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What happened before and after?. He did not pass his boards. What is the most commonly injured joint?. Ankle is the most commonly sprained joint. How many ankle injuries occur each day?. 25,000 ankle sprains per day. ¼ of all sports related injuries Most common sports related problems.
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25,000 ankle sprains per day ¼ of all sports related injuries Most common sports related problems
Risk Factors • Poor rehab • Poor proprioception • Weak muscles • Poor ankle instability • Lack of warm up • Running on uneven surfaces • Poor heel support
Ankle sprains • First degree • Second degree- partial severe tear, moderate instability, ,moderate pain • Third degree – severe pain and swelling, total tear, gross instability
Ankle Stress test • Inversion stress test or talartilt - • Cross leg test • Anterior drawer test
Cross leg test • High ankle sprain • Pressure is applied to the medial side of the knee produces pain in syndesmosis area
Inversion stress test or talar tilt - Calcaneofibularligament instabilityend feel it is grade three
Anterior Drawer test Excessive anterior displacement of talus onto the tibia
Grade three (96%) • Swelling • Hematoma • Pain on palpation • Positive anterior drawer
Functional Ankle instability Balance Impairments
Balance Error Scoring System • Time-in balance test • Foot lift test
Balance Error Scoring System BESS Three stance conditions and two surface conditions
Time-in balance test 60 seconds
Foot lift test Single leg tests touch calf
High ankle sprain Syndesmotic ankle sprain
Syndesmotic ligament • Connects the shin to the fibula • Tender front • Pain worse if foot or leg is twisted outward • Positive squeeze test • Need surgery
Ottawa ankle rules • Pain in the malleolar region plus • Bone tenderness distal 6 posterior edge of tibia or tip of MM • Bone tenderness along the distal 6 cmof the posterior edge of fibula or tip of LM • Inability to bear weight to bear weight the first 4 steps
General Rehabilitation Principles • PRICE • NASI • ROM • Strengthening • Proprioception of the ankle joint
Cryotherapy • Standard • Intermittent • Outcomes
Rehabilitation - PRICE • 2nd degree – immobilization of the ankle • 3rd degree – cast immobilization for 2 to 3 weeks, surgery maybe needed