踝关节扭伤的评价和处理.pptVIP

AssessmentAndManagementOfAnkleSprains

StevenSchepensM.D.

AnkleSprainsMostcommonathleticinjuryMostcausedbyexcessiveinversionInjurytolateralsupportingligamentMosttreatednonoperatively

RiskOfAnkleInjuriesBySportBasketball----45%Soccer--------31%Volleyball---25%Football------10-15%

AnkleConsistsOfTwoJointsTalarMortiseAllowsforplantarflexionanddorsiflexionSubtalarJointAllowsforinversion,eversion,andinternalandexternalrotation

LigamentousStructuresOfTheAnkle1)TibiofibularComplex2)MedialComplex3)LateralComplex

LigamentousStructuresOfTheAnkleTibiofibularComplexStabilizestheanklemortiseAllowslittlemovementbetweentibiaandfibula

LigamentousStructuresOfTheAnkleMedialComplexDeltoidLigamentLimitseversionLimitslateraldisplacementofthetalusMedialmalleoluswilloftenfracturebeforethisligamenttears*

LigamentousStructuresOfTheAnkleLateralComplexAnteriorTalofibular*CalcaneaofibularPosteriorTalofibularResistsinternalrotation,anteriordisplacement,andinversion

SecondaryStabilizersMusclesandTendonsPeroneousLongusAnteriorTibialisPosteriorTibialisAchillestendon

On-FieldManagementGoal--IdentifyseriousinjuryScreenfordeformitiesAxialtractionandrelocationNeurovascularassessmentWeightbearingStabilization

On-FieldManagement“GoldenPeriod”BestopportunityforaccuratediagnosisNoswellingPainhassubsidedNoguarding

AssessmentOfAnkleSprainHistoryHowdidithappen?Wheredoesithurt?Didthepainmakeyoustopplaying?Wereyouabletobearweightrightaway?Haveyouinjuredthisortheotheranklebefore?

AssessmentOfAnkleSprainPhysicalExamRemovalofshoesandsocksonbothfeetExamineuninjuredanklefirstPalpateligamentsandbonesandnoteanyswellingorecchymosisMovetheanklethroughsixrangesofmotion:Plantarflexion,dorsiflexion,andinversionandeversioninplantarflexionanddorsiflexion

AssessmentOfAnkleSprainPhysicalExamStrengthtesting(compare