleRisk Of Ankle Injuries By SportnBasketball-45%nSoccer-31%nVolleyball-25%nFootball-10-15%2020/12/103Risk Of Ankle Injuries By SporAnkle Consists Of Two Joints nTalar MortiseAllows for plantar flexion and dorsiflexionnSubtalar JointAllows for inversion,eversion,and internal and external rotation2020/12/104Ankle Consists Of Two Joints T2020/12/1052020/12/105Ligamentous Structures Of The Anklen1)Tibiofibular Complexn2)Medial Complexn3)Lateral Complex2020/12/106Ligamentous Structures Of The Ligamentous Structures Of The AnklenTibiofibular ComplexStabilizes the ankle mortiseAllows little movement between tibia and fibula 2020/12/107Ligamentous Structures Of The 2020/12/1082020/12/108Ligamentous Structures Of The AnklenMedial ComplexDeltoid LigamentnLimits eversionnLimits lateral displacement of the talusMedial malleolus will often fracture before this ligament tears*2020/12/109Ligamentous Structures Of The 2020/12/10102020/12/1010Ligamentous Structures Of The AnklenLateral ComplexAnterior Talofibular*CalcaneaofibularPosterior TalofibularnResists internal rotation,anterior displacement,and inversion2020/12/1011Ligamentous Structures Of The 2020/12/10122020/12/1012Secondary StabilizersnMuscles and TendonsPeroneous LongusAnterior TibialisPosterior TibialisAchilles tendon2020/12/1013Secondary StabilizersMuscles a2020/12/10142020/12/1014On-Field ManagementnGoal-Identify serious injuryScreen for deformitiesnAxial traction and relocationNeurovascular assessment Weight bearingStabilization2020/12/1015On-Field ManagementGoal-IdentOn-Field Managementn“Golden Period”Best opportunity for accurate diagnosisNo swelling Pain has subsidedNo guarding2020/12/1016On-Field Management“Golden PerAssessment Of Ankle SprainnHistoryHow did it happen?Where does it hurt?Did the pain make you stop playing?Were you able to bear weight right away?Have you injured this or the other ankle before?2020/12/1017Assessment Of Ankle SprainHistAssessment Of Ankle SprainnPhysical ExamRemoval of shoes and socks on both feetExamine uninjured ankle firstPalpate ligaments and bones and note any swelling or ecchymosisMove the ankle through six ranges of motion:nPlantar flexion,dorsiflexion,and inversion and eversion in plantar flexion and dorsiflexion2020/12/1018Assessment Of Ankle SprainPhysAssessment Of Ankle SprainnPhysical ExamStrength testing(compare to other ankle)Special tests for joint stability2020/12/1019Assessment Of Ankle SprainPhysAssessment Of Ankle SprainnSpecific TestsAnterior Drawer TestnAssesses the integrity of the anterior talofibular ligamentnLarge number of false negatives is assessed within the first 48 hoursn4-5 days postinjury has a sensitivity of 86%and specitivity of 74%2020/12/1020Assessment Of Ankle SprainSpec2020/12/10212020/12/1021Assessment Of Ankle SprainnSpecific TestsTalar Tilt TestnDeltoid ligament-eversionnCalcaneofibular-inversionSide-to-side TestnTibiofibular ligament93%specific 2020/12/1022Assessment Of Ankle SprainSpec2020/12/10232020/12/1023Assessment Of Ankle SprainnSpecific TestsThompsons TestnAchilles tendonSqueeze TestExternal Rotation TestnSyndesmosis injuries 2020/12/1024Assessment Of Ankle SprainSpec2020/12/10252020/12/10252020/12/10262020/12/10262020/12/10272020/12/1027Assessment Of Ankle SprainnRadiographsOttawa Ankle Rules*When are ankle X-rays necessary:nInability to bear weightnBone tenderness on the tip of either malleolus or up to 6cm up the posterior edge 2020/12/1028Assessment Of Ankle SprainRadiAssessment Of Ankle SprainnRadiographsOttawa Ankle Rules*When are foot X-rays necessary:nInability to bear weightnBone tenderness at the navicular or the base of the fifth metatarsaln100%sensitivity2020/12/1029Assessment Of Ankle SprainRadiAnkle Injury DifferentialnLateral Inversion SprainMost common injury85%of all ankle sprainsLateral ligaments damaged from anterior to posterior2020/12/1030Ankle Injury DifferentialLaterGrading Lateral Ankle Sprains2020/12/1031Grading Lateral Ankle Sprains2Mnemonic for Treating Ankle SprainsnP-rotectionnR-estnI-cenC-ompressionnE-levationnM-edicationnM-obilization2020/12/1032Mnemonic for Treating Ankle SpMedial Eversion SprainnCommonly seen in wrestlersn10%of sprains vs.85%lateraln75%of ankle fractures occur on medial sidenDeltoid Ligament2020/12/1033Medial Eversion SprainCommonlySyndesmosis Sprainn1%-11%of ankle sprainsnExternal rotation stress radiographsnLittle swellingnRecovery time of 55 days2020/12/1034Syndesmosis Sprain1%-11%of 2020/12/10352020/12/1035Bifurcate Ligament InjurynInjuryViolent Dorsiflexion,Forceful plantar flexion,direct trauman19%of inversion sprainsnAvulsion of anterior process of calcaneousnNon-weight-bearing cast for four weeks2020/12/1036Bifurcate Ligament InjuryInjur2020/12/10372020/12/1037ACHILLES TENDON RUPTUREnRapid plantar flexionn2 to 6cm above the Os Calcis2020/12/1038ACHILLES TENDON RUPTURERapid pPeroneal Tendon InjurynSubluxation or dislocationnPalpate over the tendon with dorsiflexion and eversion2020/12/1039Peroneal Tendon InjurySubluxatFlexor Hallucis Longus InjurynOccurs with people who tiptoe or stand on the balls of their feet2020/12/1040Flexor Hallucis Longus InjuryOLateral PeriostitisnJumpers anklenSymptoms similar to a lateral sprainnLateral Talus2020/12/1041Lateral PeriostitisJumpers ankAnterior Tibialis Tendon InjurynMost often in elderly peoplenFoot dropnSurgery2020/12/1042Anterior Tibialis Tendon InjurPPT教学课件谢 谢 观 看ThankYouForWatching43PPT教学课件谢谢观看Thank You For Watch