ankle injuries: sprains and more john f. meyers m.d
TRANSCRIPT
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Ankle Injuries:Sprains and More
Ankle Injuries:Sprains and More
John F. Meyers M.D.John F. Meyers M.D.
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Bony AnatomyBony Anatomy
• Tibia
• Fibula
• Talus
• Tibia
• Fibula
• Talus
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Mortice and Tenon JointMortice and Tenon Joint
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Lateral LigamentsLateral Ligaments
• Anterior talofibular• Calcaneofibular• Posterior talofibular
• Anterior talofibular• Calcaneofibular• Posterior talofibular
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Medial ligamentsMedial ligaments
• Deltoid• Deltoid
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Mechanism of InjuryDefinitions
Mechanism of InjuryDefinitions
• Plantar flexion: toes down• Dorsiflexion: Toes up• Inversion: Heel in• Adduction: Heel in• Eversion: Heel out• Abduction: Heel out
• Plantar flexion: toes down• Dorsiflexion: Toes up• Inversion: Heel in• Adduction: Heel in• Eversion: Heel out• Abduction: Heel out
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Inversion InjuryInversion Injury
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Eversion InjuryEversion Injury
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External Rotation InjuryExternal Rotation Injury
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Ankle Sprain OccurrenceAnkle Sprain Occurrence
• 27,000 ankle ligament injuries per day in United States
• Ankle sprains are more than 25% of injuries in football, basketball, soccer and volleyball
• 27,000 ankle ligament injuries per day in United States
• Ankle sprains are more than 25% of injuries in football, basketball, soccer and volleyball
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Making The DiagnosisHistory
Making The DiagnosisHistory
• Mechanism of injury– Plantar flexion and inversion– Uneven terrain-stepping in a hole– Landing on another player’s foot– Teammate on back of ankle while foot is externally
rotated
• Mechanism of injury– Plantar flexion and inversion– Uneven terrain-stepping in a hole– Landing on another player’s foot– Teammate on back of ankle while foot is externally
rotated
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Making The DiagnosisHistory
Making The DiagnosisHistory
• Audible pop• Immediate swelling• Inability to bear weight• These are all signs of a more severe injury
• Audible pop• Immediate swelling• Inability to bear weight• These are all signs of a more severe injury
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Physical ExaminationPhysical Examination
• Observe for:– Swelling– Deformiity
• Palpate for tenderness– Ligaments– Bones
• Observe for:– Swelling– Deformiity
• Palpate for tenderness– Ligaments– Bones
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Physical ExamDrawer test
Physical ExamDrawer test
• ATFL
• >4mm difference
• ATFL
• >4mm difference
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Physical ExamTalar Tilt TestPhysical ExamTalar Tilt Test
• CFL
• > 6° difference
• CFL
• > 6° difference
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Physical ExamSqueeze TestPhysical ExamSqueeze Test
• Anterior tibiofibular ligament
• High ankle sprain
• Anterior tibiofibular ligament
• High ankle sprain
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Physical ExamExternal Rotation Test
Physical ExamExternal Rotation Test
• Anterior tibiofibular ligament
• High ankle sprain
• Anterior tibiofibular ligament
• High ankle sprain
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Physical ExamPalpation
Physical ExamPalpation
• Length of tenderness predicts severity
• One week for each cm above ankle joint
• Length of tenderness predicts severity
• One week for each cm above ankle joint
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Classification and Return to SportClassification and Return to Sport
• Grade I 7-14 days
• Grade II 2-6 weeks
• Grade III 4-26 weeks
• High ankle sprain 1 week per cm
• Grade I 7-14 days
• Grade II 2-6 weeks
• Grade III 4-26 weeks
• High ankle sprain 1 week per cm
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Differential DiagnosisPhyseal Fractures OCDDifferential Diagnosis
Physeal Fractures OCD
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Differential DiagnosisDifferential Diagnosis
Jones FractureJones Fracture Peroneal Tendon SubluxationPeroneal Tendon Subluxation
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Treatment RICETreatment RICE
• Rest
• Ice
• Compression
• Elevation
• Rest
• Ice
• Compression
• Elevation
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Treatment Grade I and IIFunctional Bracing
Treatment Grade I and IIFunctional Bracing
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Treatment Grade III and SyndesmosisTreatment Grade III and Syndesmosis
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Surgery or cast – NO!Functional Bracing –YES!
Surgery or cast – NO!Functional Bracing –YES!
• Return to work 2 to 4 times sooner• No difference in long term stability• No surgical complications• 87% excellent and good results with bracing• 60% excellent and good results with surgery
• Return to work 2 to 4 times sooner• No difference in long term stability• No surgical complications• 87% excellent and good results with bracing• 60% excellent and good results with surgery
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RehabilitationRehabilitation
• Decrease swelling• Regain range of motion• Strengthen muscles• Balance and proprioceptive training• Functional drills
• Decrease swelling• Regain range of motion• Strengthen muscles• Balance and proprioceptive training• Functional drills
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Balance and ProprioceptionBalance and Proprioception
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Return to PlayReturn to Play
• Run without pain or limitations
• Sport specific movements without pain or limitation
• 90% strength• Protective brace
• Run without pain or limitations
• Sport specific movements without pain or limitation
• 90% strength• Protective brace
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Failure to RecoverGiving Way and Recurrent Sprains
Failure to RecoverGiving Way and Recurrent Sprains
Rehabilitation Bracing Surgical reconstruction
of ligaments
Rehabilitation Bracing Surgical reconstruction
of ligaments
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Failure to RecoverIntra Articular Problems
Failure to RecoverIntra Articular Problems
• OCD• Loose bodies• Bone spurs• Arthritis• Soft tissue impingment
• OCD• Loose bodies• Bone spurs• Arthritis• Soft tissue impingment
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PreventionPrevention
• High top shoes• Taping• Shoes and tape• Braces
• High top shoes• Taping• Shoes and tape• Braces
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PreventionPrevention
• Conditioning– Agility– Flexability
• Proprioception• Strengthening• Stretching and warming up• Recognize effects of fatigue
• Conditioning– Agility– Flexability
• Proprioception• Strengthening• Stretching and warming up• Recognize effects of fatigue
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Thank You
Orthopaedic Research of Virginia
Thank You
Orthopaedic Research of Virginia