Materiały źródłowe

• #1 Sprained Ankle: Symptoms, Types, Treatment & Recovery

  https://my.clevelandclinic.org/health/diseases/22048-sprained-ankle

  A sprained ankle is a common injury that occurs when the ankle ligaments are torn or stretched too far, often after a fall, or if you roll or twist your ankle. […] A sprained ankle is a common injury when the tissue that connects your ankle bones and supports your ankle (ligaments) is torn or stretched beyond its limits, often after a fall, ankle roll or twist. […] A sprained ankle is when the ligaments in your ankle are torn. […] Your healthcare provider will diagnose your sprained ankle after a physical examination of your foot and ankle to identify your range of motion and determine which ligaments are affected. The physical exam is typically followed by an imaging test, like an X-ray. […] If you fell or twisted your ankle, and the injury causes you pain, swelling, bruising and you have trouble walking, you can assume that you have a sprained ankle. Visit your healthcare provider and they’ll assess the injury, confirm the diagnosis and offer a treatment plan.

• #2 Sprained Ankle – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/

  Sprained Ankle Diagnostics, Diagnosis […] An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. The severity of a sprain can vary greatly depending on the number of ligaments involved and the extent to which the ligaments are torn. […] However, if your ankle remains swollen or painful for several weeks despite conservative treatments, or if you have difficulty putting weight on your ankle, you may need to be evaluated to ensure that you do not have a severe ankle sprain or fracture. […] Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation. […] Your doctor will diagnose your ankle sprain by asking you questions about the injury and performing a careful examination of your foot and ankle. […] An ankle sprain is largely a clinical diagnosis based on how the injury happened, symptoms, and examination by a medical professional. […] Occasionally, imaging studies, such as X-rays and magnetic resonance imaging (MRI) scans, are obtained to rule out a fracture or other injury to the nearby tendons and cartilage. […] Your doctor may be able to tell the severity of your ankle sprain based on the amount of swelling, pain, bruising, and stability. If you have difficulty bearing weight, or tenderness in the bones of the foot and ankle, you may need additional tests to rule out a fracture. […] After the examination, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments. […] Ankle sprains can be treated without surgery. Even a complete ligament tear (Grade 3) will heal without surgical repair if it is immobilized and rehabilitated appropriately.

• #3 Acute Ankle Sprain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459212/

  Acute ankle sprains are commonly seen in both primary care practices and emergency departments and can result in significant short-term morbidity, recurrent injuries, and functional instability. Appropriate initial evaluation and treatment can decrease the likelihood of these complications. […] Although nonoperative treatment is often successful in achieving satisfactory outcomes, correct diagnosis and treatment is important at the time of initial evaluation to mitigate the risks of recurrent instability. Appropriate treatment can limit the impact of long-term detrimental effect such as chronic recurrent ankle instability, arthritic progression, and long-term disability. […] In the evaluation of an ankle injury, a practitioner should elicit a history of the mechanism of injury. The practitioner should also investigate whether the injury involved inversion, eversion, rotational stressing, or direct contact, and take into account a history of previous ankle injuries and the patient’s ability to bear weight after the injury.

• #4 Sprained ankle – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231

  During a physical, your doctor will examine your ankle, foot and lower leg. The doctor will touch the skin around the injury to check for points of tenderness and move your foot to check the range of motion and to understand what positions cause discomfort or pain. […] If the injury is severe, your doctor may recommend one or more of the following imaging scans to rule out a broken bone or to evaluate in more detail the extent of ligament damage: […] X-ray. During an X-ray, a small amount of radiation passes through your body to produce images of the bones of the ankle. This test is good for ruling out bone fractures. […] Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed cross-sectional or 3-D images of soft internal structures of the ankle, including ligaments.

• #5 Sprained Ankle – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/

  Sprained Ankle Diagnostics, Diagnosis […] An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. The severity of a sprain can vary greatly depending on the number of ligaments involved and the extent to which the ligaments are torn. […] However, if your ankle remains swollen or painful for several weeks despite conservative treatments, or if you have difficulty putting weight on your ankle, you may need to be evaluated to ensure that you do not have a severe ankle sprain or fracture. […] Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation. […] Your doctor will diagnose your ankle sprain by asking you questions about the injury and performing a careful examination of your foot and ankle. […] An ankle sprain is largely a clinical diagnosis based on how the injury happened, symptoms, and examination by a medical professional. […] Occasionally, imaging studies, such as X-rays and magnetic resonance imaging (MRI) scans, are obtained to rule out a fracture or other injury to the nearby tendons and cartilage. […] Your doctor may be able to tell the severity of your ankle sprain based on the amount of swelling, pain, bruising, and stability. If you have difficulty bearing weight, or tenderness in the bones of the foot and ankle, you may need additional tests to rule out a fracture. […] After the examination, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments. […] Ankle sprains can be treated without surgery. Even a complete ligament tear (Grade 3) will heal without surgical repair if it is immobilized and rehabilitated appropriately.

• #6 Acute Ankle Sprain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459212/

  Acute ankle sprains are commonly seen in both primary care practices and emergency departments and can result in significant short-term morbidity, recurrent injuries, and functional instability. Appropriate initial evaluation and treatment can decrease the likelihood of these complications. […] Although nonoperative treatment is often successful in achieving satisfactory outcomes, correct diagnosis and treatment is important at the time of initial evaluation to mitigate the risks of recurrent instability. Appropriate treatment can limit the impact of long-term detrimental effect such as chronic recurrent ankle instability, arthritic progression, and long-term disability. […] In the evaluation of an ankle injury, a practitioner should elicit a history of the mechanism of injury. The practitioner should also investigate whether the injury involved inversion, eversion, rotational stressing, or direct contact, and take into account a history of previous ankle injuries and the patient’s ability to bear weight after the injury.

• #7 Management of Ankle Sprains | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0101/p93.html

  Ankle trauma is evaluated with a careful history (situation and mechanism of injury, previous injury to the joint, etc.) and a careful physical examination (for example, inspection, palpation, weight-bearing status, special tests). […] Gross deformity should not occur with an ankle sprain, although severe swelling can give the impression of deformity. […] The entire length of the tibia and fibula should be palpated to detect fracture of the proximal fibula (Maisonneuve fracture), which may be associated with syndesmosis injury. […] Tenderness along the base of the fifth metatarsal may indicate an avulsion of the peroneal brevis tendon. […] Palpable pain and effusion along the talocrural joint line should raise suspicion of an osteochondral talar dome lesion. […] Lack of swelling with an eversion or hyperdorsiflexion mechanism of injury, along with tenderness at the distal tibiofibular joint, may indicate a syndesmosis sprain.

