踝關(guān)節(jié)扭傷的評價(jià)和處理

1、.Assessment And Management Of Ankle SprainsSteven Schepens M.D.Ankle SprainsnMost common athletic injurynMost caused by excessive inversionInjury to lateral supporting ligamentnMost treated nonoperatively.Risk Of Ankle Injuries By SportnBasketball- 45%nSoccer- 31%nVolleyball- 25%nFootball- 10 - 15%

2、.Ankle Consists Of Two Joints nTalar MortiseAllows for plantar flexion and dorsiflexionnSubtalar JointAllows for inversion, eversion, and internal and external rotation.Ligamentous Structures Of The Anklen1) Tibiofibular Complexn2) Medial Complexn3) Lateral Complex.Ligamentous Structures Of The Ankl

3、enTibiofibular ComplexStabilizes the ankle mortiseAllows little movement between tibia and fibula .Ligamentous Structures Of The AnklenMedial ComplexDeltoid LigamentnLimits eversionnLimits lateral displacement of the talusMedial malleolus will often fracture before this ligament tears*.Ligamentous S

4、tructures Of The AnklenLateral ComplexAnterior Talofibular*CalcaneaofibularPosterior TalofibularnResists internal rotation, anterior displacement, and inversion.Secondary StabilizersnMuscles and TendonsPeroneous LongusAnterior TibialisPosterior TibialisAchilles tendon.On-Field ManagementnGoal-Identi

5、fy serious injuryScreen for deformitiesnAxial traction and relocationNeurovascular assessment Weight bearingStabilization.On-Field Managementn“Golden Period”Best opportunity for accurate diagnosisNo swelling Pain has subsidedNo guarding.Assessment Of Ankle SprainnHistoryHow did it happen?Where does

6、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?.Assessment Of Ankle SprainnPhysical ExamRemoval of shoes and socks on both feetExamine uninjured ankle firstPalpate ligaments and bones and note any swelling or ecchymo

7、sisMove the ankle through six ranges of motion:nPlantar flexion, dorsiflexion, and inversion and eversion in plantar flexion and dorsiflexion.Assessment Of Ankle SprainnPhysical ExamStrength testing (compare to other ankle)Special tests for joint stability.Assessment Of Ankle SprainnSpecific TestsAn

8、terior 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%.Assessment Of Ankle SprainnSpecific TestsTalar Tilt TestnDeltoid ligament- eversi

9、onnCalcaneofibular- inversionSide-to-side TestnTibiofibular ligament93% specific .Assessment Of Ankle SprainnSpecific TestsThompsons TestnAchilles tendonSqueeze TestExternal Rotation TestnSyndesmosis injuries .Assessment Of Ankle SprainnRadiographsOttawa Ankle Rules*When are ankle X-rays necessary:n

10、Inability to bear weightnBone tenderness on the tip of either malleolus or up to 6cm up the posterior edge .Assessment 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% sens

11、itivity.Ankle Injury DifferentialnLateral Inversion SprainMost common injury85% of all ankle sprainsLateral ligaments damaged from anterior to posterior.Grading Lateral Ankle SprainsGradeAnt.DrawerTestTalar TiltTestReturn toPlay1NegativeNegative1 10days2IncreasedLaxityNegative2- 4 weeks3PositivePosi

12、tive5 8 wkwithrehab.Mnemonic for Treating Ankle SprainsnP-rotectionnR-estnI-cenC-ompressionnE-levationnM-edicationnM-obilization.Medial Eversion SprainnCommonly seen in wrestlersn10% of sprains vs. 85% lateraln75% of ankle fractures occur on medial sidenDeltoid Ligament.Syndesmosis Sprainn1% - 11% o

13、f ankle sprainsnExternal rotation stress radiographsnLittle swellingnRecovery time of 55 days.Bifurcate Ligament InjurynInjuryViolent Dorsiflexion, Forceful plantar flexion, direct trauman19% of inversion sprainsnAvulsion of anterior process of calcaneousnNon-weight-bearing cast for four weeks.ACHIL

14、LES TENDON RUPTUREnRapid plantar flexionn2 to 6cm above the Os Calcis.Peroneal Tendon InjurynSubluxation or dislocationnPalpate over the tendon with dorsiflexion and eversion.Flexor Hallucis Longus InjurynOccurs with people who tiptoe or stand on the balls of their feet.Lateral PeriostitisnJumpers anklen