踝关节损伤的诊治幻灯教学课件.ppt

1、Assessment And Management Of Ankle SprainsnSteven Schepens M.D.2020/12/101Ankle SprainsnMost common athletic injurynMost caused by excessive inversionInjury to lateral supporting ligamentnMost treated nonoperatively2020/12/102Risk Of Ankle Injuries By SportnBasketball-45%nSoccer-31%nVolleyball-25%nF

2、ootball-10-15%2020/12/103Ankle Consists Of Two Joints nTalar MortiseAllows for plantar flexion and dorsiflexionnSubtalar JointAllows for inversion,eversion,and internal and external rotation2020/12/1042020/12/105Ligamentous Structures Of The Anklen1)Tibiofibular Complexn2)Medial Complexn3)Lateral Co

3、mplex2020/12/106Ligamentous Structures Of The AnklenTibiofibular ComplexStabilizes the ankle mortiseAllows little movement between tibia and fibula 2020/12/1072020/12/108Ligamentous Structures Of The AnklenMedial ComplexDeltoid LigamentnLimits eversionnLimits lateral displacement of the talusMedial

4、malleolus will often fracture before this ligament tears*2020/12/1092020/12/1010Ligamentous Structures Of The AnklenLateral ComplexAnterior Talofibular*CalcaneaofibularPosterior TalofibularnResists internal rotation,anterior displacement,and inversion2020/12/10112020/12/1012Secondary StabilizersnMus

5、cles and TendonsPeroneous LongusAnterior TibialisPosterior TibialisAchilles tendon2020/12/10132020/12/1014On-Field ManagementnGoal-Identify serious injuryScreen for deformitiesnAxial traction and relocationNeurovascular assessment Weight bearingStabilization2020/12/1015On-Field Managementn“Golden Pe

6、riod”Best opportunity for accurate diagnosisNo swelling Pain has subsidedNo guarding2020/12/1016Assessment Of Ankle SprainnHistoryHow did it happen?Where does it hurt?Did the pain make you stop playing?Were you able to bear weight right away?Have you injured this or the other ankle before?2020/12/10

7、17Assessment Of Ankle SprainnPhysical ExamRemoval of shoes and socks on both feetExamine uninjured ankle firstPalpate ligaments and bones and note any swelling or ecchymosisMove the ankle through six ranges of motion:nPlantar flexion,dorsiflexion,and inversion and eversion in plantar flexion and dor

8、siflexion2020/12/1018Assessment Of Ankle SprainnPhysical ExamStrength testing(compare to other ankle)Special tests for joint stability2020/12/1019Assessment Of Ankle SprainnSpecific TestsAnterior Drawer TestnAssesses the integrity of the anterior talofibular ligamentnLarge number of false negatives

9、is assessed within the first 48 hoursn4-5 days postinjury has a sensitivity of 86%and specitivity of 74%2020/12/10202020/12/1021Assessment Of Ankle SprainnSpecific TestsTalar Tilt TestnDeltoid ligament-eversionnCalcaneofibular-inversionSide-to-side TestnTibiofibular ligament93%specific 2020/12/10222

10、020/12/1023Assessment Of Ankle SprainnSpecific TestsThompsons TestnAchilles tendonSqueeze TestExternal Rotation TestnSyndesmosis injuries 2020/12/10242020/12/10252020/12/10262020/12/1027Assessment Of Ankle SprainnRadiographsOttawa Ankle Rules*When are ankle X-rays necessary:nInability to bear weight

11、nBone tenderness on the tip of either malleolus or up to 6cm up the posterior edge 2020/12/1028Assessment Of Ankle SprainnRadiographsOttawa Ankle Rules*When are foot X-rays necessary:nInability to bear weightnBone tenderness at the navicular or the base of the fifth metatarsaln100%sensitivity2020/12

12、/1029Ankle Injury DifferentialnLateral Inversion SprainMost common injury85%of all ankle sprainsLateral ligaments damaged from anterior to posterior2020/12/1030Grading Lateral Ankle SprainsGradeAnt.DrawerTestTalar TiltTestReturn toPlay1NegativeNegative1 10days2IncreasedLaxityNegative2-4 weeks3Positi

13、vePositive5 8 wkwithrehab.2020/12/1031Mnemonic for Treating Ankle SprainsnP-rotectionnR-estnI-cenC-ompressionnE-levationnM-edicationnM-obilization2020/12/1032Medial Eversion SprainnCommonly seen in wrestlersn10%of sprains vs.85%lateraln75%of ankle fractures occur on medial sidenDeltoid Ligament2020/

14、12/1033Syndesmosis Sprainn1%-11%of ankle sprainsnExternal rotation stress radiographsnLittle swellingnRecovery time of 55 days2020/12/10342020/12/1035Bifurcate Ligament InjurynInjuryViolent Dorsiflexion,Forceful plantar flexion,direct trauman19%of inversion sprainsnAvulsion of anterior process of ca

15、lcaneousnNon-weight-bearing cast for four weeks2020/12/10362020/12/1037ACHILLES TENDON RUPTUREnRapid plantar flexionn2 to 6cm above the Os Calcis2020/12/1038Peroneal Tendon InjurynSubluxation or dislocationnPalpate over the tendon with dorsiflexion and eversion2020/12/1039Flexor Hallucis Longus Inju

16、rynOccurs with people who tiptoe or stand on the balls of their feet2020/12/1040Lateral PeriostitisnJumpers anklenSymptoms similar to a lateral sprainnLateral Talus2020/12/1041Anterior Tibialis Tendon InjurynMost often in elderly peoplenFoot dropnSurgery2020/12/1042PPT教学课件谢 谢 观 看Thank You For Watching43