• #8 Ankle Sprain | UConn Musculoskeletal Institute

  https://health.uconn.edu/msi/clinical-services/orthopaedic-surgery/foot-ankle-and-podiatry/ankle-sprain/

  A sprained ankle is a very common injury. Approximately 25,000 people experience it each day. […] See your doctor to diagnose a sprained ankle. He or she may order X-rays to make sure you don’t have a broken bone in the ankle or foot. A broken bone can have similar symptoms of pain and swelling. […] The physical exam may be painful. The doctor may need to move your ankle in various ways to see which ligament has been hurt or torn. […] If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes. If this occurs, it is possible that the injury may also have caused damage to the ankle joint surface itself. […] The doctor may order an MRI (magnetic resonance imaging) scan if he or she suspects a very severe injury to the ligaments, injury to the joint surface, a small bone chip or other problem. The MRI can make sure the diagnosis is correct. The MRI may be ordered after the period of swelling and bruising resolves.

• #9 Sprained Ankle | Orthopedics & Sports Medicine

  https://health.uconn.edu/orthopedics-sports-medicine/conditions-and-treatments/where-does-it-hurt/foot-and-ankle/sprained-ankle/

  When an ankle sprain is suspected, your doctor will perform a physical exam which may be painful. The doctor may need to move your ankle in various ways to determine which ligament has been damaged. Your doctor may be able to tell you the grade of your ankle sprain based upon the amount of swelling, pain, and bruising. […] If there is a complete tear of the ligaments, the ankle may become unstable after the initial injury phase passes. If this occurs, it is possible that the injury may also have caused damage to the ankle joint surface itself. […] Your doctor may order X-rays to make sure you don’t have a broken bone in the ankle or foot. A broken bone can produce similar symptoms of pain and swelling. An MRI (magnetic resonance imaging) scan may be ordered if your doctor suspects a very severe injury to the ligaments, injury to the joint surface, a small bone chip, or other problem. The MRI may be delayed in order to allow any swelling and bruising to resolve itself.

• #10 Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/52/15/956

  The OAR are an accurate and valid tool, which can be used with patients who have a suspected ankle/foot fracture within 1 week after the initial trauma. […] The sensitivity (84%) and specificity (96%) of physical examination using the anterior drawer test are optimised if clinical assessment is delayed for between 4 and 5 days post injury. […] In case of suspicion of high-grade ligament injuries, osteochondral defects, syndesmotic injuries and occult fractures, an MRI can be performed because of its excellent sensitivity (93%-96%) and specificity (100%) for visualising these injuries. […] The recommendation includes a short summary by providing an overview of the most important diagnostic steps, which was missing in the previous guideline. […] Recommendation (new): Regarding the clinical assessment of damage to the anterior talofibular ligament, the sensitivity (84%) and specificity (96%) of assessment using the anterior drawer are optimised if clinical assessment is delayed for between 4 and 5 days post injury. In case of a suspected fracture, the OAR should be applied (level 2).

• #11

  https://journal.aspetar.com/en/archive/volume-2-issue-2/ankle-sprain-diagnosis-and-therapy-starts-with-knowledge-of-anatomy

  Based on the current available literature, the level of evidence for delayed physical examination is superior to MRI for accurate diagnosis. A further physical examination 5 to 7 days after sprain can then better diagnose the grade of the ankle sprain. The absence of swelling suggests that there is no ligament rupture, whereas extensive swelling is indicative of ligament injury. […] The clinical stability tests are better performed in a delayed physical examination. The anterior drawer test is more specific to assess the integrity of the ATFL. Increased anterior translation of the talus with respect to the tibia is a positive sign and indicates a tear of the ATFL, particularly if the translation is significantly different from the opposite side. […] Ultrasound and MRI can be useful in diagnosing associated injury, but evidence for its usefulness is lacking compared to delayed physical examination.

• #12 Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/46/12/854

  Delayed physical diagnostic examination (4 to 5 days) gives a better diagnostic result than research within 48 h. […] For a solid diagnosis of an ankle ligament rupture, patients must be re-examined 4 to 5 days after the trauma. […] If a haematoma develops and patients experience local pressure pain at palpation or a positive anterior drawer test is present or both, it is very likely that a ligament rupture exists.

• #13 Ankle Sprain: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/1907229-overview

  Ankle sprain is usually that of an inversion-type twist of the foot, followed by pain and swelling. The physical examination confirms a diagnosis made on the basis of patient history and differentiates an ankle sprain from a fracture. Examination in patients may include the following tests: Anterior drawer test: To assess for ankle instability, Prone anterior drawer test: Also tests for ligamentous instability, Talar tilt test (or inversion stress maneuver): To assess integrity of the calcaneofibular ligament, External rotation test: To evaluate the integrity of the syndesmotic ligaments, Kleiger test: Variation of the external rotation test; to assess the integrity of the deltoid ligament, Squeeze test (or fibular compression test): To evaluate for syndesmotic or fibular injury, Neurovascular evaluation: To assess neurovascular status of the affected limb. The following radiologic studies may be used to evaluate ankle sprains: Plain radiography: Guided by the Ottawa Ankle Rules to diagnose ankle or foot fractures, Stress-view radiography: May provide further assessment for ankle stability; accuracy of study increases with use of local anesthesia, Computed tomography scanning: May be indicated for imaging of soft tissues or for bone imaging beyond radiography; useful for evaluating osteochondritis dissecans and stress fractures, Magnetic resonance imaging: May be useful to assess a suspected syndesmotic or high ankle sprain or if osteochondrosis or meniscoid injury is suspected in patients with a history of recurrent ankle sprains and chronic pain, Ankle arthrography: May be useful for determining capsular damage and the number of ankle ligaments damaged, Bone scanning: To detect subtle bone abnormalities (eg, stress fracture, osteochondral defects) and syndesmotic disruptions. Drawer and talar tilt examination techniques are used to assess ankle instability; however, the use of these techniques in acute injuries is in question because of pain, edema, and muscle spasm. It is generally accepted that for most patients, operative repair of third-degree anterior talofibular ligament (ATFL) tears and medial ankle ligament tears does not contribute to an improved outcome. One of the few absolute indications for surgery in patients with a sprained ankle is a distal talofibular ligament third-degree sprain that causes widening of the ankle mortise. A second indication is a deltoid sprain with the deltoid ligament caught intra-articularly and with widening of the medial ankle mortise.

