踝关节扭伤的评价和处理

AssessmentAndManagementOfAnkleSprains

StevenSchepensM.D..AnkleSprainsMostcommonathleticinjuryMostcausedbyexcessiveinversionInjurytolateralsupportingligamentMosttreatednonoperatively.RiskOfAnkleInjuriesBySportBasketball----45%Soccer--------31%Volleyball---25%Football------10-15%.AnkleConsistsOfTwoJointsTalarMortiseAllowsforplantarflexionanddorsiflexionSubtalarJointAllowsforinversion,eversion,andinternalandexternalrotation..LigamentousStructuresOfTheAnkle1)TibiofibularComplex2)MedialComplex3)LateralComplex.LigamentousStructuresOfTheAnkleTibiofibularComplexStabilizestheanklemortiseAllowslittlemovementbetweentibiaandfibula..LigamentousStructuresOfTheAnkleMedialComplexDeltoidLigamentLimitseversionLimitslateraldisplacementofthetalusMedialmalleoluswilloftenfracturebeforethisligamenttears*..LigamentousStructuresOfTheAnkleLateralComplexAnteriorTalofibular*CalcaneaofibularPosteriorTalofibularResistsinternalrotation,anteriordisplacement,andinversion..SecondaryStabilizersMusclesandTendonsPeroneousLongusAnteriorTibialisPosteriorTibialisAchillestendon..On-FieldManagementGoal--IdentifyseriousinjuryScreenfordeformitiesAxialtractionandrelocationNeurovascularassessmentWeightbearingStabilization.On-FieldManagement“GoldenPeriod”BestopportunityforaccuratediagnosisNoswellingPainhassubsidedNoguarding.AssessmentOfAnkleSprainHistoryHowdidithappen?Wheredoesithurt?Didthepainmakeyoustopplaying?Wereyouabletobearweightrightaway?Haveyouinjuredthisortheotheranklebefore?.AssessmentOfAnkleSprainPhysicalExamRemovalofshoesandsocksonbothfeetExamineuninjuredanklefirstPalpateligamentsandbonesandnoteanyswellingorecchymosisMovetheanklethroughsixrangesofmotion:Plantarflexion,dorsiflexion,andinversionandeversioninplantarflexionanddorsiflexion.AssessmentOfAnkleSprainPhysicalExamStrengthtesting(comparetootherankle)Specialtestsforjointstability.AssessmentOfAnkleSprainSpecificTestsAnteriorDrawerTestAssessestheintegrityoftheanteriortalofibularligamentLargenumberoffalsenegativesisassessedwithinthefirst48hours4-5dayspostinjuryhasasensitivityof86%andspecitivityof74%..AssessmentOfAnkleSprainSpecificTestsTalarTiltTestDeltoidligament--eversionCalcaneofibular--inversionSide-to-sideTestTibiofibularligament93%specific..AssessmentOfAnkleSprainSpecificTestsThompson’sTestAchillestendonSqueezeTestExternalRotationTestSyndesmosisinjuries....AssessmentOfAnkleSprainRadiographsOttawaAnkleRules*WhenareankleX-raysnecessary:InabilitytobearweightBonetendernessonthetipofeithermalleolusorupto6cmuptheposterioredge.AssessmentOfAnkleSprainRadiographsOttawaAnkleRules*WhenarefootX-raysnecessary:InabilitytobearweightBonetendernessatthenavicularorthebaseofthefifthmetatarsal100%sensitivity.AnkleInjuryDifferentialLateralInversionSprainMostcommoninjury85%ofallanklesprainsLateralligamentsdamagedfromanteriortoposterior.GradingLateralAnkleSprains.MnemonicforTreatingAnkleSprainsP-rotectionR-estI-ceC-ompressionE-levationM-edicationM-obilization.MedialEversionSprainCommonlyseeninwrestlers10%ofsprainsvs.85%lateral75%ofanklefracturesoccuronmedialsideDeltoidLigament.SyndesmosisSprain1%-11%ofanklesprainsExternalrotationstressradiographsLittleswellingRecoverytimeof55days..BifurcateLigamentInjuryInjuryViolentDorsiflexion,Forcefulplantarflexion,directtrauma19%ofinversionsprainsAvulsionofanteriorprocessofcalcaneousNon-weight-bearingcastforfourweeks..ACHILLESTENDONRUPTURERapidplantarflexion2to6cmabovetheOsCalcis.PeronealTendonInjurySubluxationordislocationPalpateoverthetendonwithdorsiflexionandeversion.FlexorHallucisLongusInjuryOccurswithpeoplewhotiptoeorstandontheballsoftheirfeet.LateralPeriostitisJumpersankleSymptom