Transcript ankle injury in sport_1

DR KHAHLISO J. MOFOKENG.
CASE PRESENTATION.
 Name: M. S.
 Age : 21 YR OLD.
 SEX : MALE
 Address: QwaQwa.
 C/O of swollen, painful right ankle joint following a
hard tackle by another player while football 2days ago.
 No other significant history.
EXAMINATION
 A young man clinically stable.
 Respiration: 17breaths per minute with normal breath
sound and good air entry.
 CVS: P.R 74/min, regular full volume, B.P
110/80,mmhg. Peripheral vessels normal.
 MSS: Swollen, tender+++, restricted range of moment,
normal neurological sensation.
 Left ankle normal.
 Basic investigations: Hb 13g/dl, hgt;8.5mmol/dl,
 X-Ray: Right leg shows no fracture, soft tissue oedema
seen. The whole ankle joint intact.
 Left leg normal.
 Diagnosis: Right ankle sprain due to trauma.
 Treatment.
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Counseling.
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Analgesics.
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Crutches, and Brace
 Follow up: 2wks. No C/O, No swelling, No limping.
MGT OF ANKLE SPRAIN IN SPORT
INJURY.
 Epidemiology.
EPIDEMIOLOGY.
 Ankle Sprain Overview
 Annually, an estimated 1 million people in the U.S. visit
a doctor about an acute ankle injury, according to the
American Academy of Family Practice. The ankle joint,
which connects the foot with the lower leg, is injured
often. An unnatural twisting motion can happen when
the foot is planted awkwardly, when the ground is
uneven, or when an unusual amount of force is applied
to the joint. Ankle sprains are common sports injuries
but can also happen during everyday activities such as
walking or even getting out of bed
ANATOMY
 The ankle joint is made up of three bones.
 The tibia is the major bone of the lower leg, and it bears most of the
body's weight. Its bottom portion forms the medial malleolus, the
inside bump of the ankle.
 The fibula is the smaller of the two bones in the lower leg. Its lower end
forms the lateral malleolus, the outer bump of the ankle.
 The talus is the top bone of the foot.
 Tendons connect muscles to bones.
 Several muscles control motion at the ankle. Each has a tendon connecting it to one or
more of the bones of the foot.
 Tendons can be stretched or torn when the joint is subjected to greater than normal stress.
 Tendons also can be pulled off the bone. This type of injury is called an avulsion.
 Ligaments provide connection between bones. Sprains are injuries to the ligaments.
 The ankle has many bones that come together to form the joint, so it has many ligaments
holding it together. Stress on these ligaments can cause them to stretch or tear.
 The most commonly injured ligament is the anterior talofibular ligament that connects
the front part of the fibula to the talus bone on the front-outer part of the ankle joint.
 Ankle injuries can be painful and can make it difficult to carry out daily activities
CAUSES.
 Ligaments are injured when a greater than normal stretching force is applied to
them. This happens most commonly when the foot is turned inward or
inverted. This kind of injury can happen in the following ways:
 Awkwardly planting the foot when running, stepping up or down, or during
simple tasks such as getting out of bed
 Stepping on a surface that is irregular, such as stepping in a hole
 Athletic events when one player steps on another player (A common example is
a football player who goes up for a header and comes down on top of another
player's foot. This can cause the player's foot to roll inward.)
 Inversion injuries, in which the foot rolls inward, are more common than
eversion injuries (also referred to as a high ankle sprain), in which the foot
twists outward.
SYMPTOMS AND SIGNS
 Tissue injury and inflammation occur when an ankle is sprained. Blood
vessels become "leaky" and allow fluid to ooze into the soft tissue
surrounding the joint. White blood cells responsible for inflammation
migrate to the area, and blood flow increases. The following are signs
of inflammation:
 Swelling, due to increased fluid in the tissue, is sometimes severe.
 Pain: The nerves are more sensitive. The joint hurts and may throb. The
pain can worsen when the sore area is pressed or the foot moves in
certain directions (depending upon which ligament is involved) and
during walking or standing.
 Redness and warmth: Caused by increased blood flow to the area
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Usually, an ankle sprain itself does not require a trip to the doctor. The problem is how to tell a sprain from a more serious injury such as a fracture (break). If any of the
following occur, contact your doctor.
Pain is uncontrolled, despite the used of over-the-counter medications, elevation, and ice.
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One is unable to walk or cannot walk more than a few steps without severe pain.
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The ankle fails to improve within five to seven days. The pain need not be gone, but it should be improving.
The indications to go to a hospital's emergency department are similar to those for which to call the doctor. The following conditions suggest a fracture or more serious injury
or that a splint may be needed for pain control:
You feel severe or uncontrolled pain.
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You cannot move the injured ankle.
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The foot or ankle is misshapen beyond normal swelling.
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You cannot walk four steps, even with a limp.
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You experience severe pain when pressing over the medial or lateral malleolus, the bony bumps on each side of the ankle.
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You experience loss of feeling in the foot or toes.
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You have pain and swelling in the back of the ankle (heel pain), over the Achilles tendon area, or the inability to push the toes down (forward-like pressing a gas pedal).