• #14 Ankle Sprains: Practical points on diagnosis & treatment |

  https://carrothersorthopaedics.co.uk/practical-points-on-ankle-sprains/

  Sprained ankles are common. It is important to diagnose a sprain from a fracture though and there are also some practical tips on how you can assist a quick recovery. […] It is important to ensure that your suspected ankle sprain isnt a fracture, so diagnosis is important. […] When visiting an orthopaedic specialist they may conduct one or more of the following tests, to assess your injury: Anterior drawer test, which assesses ankle instability; Prone anterior drawer test, testing for ligamentous instability; Talar tilt test, which assesses integrity of the calcaneofibular ligament; External rotation test, which assesses the integrity of the syndesmotic ligaments; Kleiger test, which assesses the integrity of the deltoid ligament; Fibular compression test, which assesses syndemotic or fibular injury; Neuromuscular evaluation of the affected limb.

• #15 Sprained Ankle – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/

  Sprained Ankle Diagnostics, Diagnosis […] An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. The severity of a sprain can vary greatly depending on the number of ligaments involved and the extent to which the ligaments are torn. […] However, if your ankle remains swollen or painful for several weeks despite conservative treatments, or if you have difficulty putting weight on your ankle, you may need to be evaluated to ensure that you do not have a severe ankle sprain or fracture. […] Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation. […] Your doctor will diagnose your ankle sprain by asking you questions about the injury and performing a careful examination of your foot and ankle. […] An ankle sprain is largely a clinical diagnosis based on how the injury happened, symptoms, and examination by a medical professional. […] Occasionally, imaging studies, such as X-rays and magnetic resonance imaging (MRI) scans, are obtained to rule out a fracture or other injury to the nearby tendons and cartilage. […] Your doctor may be able to tell the severity of your ankle sprain based on the amount of swelling, pain, bruising, and stability. If you have difficulty bearing weight, or tenderness in the bones of the foot and ankle, you may need additional tests to rule out a fracture. […] After the examination, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments. […] Ankle sprains can be treated without surgery. Even a complete ligament tear (Grade 3) will heal without surgical repair if it is immobilized and rehabilitated appropriately.

• #16 Sprained Ankle | Boston Medical Center

  https://www.bmc.org/patient-care/conditions-we-treat/db/sprained-ankle

  Your doctor may order an MRI if he or she suspects a very severe injury to the ligaments, damage to the cartilage or bone of the joint surface, a small bone chip, or another problem. […] After your sprained ankle is diagnosed, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments. […] Almost all ankle sprains can be treated without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately. […] Your doctor may encourage you to put some weight on your ankle while it is protected. This can help with healing. […] Its rare to need surgery to treat a sprained ankle. Surgery is reserved for injuries that do not respond to nonsurgical treatment, and for patients who experience persistent ankle instability after months of rehabilitation and nonsurgical treatment.

• #17 Sprained Ankle: Symptoms, 3 Grade Classification, & Treatment

  https://www.webmd.com/fitness-exercise/what-is-an-ankle-sprain

  This injury happens when the ligaments in your ankle tear or get stretched too much. […] They will be able to diagnose whether you have a sprain and rule out any more serious injuries with similar symptoms. […] Your doctor likely will put your sprain at one of three „grades” based on the amount of damage: […] Grade 1: Your ankle will probably feel sore and may be slightly swollen. In this case, the ligament has been overstretched but not torn. […] Grade 2: You have a partial tear in the ligament. This causes prolonged pain and swelling. It might prevent you from putting your full weight on the ankle. You may also notice bruising. This is because the tear has caused bleeding under your skin. […] Grade 3: This is a full tear of the ankle ligament. You may have heard a popping sound when it happened. This level of sprain causes severe pain, swelling, and bruising. Because the ligament is no longer able to do its job, your ankle will feel unstable and you’ll be unable to walk normally.

• #18 Diagnosis and Treatment for a Sprained Ankle – PRESNow

  https://www.presnow247.org/2023/05/16/diagnosis-and-treatment-for-a-sprained-ankle/

  Ankle sprains fall under ankle injuries, including fractures and tendonitis. The severity of ankle sprains is graded as follows: […] For doctors to diagnose sprained ankles, they need to do a physical examination of the injured ankle. The exam is painful but necessary because the doctor must check for torn or stretched ligaments. […] The doctor will also test the range of motion in the ankle to establish whether there are any fractures. MRI scans, X-rays, and ultrasounds help highlight joint or cartilage damage in severe ankle injuries. […] After the physical examination, the doctor will grade the injury and provide a treatment plan.

• #19 Sprained Ankle: Symptoms, Treatment, Recovery Time, and More

  https://www.webmd.com/pain-management/ankle-sprain

  Your doctor will try to rule out a broken bone or other serious injury. Theyll move your foot and ankle to learn which bones are affected and make sure your nerves and arteries arent hurt. Theyll also check that your Achilles tendon, which runs along the back of your ankle, isnt torn. […] You might have X-rays to check for fractures. If your sprain is severe, your doctor may order more imaging tests, including: […] Doctors grade ankle sprains by how severe they are: […] Mild (grade I). Your ligaments are stretched but not torn. Your ankle still feels stable. You may have some pain and stiffness. […] Moderate (grade II). One or more ligaments are partially torn. The joint isnt totally stable, and you cant move it as much as usual. You have swelling and moderate pain. […] Severe (grade III). One or more ligaments are totally torn, and your ankle is unstable. You have a lot of pain and cant move it.

• #20 Sprains: Types, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/sprains

  A healthcare provider will diagnose a sprain with a physical exam. Your provider will examine your injured joint. Tell them when you first noticed symptoms, especially if you know exactly what caused the injury. […] Healthcare providers grade sprains based on their severity: Grade 1 sprain (mild): Very little or no tearing in your ligament. Grade 2 sprain (moderate): Your ligament is partially torn, but not all the way through. Grade 3 sprain (severe): Your ligament is completely torn. […] You might need imaging tests to take pictures of your joint and the tissue around it. These tests can show damage inside your joint and help diagnose other injuries like bone fractures. Your provider might use: X-rays. Ultrasound. Magnetic resonance imaging (MRI).

