踝关节扭伤的评价和处理课件.ppt

1、Assessment And Management Of Ankle SprainsSteven Schepens M.D.Ankle Sprains Most common athletic injury Most caused by excessive inversion Injury to lateral supporting ligament Most treated nonoperativelyRisk Of Ankle Injuries By Sport Basketball-45%Soccer-31%Volleyball-25%Football-10-15%Ankle Consi

2、sts Of Two Joints Talar MortiseAllows for plantar flexion and dorsiflexion Subtalar Joint Allows for inversion,eversion,and internal and external rotationLigamentous Structures Of The Ankle 1)Tibiofibular Complex 2)Medial Complex 3)Lateral ComplexLigamentous Structures Of The Ankle Tibiofibular Comp

3、lexStabilizes the ankle mortiseAllows little movement between tibia and fibula Ligamentous Structures Of The Ankle Medial ComplexDeltoid LigamentLimits eversionLimits lateral displacement of the talusMedial malleolus will often fracture before this ligament tears*Ligamentous Structures Of The Ankle

4、Lateral ComplexAnterior Talofibular*CalcaneaofibularPosterior Talofibular Resists internal rotation,anterior displacement,and inversionSecondary Stabilizers Muscles and TendonsPeroneous LongusAnterior TibialisPosterior TibialisAchilles tendonOn-Field Management Goal-Identify serious injuryScreen for

5、 deformitiesAxial traction and relocationNeurovascular assessment Weight bearingStabilizationOn-Field Management“Golden Period”Best opportunity for accurate diagnosisNo swelling Pain has subsidedNo guardingAssessment Of Ankle Sprain HistoryHow did it happen?Where does it hurt?Did the pain make you s

6、top playing?Were you able to bear weight right away?Have you injured this or the other ankle before?Assessment Of Ankle Sprain Physical ExamRemoval of shoes and socks on both feetExamine uninjured ankle firstPalpate ligaments and bones and note any swelling or ecchymosisMove the ankle through six ra

7、nges of motion:Plantar flexion,dorsiflexion,and inversion and eversion in plantar flexion and dorsiflexionAssessment Of Ankle Sprain Physical ExamStrength testing(compare to other ankle)Special tests for joint stabilityAssessment Of Ankle Sprain Specific TestsAnterior Drawer TestAssesses the integri

8、ty of the anterior talofibular ligamentLarge number of false negatives is assessed within the first 48 hours4-5 days postinjury has a sensitivity of 86%and specitivity of 74%Assessment Of Ankle Sprain Specific TestsTalar Tilt TestDeltoid ligament-eversionCalcaneofibular-inversionSide-to-side TestTib

9、iofibular ligament93%specific Assessment Of Ankle Sprain Specific TestsThompsons TestAchilles tendonSqueeze TestExternal Rotation TestSyndesmosis injuries Assessment Of Ankle Sprain RadiographsOttawa Ankle Rules*When are ankle X-rays necessary:Inability to bear weightBone tenderness on the tip of ei

10、ther malleolus or up to 6cm up the posterior edge Assessment Of Ankle Sprain RadiographsOttawa Ankle Rules*When are foot X-rays necessary:Inability to bear weightBone tenderness at the navicular or the base of the fifth metatarsal100%sensitivityAnkle Injury Differential Lateral Inversion SprainMost

11、common injury85%of all ankle sprainsLateral ligaments damaged from anterior to posteriorGrading Lateral Ankle SprainsGradeAnt.DrawerTestTalar TiltTestReturn toPlay1NegativeNegative1 10days2IncreasedLaxityNegative2-4 weeks3PositivePositive5 8 wkwithrehab.Mnemonic for Treating Ankle Sprains P-rotectio

12、n R-est I-ce C-ompression E-levation M-edication M-obilizationMedial Eversion Sprain Commonly seen in wrestlers 10%of sprains vs.85%lateral 75%of ankle fractures occur on medial side Deltoid LigamentSyndesmosis Sprain 1%-11%of ankle sprains External rotation stress radiographs Little swelling Recove

13、ry time of 55 daysBifurcate Ligament Injury InjuryViolent Dorsiflexion,Forceful plantar flexion,direct trauma 19%of inversion sprains Avulsion of anterior process of calcaneous Non-weight-bearing cast for four weeksACHILLES TENDON RUPTURE Rapid plantar flexion 2 to 6cm above the Os CalcisPeroneal Te

14、ndon Injury Subluxation or dislocation Palpate over the tendon with dorsiflexion and eversionFlexor Hallucis Longus Injury Occurs with people who tiptoe or stand on the balls of their feetLateral Periostitis Jumpers ankle Symptoms similar to a lateral sprain Lateral TalusAnterior Tibialis Tendon Inj

15、ury Most often in elderly people Foot drop SurgerySafe Return To Play Stable or unstable Pain free range of motion Function testing pain free 后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用主要经营：网络软件设计、图文设计制作、发布广告等公司秉着以优质的服务对待每一位客户，做到让客户满意！致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求The user can demonstrate on a projector or computer,or print the presentation and make it into a film to be used in a wider field