Ankle Injuries - Athletes Sports-Medicine Term Paper
- Length: 12 pages
- Subject: Sports
- Type: Term Paper
- Paper: #99962680
- Related Topic: Sport Injury, Athlete, Athletes
Excerpt from Term Paper :
Assessment is best performed during the "preswelling period on the sidelines" according to Trojan and McKeag (1998)The avoidance of "chronic ankle pain, laxity, or arthritis can be accomplished through "appropriate treatment." The following table illustrates the differentiation in ankle injuries that exists:
Table 1. Useful Tests for Various Ankle Injuries
Injury Location
Specific Injury
Useful Test
Lateral
Inversion sprain
Lateral malleolus fracture
Osteochondritis dissecans
Peroneal tendon subluxation
Bifurcate ligament avulsion
Anterior drawer, talar tilt
X-ray as per Ottawa ankle rules
Mortise view ankle x-rays
Resisted dorsiflexion and eversion
X-rays
Medial
Medial ankle sprain
Medial malleolus fracture
Posterior tibialis tendon injury
Flexor hallucis longus tendinitis
Eversion stress
X-ray as per Ottawa ankle rules
Single heel-rise test
Resisted first-toe flexion
Posterior
Achilles tendon rupture
Os trigonum fracture
Thompson's
Weight-bearing lateral x-ray, tenderness on passive plantar flexion
Anterior
Syndesmosis sprain
Dorsiflexion injuries
Anterior tibialis tendon injury
Squeeze," external rotation
Side-to-side
Resisted dorsiflexion
Avulsion fracture, 5th metatarsal
Maisonneuve fracture
Palpation tenderness, foot x-rays
Palpation tenderness, fibula x-rays
Source: Trojan & Mckeag (1998)
Lateral Inversion Sprain
The lateral inversion sprain is sated to be "the most common ankle injury" accounting for approximately 85% of ankle sprains. The inversion injury will result in lateral ligaments being stretched and/or torn (generally from anterior to posterior)" (Trojan & McKeag, 1998. The following table illustrates how the physician grades the injury and reveals the prognosis as well:
Table 2. Grading of Lateral Ankle Sprains and Return to Play (11)
Grade
Anterior
Drawer Test
Talar Tilt
Test
Return to Play
Negative
1-10 dy
Increased laxity
Negative
2-4 wk
Positive
5-8 wk with optimal rehab
Source: Trojan & Mckeag (1998)
Treatment for lateral sprains are stated as being inclusive of "rest, ice, compression and elevation" along with assistance of crutches and pain and swelling medication as illustrated in the PRICEMMM Table below:
Protection with ankle bracing to prevent reinjury while ligament heals;
Rest for injured ankle until normal heel-toe gait is restored;
Ice on ankle to decrease swelling and relieve pain;
Compression as soon as possible to decrease swelling;
Elevation: the initial step for reducing swelling;
Medication: NSAIDs or acetominophen for pain relief;
Mobilization early on when pain free to expedite return to play; and Modalities: exercise and proprioception training to prevent reinjury.
Source: Trojan & McKeag (1998)
Medial Eversion Sprain
The medial eversion sprain is the type of sprains that wrestlers commonly deal with in. These types of sprains are not as common as lateral sprains with lateral sprains accounting for 85% of ankle sprains and eversion sprains accounting for 10% of ankle sprains. But, when a fracture does occur, 75% of the time it occurs on the medial side.
Syndesmosis Sprain
The Syndesmosis sprain is "postulated to be external rotation and hyperdorsiflexion" in nature as to the causal mechanism. Syndesmosis sprains account for between 1% and 11% of all ankle sprains and occurs more in contact sports. These sprains typically take longer to heal and recovery is 55 days instead of the 35 days allotted for a lateral sprain with a rating of grade 3. The bifurcate ligament injury usually happens due to "violent dorsiflexion, forceful plantar flexion, or direct trauma"(Trojan & McKeag, 1998) This type of sprain accounts for 19% of ankle inversion sprains.