• #21 Sprained Ankles: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/orthopedics/columbia-orthopedics/ankle-sprain/treatment

  How are Sprained Ankles Diagnosed? Diagnosis If you think you might have a sprained ankle, schedule a visit with your doctor. They will examine your ankle, foot, and lower leg, touching the area around the injury to check for pain or tenderness. Your doctor will also test your range of motion to determine the ankle joint’s stability and if movement causes discomfort. […] For a severe injury, your doctor may conduct one or more imaging scans to rule out a broken bone and determine the extent of ligament damage: […] X-ray: During an X-ray, radiation passes through the body to capture an image of the ankle bone. This helps determine if your injury is a sprain or a fracture. […] Magnetic resonance imaging (MRI) scan: Your doctor may order an MRI to evaluate the damage to the ligaments and tendons of the ankle. An MRI isn’t necessary to diagnose a sprain, but it can provide more detailed information about your injury.

• #22 Acute Ankle Sprain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459212/

  The Ottawa ankle rules have been demonstrated to be accurate in predicting which patients with ankle injuries require x-rays to exclude fractures in both adult and children older than five years. […] A typical ankle x-ray series would include anteroposterior, lateral, and mortise views. […] Initial management of ankle sprains includes the PRICE protocol (protection, rest, ice, compression, and elevation). Resting the injured ankle for the first 72 hours followed by gradual resumption of activity as tolerated is a reasonable approach. […] Patients with evidence of ligamentous laxity should be immobilized, given crutches to allow ambulation without weight-bearing of the injured ankle, and referred to a sports medicine specialist or orthopedic surgeon. […] While most ankle sprains are successfully managed with nonoperative modalities, recurrent instability and associated defects can be seen in up to 25-40% of patients. Recognition of these possible concomitant injuries and the appropriate referral to an orthopedic/sports medicine specialist is mandatory to mitigate the risks of long-term detrimental outcomes.

• #23 Management of Ankle Sprains | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0101/p93.html

  Special tests are useful to further substantiate the presence of a syndesmosis sprain. […] The Ottawa ankle rules can be used to determine when radiographic studies are indicated in the patient with ankle trauma. […] According to these rules, radiographs should be obtained to rule out fracture when a patient presents (within 10 days of injury) with bone tenderness in the posterior half of the lower 6 cm (2.5 in) of the fibula or tibia or an inability to bear weight immediately after the injury and in the emergency department (or physician’s office). […] If indicated on the basis of the Ottawa ankle rules, anteroposterior, lateral and mortise radiographs should be obtained after the initial physical examination. […] Radiographs may reveal malleolar fractures, talar dome fractures or disruption of the ankle syndesmosis.

• #24 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  This study presents a transparent algorithm with clear decision rules for the diagnosis and treatment of acute ankle injuries based on the currently available trials. […] Recommendation: when applied within 48 h after trauma the Ottawa Ankle/Foot Rule proofed to have a sensitivity of 99.6%. These rules can be applied with a similar sensitivity to children older than one year (level I). Due to the unreliability and the disadvantages associated with obtaining stress views, X-rays are not recommended. […] Recommendation: in 282 patients, physical examination, and especially delayed examination, demonstrated a sensitivity of 96% when compared to operative findings (Figure 3) (level I). Clinical tests for injuries of the syndesmosis have been validated only in small numbers of patients, since isolated injuries of the syndesmosis are rare (Figure 3) (level II). If in doubt, early MRI should be performed.

• #25 Lateral Ankle Sprain | Diagnosis & Treatment

  https://www.physiotutors.com/conditions/lateral-ankle-sprain/

  To exclude possible fractures we can trust the Ottawa ankle rules. An inability to weight-bear four steps after injury or pain on palpation on the posterior edge of the distal 6 cm of the medial or lateral malleolus should increase your suspicion of a possible fracture. If this is the case, an X-ray is warranted (Gomes et al 2022). […] Overall, a thorough examination that considers both physical and functional aspects of the injury is important to accurately diagnose and manage acute lateral ankle sprains (Delahunt et al 2018).

• #26 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  This study presents a transparent algorithm with clear decision rules for the diagnosis and treatment of acute ankle injuries based on the currently available trials. […] Recommendation: when applied within 48 h after trauma the Ottawa Ankle/Foot Rule proofed to have a sensitivity of 99.6%. These rules can be applied with a similar sensitivity to children older than one year (level I). Due to the unreliability and the disadvantages associated with obtaining stress views, X-rays are not recommended. […] Recommendation: in 282 patients, physical examination, and especially delayed examination, demonstrated a sensitivity of 96% when compared to operative findings (Figure 3) (level I). Clinical tests for injuries of the syndesmosis have been validated only in small numbers of patients, since isolated injuries of the syndesmosis are rare (Figure 3) (level II). If in doubt, early MRI should be performed.

• #27 Sprained ankle – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231

  During a physical, your doctor will examine your ankle, foot and lower leg. The doctor will touch the skin around the injury to check for points of tenderness and move your foot to check the range of motion and to understand what positions cause discomfort or pain. […] If the injury is severe, your doctor may recommend one or more of the following imaging scans to rule out a broken bone or to evaluate in more detail the extent of ligament damage: […] X-ray. During an X-ray, a small amount of radiation passes through your body to produce images of the bones of the ankle. This test is good for ruling out bone fractures. […] Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed cross-sectional or 3-D images of soft internal structures of the ankle, including ligaments.

• #28 Sprained ankle – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231

  CT scan. CT scans can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional or 3-D images. […] Ultrasound. An ultrasound uses sound waves to produce real-time images. These images may help your doctor judge the condition of a ligament or tendon when the foot is in different positions. […] Schedule an appointment or get emergency medical care for suspected sprains that don’t respond to self-care strategies or that cause continued pain or instability. If your sprain is severe, you may be referred to a doctor who specializes in sports medicine or orthopedic surgery.

