踝关节扭伤的评价和处理

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1、AssessmentAndManagementOfAnkleSprainsStevenSchepensM.D.AnkleSprainsMostcommonathleticinjuryMostcausedbyexcessiveinversionInjurytolateralsupportingligamentMosttreatednonoperativelyRiskOfAnkleInjuriesBySportBasketball----45%Soccer--------31%Volleyball---25%Football------10-15%AnkleConsists

2、OfTwoJointsTalarMortiseAllowsforplantarflexionanddorsiflexionSubtalarJointAllowsforinversion,eversion,andinternalandexternalrotationLigamentousStructuresOfTheAnkle1)TibiofibularComplex2)MedialComplex3)LateralComplexLigamentousStructuresOfTheAnkleTibiofibularComplexStabilizestheanklemorti

3、seAllowslittlemovementbetweentibiaandfibulaLigamentousStructuresOfTheAnkleMedialComplexDeltoidLigamentLimitseversionLimitslateraldisplacementofthetalusMedialmalleoluswilloftenfracturebeforethisligamenttears*LigamentousStructuresOfTheAnkleLateralComplexAnteriorTalofibular*Calcaneaofibular

4、PosteriorTalofibularResistsinternalrotation,anteriordisplacement,andinversionSecondaryStabilizersMusclesandTendonsPeroneousLongusAnteriorTibialisPosteriorTibialisAchillestendonOn-FieldManagementGoal--IdentifyseriousinjuryScreenfordeformitiesAxialtractionandrelocationNeurovascularassessme

5、ntWeightbearingStabilizationOn-FieldManagement“GoldenPeriod”BestopportunityforaccuratediagnosisNoswellingPainhassubsidedNoguardingAssessmentOfAnkleSprainHistoryHowdidithappen?Wheredoesithurt?Didthepainmakeyoustopplaying?Wereyouabletobearweightrightaway?Haveyouinjuredthisortheotheranklebe

6、fore?AssessmentOfAnkleSprainPhysicalExamRemovalofshoesandsocksonbothfeetExamineuninjuredanklefirstPalpateligamentsandbonesandnoteanyswellingorecchymosisMovetheanklethroughsixrangesofmotion:Plantarflexion,dorsiflexion,andinversionandeversioninplantarflexionanddorsiflexionAssessmentOfAnkle

7、SprainPhysicalExamStrengthtesting(comparetootherankle)SpecialtestsforjointstabilityAssessmentOfAnkleSprainSpecificTestsAnteriorDrawerTestAssessestheintegrityoftheanteriortalofibularligamentLargenumberoffalsenegativesisassessedwithinthefirst48hours4-5dayspostinjuryhasasens