Professional Documents
Culture Documents
Ankle Injuries12344123
Ankle Injuries12344123
Ankle Injuries12344123
sprain.
AETIOLOGY and patient history are more important for clinical decisions. MRI
often misses superficial cartilage injuries.
Impingement syndrome is not a diagnosis
TREATMENT
but a symptom and may be caused by repetitive
NSAID can give short-term relief, as can intra-articular cortisone
trauma to the anterior ankle joint, for example
injections. If there are persistent or severe symptoms, arthroscopy
from striking footballs, recurrent sprains causing with debriding and excision of impinged structures is recommended
bodies. Several underlying pathoanatomical factors Refer to orthopaedic ankle surgeon for consideration of arthroscopy.
fibrosis, chondral flap tears, synovitis and impinging Rest will not help so allow all kinds of sporting activities using well-
fitting shoes. If there is pain on impact suggest low-impact activities
soft tissue flaps.
such as cycling and swimming.
CLINICAL FINDINGS
EVALUATION OF TREATMENT OUTCOMES
There is effusion andlocalized tenderness on palpation over the
Monitor decrease of clinical symptoms and signs. The anterior
anterior talus dome during forced dorsiflexion while compressing the
impingement test should be negative.
extensor tendons and capsule. This is the ‘anterior impingement
test’.
INVESTIGATIONS
properly following the injury, it softens and begins to break off. The aetiology is direct or indirect trauma to the talus dome cartilage,
Sometimes a broken piece of the damaged cartilage and bone will often occurring in contact sports like soccer and rugby. This is the
float in the ankle. most common cause for ankle pain persisting for more than three
weeks after an ankle sprain.
CLINICAL FINDINGS
EXERCISE PRESCRIPTION
Rest will not help so allow all kinds of sporting activities using well-
fitting shoes and avoiding impact. If there is pain on impact suggest
low-impact activities such as cycling and swimming. Arthroscopy of the ankle can be done as an outpatient procedure
EVALUATION OF TREATMENT OUTCOMES and is very useful in diagnosing and treating inter-articular ankle
injuries.
Monitor decrease of clinical symptoms and signs. DIFFERENTIAL
DIAGNOSES OCD, which has a typical appearance on MRI but is PROGNOSIS
treated in the same manner, with arthroscopy. Excellent and Good Osteoarthritis of the ankle joint after mild to
moderate cartilage injuries is rare.
LATERAL ANKLE LIGAMENT RUPTURES INVESTIGATIONS
A sprained ankle occurs when your ankle ligaments are X-ray is often normal but should be taken to rule out fractures, in
overstretched. Ankle sprains vary in their severity, from mild "twisted particular in growing athletes with open growth plates and in elderly
ankle" or "rolled ankle" sprain through to severe complete ligament athletes when osteoporosis is suspected. MRI may show localise
ruptures, avulsion fractures or broken bones. doedemaove not required for the diagnosis, but rather to rule out
associated injuries to other major structures the lateral ligaments
What Causes a Sprained Ankle?
though is.
Ankle sprains can occur simply by rolling your ankle on some
CLINICAL FINDINGS
unstable ground. Common examples of this occur when awkwardly
planting your foot when running, landing unbalanced from a jump or After an acute episode there is tenderness on palpation over the
stepping onto an irregular surface. lateral ligaments localised bruising or swelling and/or haemarthrosis/
effusion of the joint if both ligaments rupture. Positive anterior drawer
SYMPTOMS
(ATF) and talar tilt (FC) tests are typical for these two ligament
The patient refers to a sudden sharp ruptures.
tearing pain around the lateral aspect of the ankle joint after an acute TREATMENT
inversion sprain or, on occasions, of recurrent instability after
After an acute sprain rest, ice, compression, elevation (RICE) is
previous sprains.
advocated. Early proprio - Anterior drawer test (ATFL rupture); tibia
is fixed with one hand, the other hand grips as show and pulls the
foot anteriorly. If there is increased laxity and no distinct endpoint the
test is positive ceptive training and weight-bearing exercises are
often recommended. Rehabilitation is usually curative and the athlete
can resume sport within two to three weeks, occasionally using a
brace or strapping during the first 12 weeks. If there is persistent
Anterior view of the ankle, illustrating the anterior talofibular ligament
(ATFL)
pain or effusion after three weeks, suspect associated injuries to experience subjective or functional instability. Compare with the non-
cartilage or other structures. injured side. There are different functional tests for ankle stability for
different kinds of sports.
REFERRALS
Strapping the ankle is very useful in the early period after returning to
Refer to physiotherapist for mild symptoms and to orthopaedic
play, to avoid re-injury, but it cannot replace proper training.
surgeon if there is severe pain or effusion persists for more than
three weeks. DIFFERENTIAL DIAGNOSES