• #29 Management of Ankle Sprains | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0101/p93.html

  Special tests are useful to further substantiate the presence of a syndesmosis sprain. […] The Ottawa ankle rules can be used to determine when radiographic studies are indicated in the patient with ankle trauma. […] According to these rules, radiographs should be obtained to rule out fracture when a patient presents (within 10 days of injury) with bone tenderness in the posterior half of the lower 6 cm (2.5 in) of the fibula or tibia or an inability to bear weight immediately after the injury and in the emergency department (or physician’s office). […] If indicated on the basis of the Ottawa ankle rules, anteroposterior, lateral and mortise radiographs should be obtained after the initial physical examination. […] Radiographs may reveal malleolar fractures, talar dome fractures or disruption of the ankle syndesmosis.

• #30 Ankle Sprain Workup: Approach Considerations, Plain Radiographic Imaging, Stress-View Radiographic Imaging

  https://emedicine.medscape.com/article/1907229-workup

  Plain radiographs may be clinically indicated to diagnose a fracture of the ankle or foot. […] MRI is not indicated unless unusual features are present, such as extensive swelling, ecchymosis, or pain, that suggest an osteochondral lesion not observed on plain radiographs. […] The Ottawa Ankle Rules remain valid for determining the need for x-rays. […] Stress radiography is unreliable for detecting acute injuries to the ankle and midfoot. […] Magnetic resonance imaging (MRI) and computed tomography (CT) scanning accurately detect talar osteochondral lesions; both techniques are also more accurate than arthrography and tenography for detecting lateral ligamentous injury, especially when arthrography and tenography are performed 48 hours post injury. […] MRI is reliable for detecting acute tears of the anterior talofibular ligament and calcaneofibular ligament; diagnostic ultrasonography is useful but less accurate and sensitive than MRI. […] MRI is highly sensitive, specific, and accurate after acute trauma for determining the level of injury to the ankle syndesmotic ligaments.

• #31 Sprained ankle – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231

  CT scan. CT scans can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional or 3-D images. […] Ultrasound. An ultrasound uses sound waves to produce real-time images. These images may help your doctor judge the condition of a ligament or tendon when the foot is in different positions. […] Schedule an appointment or get emergency medical care for suspected sprains that don’t respond to self-care strategies or that cause continued pain or instability. If your sprain is severe, you may be referred to a doctor who specializes in sports medicine or orthopedic surgery.

• #32 Sprained ankle – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231

  CT scan. CT scans can reveal more detail about the bones of the joint. CT scans take X-rays from many different angles and combine them to make cross-sectional or 3-D images. […] Ultrasound. An ultrasound uses sound waves to produce real-time images. These images may help your doctor judge the condition of a ligament or tendon when the foot is in different positions. […] Schedule an appointment or get emergency medical care for suspected sprains that don’t respond to self-care strategies or that cause continued pain or instability. If your sprain is severe, you may be referred to a doctor who specializes in sports medicine or orthopedic surgery.

• #33 Ankle Sprains: Practical points on diagnosis & treatment |

  https://carrothersorthopaedics.co.uk/practical-points-on-ankle-sprains/

  In addition to a thorough assessment by your doctor, radiologic studies of your ankle and foot may be required to assist with diagnosis. […] These could include: Radiography; Stress view radiography to confirm ankle stability; Computed tomography scanning useful to diagnose stress fractures and osteochondritis dissecans; Magnetic resonance imaging useful to diagnose high ankle sprains, people with chronic pain, or injures in patients with recurring ankle sprains; Ankle arthrography useful in diagnosing capsular damage and further assessment of ligament damage; Bone scanning useful to detect stress fractures or bone abnormalities.

• #34 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  Recommendation: MRI shows a high sensitivity for diagnosing ligament injuries of the ankle. Due to the high incidence of ankle injuries, the poor availability and high costs it should be limited to chronic instability of the ankle or reasonable suspicion of osteochondral lesions, occult fractures or injuries of the tibiofibular syndesmosis (Figure 3) (level I). […] Recommendation: a classification should allow reproducible and easy grading of the injury without elaborate techniques and also provide relevant information for treatment. Consequently, classification criteria for stable and unstable injuries, based on clinical findings, is the most suitable approach for use in an emergency department or doctor’s practice (Figure 3). […] Recommendation: conservative treatment should be favored over surgery due to comparable results with fewer complications after conservative treatment and significantly lower costs. Surgery should, therefore, be reserved for patients with persistent symptoms, particularly since secondary reconstruction of the ruptured ligaments is possible even years after the injury with results equal to those of primary repair (level I).

• #35 Management of Ankle Sprains | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0101/p93.html

  For ankle sprains that remain symptomatic for more than six weeks, computed tomographic (CT) scanning or magnetic resonance imaging (MRI) should be considered to rule out talar dome lesions. […] MRI studies may be helpful in identifying syndesmosis sprains and peroneal tendon involvement. […] The history, physical examination and radiologic evaluation should be adequate for determining whether orthopedic referral is indicated. […] Specific indications for referral include the following: fracture or dislocation, neurovascular compromise, tendon rupture or subluxation, a wound that penetrates the joint, mechanical locking of the joint and injury to the syndesmosis.

• #36 Ankle Sprains – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/ankle-sprains

  An ankle x-ray is recommended only if patients have ankle pain and one of the following: Inability to bear weight without assistance immediately after the injury AND in the emergency department (for 4 steps), with or without limping. […] Sprains that are painful after 6 weeks may require additional testing (eg, MRI) to identify overlooked and subtle injuries, such as talar dome fractures, high ankle sprains, or other complex ankle sprains.

• #37 Ankle Sprain Workup: Approach Considerations, Plain Radiographic Imaging, Stress-View Radiographic Imaging

  https://emedicine.medscape.com/article/1907229-workup

  Plain radiographs may be clinically indicated to diagnose a fracture of the ankle or foot. […] MRI is not indicated unless unusual features are present, such as extensive swelling, ecchymosis, or pain, that suggest an osteochondral lesion not observed on plain radiographs. […] The Ottawa Ankle Rules remain valid for determining the need for x-rays. […] Stress radiography is unreliable for detecting acute injuries to the ankle and midfoot. […] Magnetic resonance imaging (MRI) and computed tomography (CT) scanning accurately detect talar osteochondral lesions; both techniques are also more accurate than arthrography and tenography for detecting lateral ligamentous injury, especially when arthrography and tenography are performed 48 hours post injury. […] MRI is reliable for detecting acute tears of the anterior talofibular ligament and calcaneofibular ligament; diagnostic ultrasonography is useful but less accurate and sensitive than MRI. […] MRI is highly sensitive, specific, and accurate after acute trauma for determining the level of injury to the ankle syndesmotic ligaments.