Achilles Tendon Rupture
Achilles tendon rupture usually occurs in older athletes who are not conditions and in younger athletes that have been inactive due to another injury. The sensation is reported to be sharp pain in the Achilles and say it sounded like they were shot. Trojan & McKeag (1998) state of treatment in this injury that it is "controversial."..and that... "Casting is a reasonable option, especially if the tear is more than 2 cm from the calcaneal attachment. Surgery should be considered for the elite athlete to minimize the chance of rerupture."(Trojan & McKeag,1998)
Other Ankle Injury Classifications
Achilles tendon rupture usually occurs in older athletes who are not conditions and in younger athletes that have been inactive due to another injury. The sensation is reported to be sharp pain in the Achilles and say it sounded like they were shot. Trojan & McKeag (1998) state of treatment in this injury that it is "controversial."..and that... "Casting is a reasonable option, especially if the tear is more than 2 cm from the calcaneal attachment. Surgery should be considered for the elite athlete to minimize the chance of rerupture."(Trojan & McKeag,1998) Other sprains are the: (1) Peroneal Tendon Subluxation or Dislocation; (2) The Flexor Hallucis longus injury; (3) The Lateral Periostitis or 'Jumpers Ankle"; (4) Os trigonum injury; (5) Anterior tibialis tendon injury; and (6) Fractures which account for 15% of all ankle injuries among athletes. (Trojan & McKeag, 1998) The following table illustrates the diagnosis and care for varying types of ankle sprain and strain:
Table 4. Diagnosing and Managing Ankle Fractures
Site or Type
Characteristics and Findings
Treatment
Comments
Malleolus
Injuries that extend across an imaginary line drawn through the top of talar dome on AP x-ray considered unstable
Referral for unstable fxs; closed reduction, postreduction x-rays, casting and non-weight bearing for stable fxs
Epiphysis of tibia
Type 1 (Salter-Harris)
Localized swelling or minimal widening on x-ray
Casting for 2-4 wk
Be wary of "ankle sprain" in prepubescent patients since ligaments are stronger than physis at this age. Good to excellent healing for types 1-3; poor prognosis for types 4 and five.
Type 2
Metaphyseal fx into physis on x-ray
Closed reduction, long leg cast
Type 3
Epiphyseal fx into physis on x-ray
Referral to surgeon
Type 4
Fx through both metaphysis and epiphysis on x-ray
Referral to surgeon
Type 5
Narrowing of physis on x-ray
Referral to surgeon
Osteochondral
Weak ankles, crepitus, locking, deep pain, recurrent swelling
Casting if fragment not avulsed from talar dome; otherwise, surgical intervention
Often missed initially; may follow compression injury of talar dome.
Posterior tubercle of talus and os trigonum
Mechanism is severe plantar flexion of foot; patient has lateral posterior triangle pain; resisted eversion pain free; passive plantar flexion mimics symptoms
Short leg cast in 15° of plantar flexion for 4 wk; surgical excision occasionally
Occur in dancers, runners, soccer players.
Avulsion of fifth metatarsal
Inversion injury can avulse plantar aponeurosis from proximal tuberosity; produces tenderness at base of 5th metatarsal
Symptomatic care in cast shoe or hard shoe
Jones fracture
Tenderness at base of 5th metatarsal
Surgical screw fixation followed by non-weight-bearing cast
Common in basketball players and ballroom dancers
Lateral process of talus
Inversion injury; seen on mortise view but difficult to see on lateral view; bone scan or CT scan may help identify
Nondisplaced fxs: short leg cast for 6 wk, 4 wk non-weight bearing; displaced fxs: surgical intervention
Often missed for months because of proximity to lateral ligaments. Common in snowboarders.
Maisonneuve fracture
Eversion injury often associated with deltoid ligament sprain; pain and x-ray findings on proximal third of fibula; involves interosseus membrane
Referral for internal fixation
Often misdiagnosed; important to palpate entire fibula with eversion injuries.
Calcaneus
Extra-articular fx often from twisting forces; intra-articular fx often from fall from height; both involve pain with walking or inability to bear weight; CT can delineate two types
Extra-articular: non-weight-bearing cast; intra-articular: surgical referral
Extra-articular fxs often heal well.
Cuboid
Subluxation
Occurs during pronation; pain over lateral side of foot, often along sinus tarsi; pain is elicited by pressing on plantar aspect of cuboid in dorsal direction; running, cutting, jumping markedly increase pain
Repositioning cuboid by holding the forefoot with thumbs over plantar surface of cuboid and 'whipping' the foot into plantar flexion while thumbs push cuboid dorsally
Mostly seen in classical ballet dancers and distance runners.
Fracture
Uncommon but can occur with inversion and plantar flexion; mimics severe sprain or fx of anterior process of calcaneus
Short leg cast for nondisplaced fx; displaced fx requires surgery
Subtalar dislocation
Violent plantar flexion and inversion of foot produce medial dislocation; dorsiflexion and eversion lead to lateral dislocation; foot is deformed in both types
Reduction under general anesthesia
85% are medial. Neurovascular assessment is critical.
AP = anteroposterior, fx = fracture
Importance of the Study
The importance of this study is the addition of relevant compilation of information for the practical use of athletes, coaches and trainers in their response to ankle injury in terms of assessment and treatment of the injury for optimum healing capacity and minimal long-term damage.
Methodology
Methodology of this research has been through a review of relevant peer-reviewed literature that held as its' focus ankle injuries in athletes.
Findings & Implications of the Study
Findings of this study are stated to be that there is always a change of lessening or furthering damage done when an athlete sprains their ankle. It is critical that coaches and trainers, as well as the athletes themselves become knowledgeable in relation to the various types of ankle injuries that exist and the assessment, care and treatment of these injuries so as to not become disabled due to poor medical attention to the injury.
Summary & Conclusion
Ankle injuries…
