Transcript ANKLE
MOST COMMON INJURY GROSS AND FUNCTIONAL ANATOMY OF THE ANKLE JOINT JOINT STABILITY Shape of Bones Ligaments Strength of Muscles BONY ANKLE JOINT F T Ta Achilles Tendon P. Longus Flex. Hallucis Longus Flex. Digitorum Longus P. Brevis Tib. Posterior P. Tertius Tib. Anterior Ext. Digitorum Longus Ext. Hallucis Longus SYNOVIAL JOINTS LATERAL LIGAMENTS MEDIAL ANKLE Tibia Deltoid Ligament Calcaneus Talus Navicular Sustentaculum Tali ANKLE MOVEMENT AND THE EFFECTS ON LIGAMENTS Plantar Neutral Dorsi INVERSION SPRAIN BOTH INVERSIONS? A B INVERSION SPRAIN 85% of all sprains Happens during loading and unloading of the ankle. What ligament is the first line of defence? Depends on ankle position Peroneus Brevis Base 5th Lateral Structures Ankle Post. Talofib. Anterior Inf. Tib-fib. Ant. Talofibular. Calcaneofibular P. Brevis Base 5 MANDATE ON PLAYING SURFACE HOW SEVERE IS THE INJURY. HOW DO WE REMOVE THEM FROM THE FIELD ASSESSMENT S. Subjective O. Objective A. Analysis P. Plan Subjective: Information that is gathered from the athlete. Objective: Observable or measurable findings. WEIGHT BEARING OR NON-WEIGHT BEARING PAIN RESPONSE OF DAMAGED TISSUE 1. Damaged muscle and ligaments are painful when stretched. 2. Damaged muscle is painful to contract. PAIN RESPONSE .. Con’t 3. Both structures are painful if palpated at the site of tear. FIELD ASSESSMENT Ankle Sprains - General Mechanism of Injury Pain …… where? Hear/feel anything? Injured before? Continue with activity? PALPATION 1 3 Anterior Inferior Tibiofibular Ligament 2 Anterior Talofibular Calcaneofibular Lig. 5th Base of Metatarsal 4 INVERSION SPRAINS One area of tenderness. No sensation of tearing or feeling unstable. Full ROM with discomfort on active plantar flexion and inversion. .. 2 .. 2 Stand athlete to check for pain in ankle or leg. Walk to the sideline if athlete can walk without a limp. INVERSION SPRAIN At least two areas of pain. Hear/feel of tearing. Painful ankle. Limitation of pl. flexion and inversion. 2.. …2 Check to see if the athlete can stand. Determine where the pain is located (leg pain N.W.B.). If they can walk, but limp, remove N.W.B. EVERSION SPRAIN • Least common sprain. • Most fractures happen in eversion. • Stability of the medial ankle depends upon the Deltoid Ligament and the lateral malleolus. EVERSION • Slight medial tenderness. • Pain and slight limitation on active eversion. • Stand to determine if there is leg pain. • Walk off playing surface if not antalgic. ANKLE SPRAIN SEVERE Rigid, high footwear. Unable to continue on with the activity. Leg pain on standing. Eversion and External Rotation of the ankle without Deltoid Ligament tear. 3. Fracture 2. Ant. Inf. Tib-fib. 1. Deltoid Hockey Player Inversion Minimal Pain Mild swelling Mild bruising Return in five days Day 6 THE MINOR SPRAIN Can this athlete return to play during this contest? Definition… Discomfort versus pain? Pain changes the way you do things! Dissect the sport into its’ components starting from the most simple on the ankle and progress to the most difficult. If they can perform the test without pain… then return. (Following taping?) NON-RETURNING ATHLETE C.I.C.E.R. Crutches for proper gait. Referral for physio. Prepare for return. PREPARE FOR RETURN Aside from the ‘formal’ rehabilitation, the athlete must work on maintaining conditioning and doing whatever sport skills they can. WHEN DO I KNOW THAT I AM READY TO RETURN????? WALK JOG Pain FIGURE 8 SHUTTLE RUN Figure 8 and Shuttle Run FIGURE 8 SHUTTLE ½ Speed ¾ Speed L 25 m R ???