• #38

  https://www.footcaremd.org/conditions-treatments/ankle/ankle-sprain

  Ankle sprains usually can be diagnosed with a physical exam and X-rays. Pain on the outside of the ankle, tenderness and swelling, and an ankle with an inversion-type injury may indicate a sprain. In these patients, normal X-rays also suggest that the bone has not been broken and instead the ankle ligaments have been torn or sprained. […] It is very important, however, not to simply regard any injury as an ankle sprain. Other injuries can occur as well. For example, the peroneal tendons can be torn. Achilles tendon tears are sometimes thought to be ankle sprains and go untreated. There also can be fractures in other bones around the ankle, including the fifth metatarsal or the calcaneus (heel bone). See a foot and ankle orthopaedic surgeon in your area for a thorough examination. […] In very severe cases, an MRI may be useful to rule out other problems in the ankle such as damage to the cartilage. An MRI typically is not necessary to diagnose a sprain and is reserved for patients who are slow to recover and do not follow the normal progression of healing.

• #39

  https://journal.aspetar.com/en/archive/volume-2-issue-2/ankle-sprain-diagnosis-and-therapy-starts-with-knowledge-of-anatomy

  A thorough knowledge of anatomy is imperative for adequate assessment of joint injury. It is particularly important in the ankle joint where sprains are one of the most prevalent injuries of the musculoskeletal system. […] Accurate diagnosis is important because both management and prognosis may differ substantially from that of the more common alternative diagnosis of a lateral ankle ligament sprain. […] The term sprain includes diverse morphologic conditions with diversity of pathologic conditions. These range from overstretching of the ligament to complete rupture with instability of the joint. Severity of the LCL injuries are graded from I to III, based on the increasing ligamentous damage and morbidity. […] Poor anatomical knowledge might lead to an inaccurate examination of the foot and ankle, incorrect diagnosis or even inadequate treatment.

• #40 Ankle Sprains – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sprains-and-other-soft-tissue-injuries/ankle-sprains

  Ankle sprains are very common, most often resulting from turning the foot inward (inversion). Diagnosis is by clinical evaluation and sometimes x-rays. […] Diagnosis of ankle sprains is primarily clinical; not every patient requires x-rays. […] Stress testing to evaluate ligament integrity is important. However, if patients have marked pain and swelling or spasm, the examination is typically delayed until x-rays exclude fractures. […] The ankle anterior drawer test is done to evaluate the stability of the anterior talofibular ligament and thus help differentiate between 2nd- and 3rd-degree lateral ligament sprains. […] If findings suggest a deltoid ligament or high ankle sprain, practitioners should check for evidence of a proximal fibular fracture. […] Ankle sprains should be differentiated from avulsion fractures of the base of the 5th metatarsal, Achilles tendon injuries, and talar dome fractures, which may cause similar symptoms.

• #41 Management of Ankle Sprains | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0101/p93.html

  For ankle sprains that remain symptomatic for more than six weeks, computed tomographic (CT) scanning or magnetic resonance imaging (MRI) should be considered to rule out talar dome lesions. […] MRI studies may be helpful in identifying syndesmosis sprains and peroneal tendon involvement. […] The history, physical examination and radiologic evaluation should be adequate for determining whether orthopedic referral is indicated. […] Specific indications for referral include the following: fracture or dislocation, neurovascular compromise, tendon rupture or subluxation, a wound that penetrates the joint, mechanical locking of the joint and injury to the syndesmosis.

• #42 Acute Ankle Sprain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459212/

  The Ottawa ankle rules have been demonstrated to be accurate in predicting which patients with ankle injuries require x-rays to exclude fractures in both adult and children older than five years. […] A typical ankle x-ray series would include anteroposterior, lateral, and mortise views. […] Initial management of ankle sprains includes the PRICE protocol (protection, rest, ice, compression, and elevation). Resting the injured ankle for the first 72 hours followed by gradual resumption of activity as tolerated is a reasonable approach. […] Patients with evidence of ligamentous laxity should be immobilized, given crutches to allow ambulation without weight-bearing of the injured ankle, and referred to a sports medicine specialist or orthopedic surgeon. […] While most ankle sprains are successfully managed with nonoperative modalities, recurrent instability and associated defects can be seen in up to 25-40% of patients. Recognition of these possible concomitant injuries and the appropriate referral to an orthopedic/sports medicine specialist is mandatory to mitigate the risks of long-term detrimental outcomes.

• #43 Ankle Injuries – When to See a Doctor | Mass General Brigham

  https://www.massgeneralbrigham.org/en/about/newsroom/articles/ankle-injuries-medical-attention

  Sudden pain, swelling, trouble walking, and other symptoms can signal a need for medical attention. […] Acute, sudden pain in the ankle with a trauma is often caused by an ankle injury, Dr. Waryasz says. If you feel a pop, or if you feel like someone kicked you in the back of the leg but nobodys there, then you should be seen within 24 to 48 hours. […] Dr. Waryasz suggests medical attention for any of the following symptoms, especially if they last more than 24 to 48 hours: Bruising or swelling in the area, Deformity, meaning your ankle looks misshapen, Popping or cracking noise, specifically when its associated with pain, Sudden, sharp pain, Tenderness when you touch the injured spot, Trouble moving your ankle, walking, weightbearing, or lifting your foot. […] An ankle sprain and a broken ankle can feel similar, and both can be serious. Many people may think, Its just an ankle sprain, Dr. Waryasz says. But sprains arent a nothing injury. Many sprains can lead to chronic instability and problems down the road. A fair number of sprains lead to chronic instability of the ankle that can require surgery.

• #44 Sprained Ankle: Symptoms, Types, Treatment & Recovery

  https://my.clevelandclinic.org/health/diseases/22048-sprained-ankle

  For the majority of ankle sprains, healthcare providers recommend using the PRICE method for the first 24-48 hours after injury. […] If your sprain is very painful and swollen or you’re having trouble walking and putting pressure on your ankle, visit your healthcare provider for treatment. […] Anti-inflammatory drugs, like ibuprofen, may help alleviate pain and swelling from the sprain. […] Your healthcare provider may recommend the use of crutches, a boot or a brace/splint to keep weight off of your ankle and give your ankle support and stability (protection). […] Your healthcare provider may recommend physical therapy to help you regain strength and mobility. […] Surgery is rare to treat an acute ankle sprain. […] Most sprains heal on their own, but rebuilding strength in your ankle can help prevent future injuries. […] You should visit your healthcare provider for severe sprain evaluation if you can’t walk after an injury and your swelling and pain haven’t improved or have gotten worse 24-48 hours after the sprain occurred.

