Ankle Sprain (2).docx

**Ankle Sprain** **Overview of Ankle Sprains** - **Common Injury**: Ankle sprains involve the lateral ligament, typically the anterior talofibular ligament (ATFL), due to inversion and supination. - **Clinical Presentation**: Localized tenderness, bruising (indicating severity and...

**Ankle Sprain** **Overview of Ankle Sprains** - **Common Injury**: Ankle sprains involve the lateral ligament, typically the anterior talofibular ligament (ATFL), due to inversion and supination. - **Clinical Presentation**: Localized tenderness, bruising (indicating severity and timing), swelling, decreased range of motion, warmth, and potential visible deformity. **Assessment in the Emergency Room** - **Physical Examination**: Assess tenderness, bruising patterns, swelling extent (including beyond lateral malleolus), and presence of pitting edema. - **Ottawa Ankle Rules**: Used to determine if X-rays are necessary based on tenderness over specific anatomical points and ability to bear weight. **Imaging Considerations** - **X-ray Indications**: Rule out fractures such as ankle mortise, malleolus, talus, or fibular fractures. - **Clinical Assessment**: Tenderness 6 cm up the fibula without pain indicates low fracture risk. Weight-bearing ability (four steps immediately post-injury) further assesses fracture likelihood. **Treatment Approaches** - **Symptomatic Management**: Rest, ice (20 minutes on, 40 minutes off), compression, elevation to reduce swelling. - **Immobilization**: Air or gel-filled casts to stabilize the ankle. - **OMM (Osteopathic Manipulative Medicine)**: - **Range of Motion**: Early, controlled movement to prevent stiffness and aid healing. - **Myofascial Release**: Indicated for restricted ankle motion, focusing on interosseous membranes if applicable. - **Fibular Head Manipulation**: Addressing anterior or posterior movement to restore stability and prevent further injury. **Rehabilitation and Follow-up** - **Functional Rehabilitation**: Exercises to restore full range of motion, promote lymphatic drainage, and regain balance and strength. - **NSAIDs**: Used to reduce inflammation and pain. - **Referral**: Consider referral to a surgeon if symptoms persist or worsen, indicating possible ligamentous tear requiring surgical intervention. **Osteopathic Considerations** - **Biomechanical Assessment**: Ensure ankle dorsiflexion and plantarflexion are restored to prevent recurrent sprains. - **Interosseous Membrane**: Assess for strain and consider myofascial release if restricted motion persists. **Advanced Techniques** - **Balanced Ligamentous Tension**: Adjust fibular head and interosseous membrane tension to optimize ankle stability and function. - **Fibular Head Manipulation**: Gentle manipulation to realign fibular head if displaced, aiding in restoration of normal biomechanics. **Conclusion** - **Outcome Assessment**: Regular re-evaluation of range of motion, pain levels, and functional ability post-treatment. - **Patient Education**: Emphasize rehabilitation exercises, proper footwear, and precautions against recurrent sprains. \_\_\_\_\_\_ As a clinical decision tool to determine the need for ankle x-rays, which of the following are the Ottawa ankle rules? (Select all that apply) - Inability to bear weight immediately after injury and during the evaluation - Bone tenderness at the tip of the medial malleolus or along the posterior edge of the distal 6 cm of the posterior/medial tibia - Bone tenderness at the distal lateral malleolus or along the posterior edge of the distal 6 cm of the posterior fibula