踝關(guān)節(jié)扭傷的評(píng)價(jià)和處理 ppt課件

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

2、nkle Consists Of Two Joints nTalar MortisenAllows for plantar flexion and dorsiflexionnSubtalar JointnAllows for inversion, eversion, and internal and external rotationLigamentous Structures Of The Anklen1) Tibiofibular Complexn2) Medial Complexn3) Lateral ComplexLigamentous Structures Of The Anklen

3、Tibiofibular ComplexnStabilizes the ankle mortisenAllows little movement between tibia and fibula Ligamentous Structures Of The AnklenMedial ComplexnDeltoid LigamentnLimits eversionnLimits lateral displacement of the talusnMedial malleolus will often fracture before this ligament tears*Ligamentous S

4、tructures Of The AnklenLateral ComplexnAnterior Talofibular*nCalcaneaofibularnPosterior TalofibularnResists internal rotation, anterior displacement, and inversionSecondary StabilizersnMuscles and TendonsnPeroneous LongusnAnterior TibialisnPosterior TibialisnAchilles tendonOn-Field ManagementnGoal-I

5、dentify serious injurynScreen for deformitiesnAxial traction and relocationnNeurovascular assessment nWeight bearingnStabilizationOn-Field Managementn“Golden PeriodnBest opportunity for accurate diagnosisnNo swelling nPain has subsidednNo guardingAssessment Of Ankle SprainnHistorynHow did it happen?

6、nWhere does it hurt?nDid the pain make you stop playing?nWere you able to bear weight right away?nHave you injured this or the other ankle before?Assessment Of Ankle SprainnPhysical ExamnRemoval of shoes and socks on both feetnExamine uninjured ankle firstnPalpate ligaments and bones and note any sw

7、elling or ecchymosisnMove the ankle through six ranges of motion:nPlantar flexion, dorsiflexion, and inversion and eversion in plantar flexion and dorsiflexionAssessment Of Ankle SprainnPhysical ExamnStrength testing (compare to other ankle)nSpecial tests for joint stabilityAssessment Of Ankle Sprai

8、nnSpecific TestsnAnterior 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 TestsnTalar Tilt TestnDelto

9、id ligament- eversionnCalcaneofibular- inversionnSide-to-side TestnTibiofibular ligamentn93% specific Assessment Of Ankle SprainnSpecific TestsnThompsons TestnAchilles tendonnSqueeze TestnExternal Rotation TestnSyndesmosis injuries Assessment Of Ankle SprainnRadiographsnOttawa Ankle Rules*nWhen are

10、ankle X-rays necessary:nInability to bear weightnBone tenderness on the tip of either malleolus or up to 6cm up the posterior edge Assessment Of Ankle SprainnRadiographsnOttawa Ankle Rules*nWhen are foot X-rays necessary:nInability to bear weightnBone tenderness at the navicular or the base of the f

11、ifth metatarsaln100% sensitivityAnkle Injury DifferentialnLateral Inversion SprainnMost common injuryn85% of all ankle sprainsnLateral ligaments damaged from anterior to posteriorGrading Lateral Ankle SprainsGradeAnt.DrawerTestTalar TiltTestReturn toPlay1NegativeNegative1 10days2IncreasedLaxityNegat

12、ive2- 4 weeks3PositivePositive5 8 wkwithrehab.Mnemonic for Treating Ankle SprainsnP-rotectionnR-estnI-cenC-ompressionnE-levationnM-edicationnM-obilizationMedial Eversion SprainnCommonly seen in wrestlersn10% of sprains vs. 85% lateraln75% of ankle fractures occur on medial sidenDeltoid LigamentSynde

13、smosis Sprainn1% - 11% of ankle sprainsnExternal rotation stress radiographsnLittle swellingnRecovery time of 55 daysBifurcate Ligament InjurynInjurynViolent Dorsiflexion, Forceful plantar flexion, direct trauman19% of inversion sprainsnAvulsion of anterior process of calcaneousnNon-weight-bearing c

14、ast for four weeksACHILLES TENDON RUPTUREnRapid plantar flexionn2 to 6cm above the Os CalcisPeroneal Tendon InjurynSubluxation or dislocationnPalpate over the tendon with dorsiflexion and eversionFlexor Hallucis Longus InjurynOccurs with people who tiptoe or stand on the balls of their feetLateral PeriostitisnJumpers ank