• #45 Ankle Sprains Diagnosis | Sports Injury Physio

  https://www.sports-injury-physio.com/post/diagnose-injuries-ankle-sprains

  Learn how to diagnose your ankle sprain. […] You can be pretty sure that you’ve at least partially torn an ankle ligament if there’s some local swelling and bruising in the area of the ligament and it is painful to press on it. […] You should go to AE if you suspect that you may have broken a bone in your foot or ankle. […] You should also go to AE if your ankle swells up very quickly, within 30 minutes of injuring it, or you are unable to walk on it for four steps. […] Research has shown that a physical examination carried out 4 or 5 days after an ankle injury produces more accurate results than if it is done on the day of injury.

• #46 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. […] According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries.

• #47 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  Recommendation: there is consistent evidence that functional treatment should be considered the treatment of choice. It leads to a faster recovery with greater patient satisfaction at lower costs (Figure 3) (level I). […] Recommendation: cryotherapy is effective in reducing pain and swelling in acute injuries of the soft tissues, especially when applied soon after the injury for 35 days (Figure 3) (level I). […] Recommendation: NSAIDs reduce pain during short-term follow up. In addition to cryotherapy, they should be applied when treating acute ankle injuries for 37 days (Figure 3) (level I). […] Therefore, they should not be considered as part of the standard regime in treating acute ankle injuries. […] Based on these findings, we developed a comprehensive algorithm (Figure 3) with simple step by step decision rules. Using this algorithm helps to ensure quality of treatment. It can be easily implemented in any emergency department or doctor’s practice.

• #48 Sprained Ankle – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/

  Sprained Ankle Diagnostics, Diagnosis […] An ankle sprain occurs when the strong ligaments that support the ankle stretch beyond their limits and tear. The severity of a sprain can vary greatly depending on the number of ligaments involved and the extent to which the ligaments are torn. […] However, if your ankle remains swollen or painful for several weeks despite conservative treatments, or if you have difficulty putting weight on your ankle, you may need to be evaluated to ensure that you do not have a severe ankle sprain or fracture. […] Symptoms of a severe sprain are similar to those of a broken bone and require prompt medical evaluation. […] Your doctor will diagnose your ankle sprain by asking you questions about the injury and performing a careful examination of your foot and ankle. […] An ankle sprain is largely a clinical diagnosis based on how the injury happened, symptoms, and examination by a medical professional. […] Occasionally, imaging studies, such as X-rays and magnetic resonance imaging (MRI) scans, are obtained to rule out a fracture or other injury to the nearby tendons and cartilage. […] Your doctor may be able to tell the severity of your ankle sprain based on the amount of swelling, pain, bruising, and stability. If you have difficulty bearing weight, or tenderness in the bones of the foot and ankle, you may need additional tests to rule out a fracture. […] After the examination, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments. […] Ankle sprains can be treated without surgery. Even a complete ligament tear (Grade 3) will heal without surgical repair if it is immobilized and rehabilitated appropriately.

• #49 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  Recommendation: there is consistent evidence that functional treatment should be considered the treatment of choice. It leads to a faster recovery with greater patient satisfaction at lower costs (Figure 3) (level I). […] Recommendation: cryotherapy is effective in reducing pain and swelling in acute injuries of the soft tissues, especially when applied soon after the injury for 35 days (Figure 3) (level I). […] Recommendation: NSAIDs reduce pain during short-term follow up. In addition to cryotherapy, they should be applied when treating acute ankle injuries for 37 days (Figure 3) (level I). […] Therefore, they should not be considered as part of the standard regime in treating acute ankle injuries. […] Based on these findings, we developed a comprehensive algorithm (Figure 3) with simple step by step decision rules. Using this algorithm helps to ensure quality of treatment. It can be easily implemented in any emergency department or doctor’s practice.

• #50 Sprained Ankle: Symptoms, Types, Treatment & Recovery

  https://my.clevelandclinic.org/health/diseases/22048-sprained-ankle

  For the majority of ankle sprains, healthcare providers recommend using the PRICE method for the first 24-48 hours after injury. […] If your sprain is very painful and swollen or you’re having trouble walking and putting pressure on your ankle, visit your healthcare provider for treatment. […] Anti-inflammatory drugs, like ibuprofen, may help alleviate pain and swelling from the sprain. […] Your healthcare provider may recommend the use of crutches, a boot or a brace/splint to keep weight off of your ankle and give your ankle support and stability (protection). […] Your healthcare provider may recommend physical therapy to help you regain strength and mobility. […] Surgery is rare to treat an acute ankle sprain. […] Most sprains heal on their own, but rebuilding strength in your ankle can help prevent future injuries. […] You should visit your healthcare provider for severe sprain evaluation if you can’t walk after an injury and your swelling and pain haven’t improved or have gotten worse 24-48 hours after the sprain occurred.

• #51 Sprained Ankle | Boston Medical Center

  https://www.bmc.org/patient-care/conditions-we-treat/db/sprained-ankle

  Your doctor may order an MRI if he or she suspects a very severe injury to the ligaments, damage to the cartilage or bone of the joint surface, a small bone chip, or another problem. […] After your sprained ankle is diagnosed, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments. […] Almost all ankle sprains can be treated without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately. […] Your doctor may encourage you to put some weight on your ankle while it is protected. This can help with healing. […] Its rare to need surgery to treat a sprained ankle. Surgery is reserved for injuries that do not respond to nonsurgical treatment, and for patients who experience persistent ankle instability after months of rehabilitation and nonsurgical treatment.

• #52 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. […] According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries.