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You have pain or swelling into the upper part of the lower leg just below the knee or swelling of the calf muscle.
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Redness or red streaks spreading out from the injury are observed.
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You don't know how serious the injury may be or are unsure how to care
DIAGNOSIS
 The doctor will perform a physical exam to see if a fracture or other
serious injury has happened that requires immediate care.
 The examination should check that the nerves or arteries to the foot
have not been injured and that the knee or the rest of the leg is not
involved.
 The doctor will handle and move the foot and ankle to determine what
bony areas are involved.
 The Achilles tendon will be checked for signs of rupture.
 X-rays are often needed to confirm that a fracture is present. In some
cases of fracture, a CT scan may be needed.
TREATMENT
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Self-Care at Home
Care at home can help reduce pain and aid healing. Because most of the pain is caused by
inflammation, the goal is to reduce and prevent inflammation.
Remember RICE: rest, ice, compression, and elevation.
Rest prevents further injury and avoids stress on already inflamed tissue.
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Put the ankle joint at rest by wearing a brace or splint.
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More severe sprains may be treated with use of crutches.
Ice is the best treatment.
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Applying ice to the injury will do more for most people than medications.
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Ice counteracts the increased blood flow to the injured area.
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It reduces swelling, redness, and warmth.
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Applied soon after the injury, ice prevents much of the inflammation from developing.
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Do not apply ice directly to the skin. Use a towel between the ice and the injury, or use an ice bag. Apply ice for 20 minutes at a time,
with at least 30 minutes between applications. This is to prevent frostbite, which can occur if you use ice too much or use it directly on
your skin.
Compression (sometimes called "strapping") provides support and helps prevent inflammation.
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Elastic wraps such as Ace bandages immobilize the ankle.
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Do not apply wraps too tightly.
Elevation (keeping the injured area up as high as possible) will help the body absorb fluid that has leaked into the tissue.
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Ideally, prop the ankle up so that it is above the level of the heart.
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Sit in a reclining chair or prop your legs up with pillows.
Anti-inflammatory pain medications such as ibuprofen (Motrin IB and Advil) and naproxen (Aleve or Naprosyn) will reduce the pain and
combat the swelling.
MEDICAL TREATMENT.
 Treatment by a doctor will be similar to home care,
especially using ice to reduce the inflammation.
 The doctor may elect to apply a brace or cast to reduce
motion of the ankle. Crutches are frequently provided so
the patient does not have to bear weight on the injured
ankle.
 The most common medications used for ankle sprains are
anti-inflammatory pain medications that both reduce pain
and help control inflammation. If the patient cannot
tolerate these drugs, acetaminophen (Tylenol) or narcotics
are common alternatives.
FOLLOW-UP.
 Follow-up for ankle sprains is needed only if the ankle is not
healing well. This could indicate there is a previously undetected
fracture or torn ligaments. An orthopedic or podiatric specialist
should be consulted if initial treatment fails. Go to a doctor for
follow-up care if any of the following is true:
 You cannot walk on the injured ankle within a week of the injury.
 Your ankle continues to hurt after two weeks.
 A follow-up visit one to two weeks after the injury is advisable to
help with flexibility and strengthening exercises. In some cases,
you may be sent to a physical therapist for rehabilitation of the
injured ankle.
Ankle Sprain Prevention
 Ankle sprain prevention can be as simple as wearing the right shoes or as complicated as
balance training for athletes.
 Keep the ankles strong and flexible. Consult with the doctor or physical therapist for
strengthening exercises.
 Wear proper shoes for the activity. Always wear stable shoes that give your ankle proper
support. High-top basketball shoes are a good choice. (High heels or platform shoes are
not the best choice if you're trying to prevent an ankle sprain.)
 When participating in a sport, consider having a weak ankle taped to offer extra support.
If you have repeated sprains, wearing an ankle brace while playing may help.
 Making sure that the playing field (or home environment) is clear of any holes or
obstacles also can help avoid injury.
Ankle Sprain Prognosis
 Most ankle sprains heal without complications or difficulty.
 Surgery is seldom needed for torn ligaments. Ligament tears are
often noticed when sprains fail to get better. If the diagnosis of a
tendon tear that needs surgery is not made right away, the
outcome of the surgery is the same as if the doctor did the
operation immediately.
 Recovery time depends upon the severity of the ankle sprain and
possible accompanying injuries.
 Exercises should be started to maintain flexibility and strength
when the swelling has resolved and the patient can walk without
pain.
Synonyms and Keywords
 ankle sprain, twisted ankle, turned ankle, rolled ankle,
tibia, medial malleolus, fibula, talus, anterior
talofibular ligament, sprained ankle, ankle injury
REFERENCES:
 United States. National Institute of Arthritis and
Musculoskeletal and Skin Diseases. "Sprains and
Strains." Apr. 2009.
<http://www.niams.nih.gov/Health_Info/Sprains_Stra
ins/default.asp#strain_k>.
Wolfe, Michael W., Tim L. Uhl, and Leland C.
McCluskey. "Management of Ankle Sprains." Am Fam
Physician 63.1 Jan. 1, 2001: 93-105.
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THANK YOU.