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34 Cards in this Set
- Front
- Back
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What is the first injured ligament in a lateral sprain with ankle plantar flexed?
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Anterior Talofibular Ligament
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What is the first injured ligament in a lateral sprain with ankle dorsiflexed?
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Calcaneofibular ligament
This is the strongest lateral ligament |
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What are the lateral Collateral Ligaments in an ankle?
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Anterior Talofibular Ligament
Calcaneofibular Ligament Posterior Talofibular Ligament |
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What ligaments make up a Syndesmosis?
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Anterior Inferior Tibiofibular Ligament
Posterior Inferior Tibiofibular ligament Transverse Tibiofibular Ligament Interosseous Ligament Interosseous Membrane |
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What are the medial ligaments of the ankle?
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Deltoid LIgaments (Superficial and Deep)
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What are the Lateral Tendons of the ankle?
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Peroneus Brevis
Peroneus Longus Innervation: Superficial peroneal Nerve and Sural Nerve |
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What are the Anterior tendons in the ankle?
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Tibialis Anterior Tendon
Extensor Digitorum Longus Extensor Hallucis Longus |
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What are the posterior tendons in the Ankle?
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Achilles Tendon
Tibialis Posterior |
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What vessels supply the ankle?
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Anterior: Saphenous Vein/ Anterior Tibial Arterior
Posterior: Posterior Tibial Artery |
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How to perform a physical Exam on the Ankle
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1) Palpate medial and lateral malleoli
2) Palpate deltoid ligament 3) Palpate ATFL, CFL, and PTFL 4) Neurovascular Exam 5) Anterior Drawer test for ATFL 6) Talor Tilt to assess CFL 7) Squeeze test for Syndesmotic Inury *Swelling could last 6 months to a year |
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What is the most common ankle sprain?
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Lateral
- Inversion stress with platarflexion |
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What views should you order for an ankle x-ray?
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1) AP
2) Lateral: Mortise View (ankle is internally rotated & look at fibula) 3) Oblique: Talor Tilt View 4) External Rotation View (syndesmotic injury) |
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Grade I Lateral Ankle Sprain
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- Anterior Talofibular Ligament disrupted
- Normal Stress tests Treatment: - RICE with ankle brace and protected weight bearing |
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Grade II Lateral Ankle Sprain
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- ATFL and Calcanealfibular Ligament disrupted
- Increased pain swelling - May have positive stress test Treatment: -RICE with ankle brace and protected weight bearing |
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Grade III Lateral Ankle Sprain
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- ATFL, CFL, and PTFL disrupted
- Severe pain swelling - Positive stress tests - May need ligament reconstruction Treatment: - May require a walking boot or cast for 4 to 6 weeks - May need up to 6 months of protective bracing |
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Treatment for Lateral Ankle Sprain
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- RICE
- ROM exercises - Peroneal strengthening and proprioceptive training - Bracing or taping for 4 to 6 weeks depending on activity - Return to sports when able to cut without pain |
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Physical Exam of Medial Ankle Sprain
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- Tenderness or swelling over deltoid ligament
- External rotation test elicits pain in the deltoid and possibly syndesmosis |
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Treatment for a Stable Medial Ankle Sprain
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- NO TALAR SUBLUXATION
- SImilar to lateral sprain - RICE - Early weight bearing - Early ROM - Functional brace - Functional Rehab |
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Treatment for Unstable Medial Ankle Sprain
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- TALAR SUBLUXATION
- Anatomical reduction and surgical stabilization of syndesmosis |
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What is damaged in a syndesmosis ankle injury?
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- Rupture of interosseous ligaments btw tibia and fibula (without fracture)
- Medial malleolar fracture or deltoid ligament rupture - Persistent instability and gap in the joint after bimalleolar fixation |
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What tests are performed to determine a Syndesmosis injury of ankle?
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- Squeeze Test- squeeze the syndesmosis above the ankle to elicit pain
- Abduction/ External Rotation Stress Test- Further instability with external rotation |
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What radiographs need to be performed for a Syndesmotic Ankle Sprain?
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- AP/Lateral/Oblique- look for syndesmotic widening, medial joint space widening, presence of fibula FX
- External Rotation Stress X-Rays - Tibula/Fibula X-rays to rule out fracture |
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Treatment of Syndesmosis Injury that is non-displaced without fracture
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- May consider casting for 6 weeks
- Surgical treatment with syndesmotic screws |
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Treatment of Syndesmosis injury that is displaced
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- Surgical treatment with syndesmotic screws
- New Technique: Heavy suture and Endobuttons |
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Weber A Ankle Fracture
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Fibula distal to Mortise
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Weber B Ankle Fracture
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Fibula at level of mortise
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Weber C Ankle Fracture
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Fibula proximal to Mortise
- The higher the fibula the more severe the injury |
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Nonoperative Treatment for Ankle Fractures
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- Nondisplaced stable fracture with intact syndesmosis
- Patient whose overall condition is unstable and would not tolerate an operative procedure - Below the knee cast for 4-6 weeks |
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Operative Treatment for Ankle Fractures
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- Talor subluxation
- Malposition - Fixation constructs |
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What causes an Achilles Tendon Rupture?
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- Acute pain in back of ankle with contraction (history)
- Steroid, FLUORQUINOLONES, and chronic overuse |
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Where does a Achilles Tendon Rupture Occur?
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3-4 cm above the Achilles Insertion in a watershed area
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Physical exam for an Achilles Tendon Rupture
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- Tenderness over achilles tendon
- Palpable defect - Positive Thompson's Test |
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Treatment for Achilles Tendon Rupture
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- Surgical repair in Younger Active patients
- Nonoperative on older sendentary patients or with an increase of soft tissue complications (smokers, vascular disease) - short leg cast (8 to 10 wks) - long leg cast (6 wks then short leg cast for 4 weeks) |
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Problems with Non-operative Treatment
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- Weaker tendon
- Higher risk of re-rupture - Slower to return to sport - No surgical morbidity *Lower cost |
