踝关节扭伤的评价和处理教学课件

1、Ankle SprainsMost common athletic injuryMost caused by excessive inversionInjury to lateral supporting ligamentMost treated nonoperativelyRisk Of Ankle Injuries By SportBasketball- 45%Soccer- 31%Volleyball- 25%Football- 10 - 15% Ankle Consists Of Two Joints Talar MortiseAllows for plantar flexion an

2、d dorsiflexionSubtalar JointAllows for inversion, eversion, and internal and external rotationLigamentous Structures Of The Ankle1) Tibiofibular Complex2) Medial Complex3) Lateral ComplexLigamentous Structures Of The AnkleTibiofibular ComplexStabilizes the ankle mortiseAllows little movement between

3、 tibia and fibula Ligamentous Structures Of The AnkleMedial ComplexDeltoid LigamentLimits eversionLimits lateral displacement of the talusMedial malleolus will often fracture before this ligament tears*Ligamentous Structures Of The AnkleLateral ComplexAnterior Talofibular*CalcaneaofibularPosterior T

4、alofibularResists internal rotation, anterior displacement, and inversionSecondary StabilizersMuscles and TendonsPeroneous LongusAnterior TibialisPosterior TibialisAchilles tendonOn-Field ManagementGoal-Identify serious injuryScreen for deformitiesAxial traction and relocationNeurovascular assessmen

5、t Weight bearingStabilizationOn-Field Management“Golden Period”Best opportunity for accurate diagnosisNo swelling Pain has subsidedNo guardingAssessment Of Ankle SprainHistoryHow did it happen?Where does it hurt?Did the pain make you stop playing?Were you able to bear weight right away?Have you inju

6、red this or the other ankle before?Assessment Of Ankle SprainPhysical 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:Plantar flexion, dorsiflexion, and inversion and ev

7、ersion in plantar flexion and dorsiflexionAssessment Of Ankle SprainPhysical ExamStrength testing (compare to other ankle)Special tests for joint stabilityAssessment Of Ankle SprainSpecific TestsAnterior Drawer TestAssesses the integrity of the anterior talofibular ligamentLarge number of false nega

8、tives is assessed within the first 48 hours4 - 5 days postinjury has a sensitivity of 86% and specitivity of 74%Assessment Of Ankle SprainSpecific TestsTalar Tilt TestDeltoid ligament- eversionCalcaneofibular- inversionSide-to-side TestTibiofibular ligament93% specific Assessment Of Ankle SprainSpec

9、ific TestsThompsons TestAchilles tendonSqueeze TestExternal Rotation TestSyndesmosis injuries Assessment Of Ankle SprainRadiographsOttawa Ankle Rules*When are ankle X-rays necessary:Inability to bear weightBone tenderness on the tip of either malleolus or up to 6cm up the posterior edge Assessment O

10、f Ankle SprainRadiographsOttawa Ankle Rules*When are foot X-rays necessary:Inability to bear weightBone tenderness at the navicular or the base of the fifth metatarsal100% sensitivityAnkle Injury DifferentialLateral Inversion SprainMost common injury85% of all ankle sprainsLateral ligaments damaged

11、from anterior to posteriorGrading Lateral Ankle SprainsMnemonic for Treating Ankle SprainsP-rotectionR-estI-ceC-ompressionE-levationM-edicationM-obilizationMedial Eversion SprainCommonly seen in wrestlers10% of sprains vs. 85% lateral75% of ankle fractures occur on medial sideDeltoid LigamentSyndesm

12、osis Sprain1% - 11% of ankle sprainsExternal rotation stress radiographsLittle swellingRecovery time of 55 daysBifurcate Ligament InjuryInjuryViolent Dorsiflexion, Forceful plantar flexion, direct trauma19% of inversion sprainsAvulsion of anterior process of calcaneousNon-weight-bearing cast for fou

13、r weeksACHILLES TENDON RUPTURERapid plantar flexion2 to 6cm above the Os CalcisPeroneal Tendon InjurySubluxation or dislocationPalpate over the tendon with dorsiflexion and eversionFlexor Hallucis Longus InjuryOccurs with people who tiptoe or stand on the balls of their feetLateral PeriostitisJumpers ankleSymptom