• #53 Sprained Ankle: Symptoms, Types, Treatment & Recovery

  https://my.clevelandclinic.org/health/diseases/22048-sprained-ankle

  For the majority of ankle sprains, healthcare providers recommend using the PRICE method for the first 24-48 hours after injury. […] If your sprain is very painful and swollen or you’re having trouble walking and putting pressure on your ankle, visit your healthcare provider for treatment. […] Anti-inflammatory drugs, like ibuprofen, may help alleviate pain and swelling from the sprain. […] Your healthcare provider may recommend the use of crutches, a boot or a brace/splint to keep weight off of your ankle and give your ankle support and stability (protection). […] Your healthcare provider may recommend physical therapy to help you regain strength and mobility. […] Surgery is rare to treat an acute ankle sprain. […] Most sprains heal on their own, but rebuilding strength in your ankle can help prevent future injuries. […] You should visit your healthcare provider for severe sprain evaluation if you can’t walk after an injury and your swelling and pain haven’t improved or have gotten worse 24-48 hours after the sprain occurred.

• #54 Sprained Ankle | Boston Medical Center

  https://www.bmc.org/patient-care/conditions-we-treat/db/sprained-ankle

  Your doctor may order an MRI if he or she suspects a very severe injury to the ligaments, damage to the cartilage or bone of the joint surface, a small bone chip, or another problem. […] After your sprained ankle is diagnosed, your doctor will determine the grade of your sprain to help develop a treatment plan. Sprains are graded based on how much damage has occurred to the ligaments. […] Almost all ankle sprains can be treated without surgery. Even a complete ligament tear can heal without surgical repair if it is immobilized appropriately. […] Your doctor may encourage you to put some weight on your ankle while it is protected. This can help with healing. […] Its rare to need surgery to treat a sprained ankle. Surgery is reserved for injuries that do not respond to nonsurgical treatment, and for patients who experience persistent ankle instability after months of rehabilitation and nonsurgical treatment.

• #55 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  Acute ankle injuries are among the most common injuries in emergency departments. However, there are still no standardized examination procedures or evidence-based treatment. Therefore, the aim of this study was to systematically search the current literature, classify the evidence, and develop an algorithm for the diagnosis and treatment of acute ankle injuries. […] According to the currently available literature, the following recommendations have been formulated: i) the Ottawa Ankle/Foot Rule should be applied in order to rule out fractures; ii) physical examination is sufficient for diagnosing injuries to the lateral ligament complex; iii) classification into stable and unstable injuries is applicable and of clinical importance; iv) the squeeze-, crossed leg- and external rotation test are indicative for injuries of the syndesmosis; v) magnetic resonance imaging is recommended to verify injuries of the syndesmosis; vi) stable ankle sprains have a good prognosis while for unstable ankle sprains, conservative treatment is at least as effective as operative treatment without the related possible complications; vii) early functional treatment leads to the fastest recovery and the least rate of reinjury; viii) supervised rehabilitation reduces residual symptoms and re-injuries.

• #56 Sprained Ankle: Symptoms, Types, Treatment & Recovery

  https://my.clevelandclinic.org/health/diseases/22048-sprained-ankle

  For the majority of ankle sprains, healthcare providers recommend using the PRICE method for the first 24-48 hours after injury. […] If your sprain is very painful and swollen or you’re having trouble walking and putting pressure on your ankle, visit your healthcare provider for treatment. […] Anti-inflammatory drugs, like ibuprofen, may help alleviate pain and swelling from the sprain. […] Your healthcare provider may recommend the use of crutches, a boot or a brace/splint to keep weight off of your ankle and give your ankle support and stability (protection). […] Your healthcare provider may recommend physical therapy to help you regain strength and mobility. […] Surgery is rare to treat an acute ankle sprain. […] Most sprains heal on their own, but rebuilding strength in your ankle can help prevent future injuries. […] You should visit your healthcare provider for severe sprain evaluation if you can’t walk after an injury and your swelling and pain haven’t improved or have gotten worse 24-48 hours after the sprain occurred.

• #57 Guide | Physical Therapy Guide to Ankle Sprain | Choose PT

  https://www.choosept.com/guide/physical-therapy-guide-ankle-sprain

  Physical therapists help people with ankle sprains recover more quickly than they would without treatment. […] Your physical therapist will design the right treatment program for you based on your condition and goals. […] Your physical therapist is an expert in choosing the best treatments and exercises to help you safely heal. Following your prescribed exercise program will help you return to your normal lifestyle and reach your goals faster than you are likely to do on your own. […] If surgery is needed, you will follow a recovery program over several weeks, guided by your physical therapist. […] Your physical therapist can recommend a home exercise program to help prevent ankle sprains. […] If you have sprained your ankle once, it is at greater risk for reinjury in the future. […] You may want to consider a physical therapist who is experienced in treating people with musculoskeletal injuries.

• #58 Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/46/12/854

  Delayed physical diagnostic examination (4 to 5 days) gives a better diagnostic result than research within 48 h. […] For a solid diagnosis of an ankle ligament rupture, patients must be re-examined 4 to 5 days after the trauma. […] If a haematoma develops and patients experience local pressure pain at palpation or a positive anterior drawer test is present or both, it is very likely that a ligament rupture exists.

• #59 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  This study presents a transparent algorithm with clear decision rules for the diagnosis and treatment of acute ankle injuries based on the currently available trials. […] Recommendation: when applied within 48 h after trauma the Ottawa Ankle/Foot Rule proofed to have a sensitivity of 99.6%. These rules can be applied with a similar sensitivity to children older than one year (level I). Due to the unreliability and the disadvantages associated with obtaining stress views, X-rays are not recommended. […] Recommendation: in 282 patients, physical examination, and especially delayed examination, demonstrated a sensitivity of 96% when compared to operative findings (Figure 3) (level I). Clinical tests for injuries of the syndesmosis have been validated only in small numbers of patients, since isolated injuries of the syndesmosis are rare (Figure 3) (level II). If in doubt, early MRI should be performed.

• #60 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  Recommendation: MRI shows a high sensitivity for diagnosing ligament injuries of the ankle. Due to the high incidence of ankle injuries, the poor availability and high costs it should be limited to chronic instability of the ankle or reasonable suspicion of osteochondral lesions, occult fractures or injuries of the tibiofibular syndesmosis (Figure 3) (level I). […] Recommendation: a classification should allow reproducible and easy grading of the injury without elaborate techniques and also provide relevant information for treatment. Consequently, classification criteria for stable and unstable injuries, based on clinical findings, is the most suitable approach for use in an emergency department or doctor’s practice (Figure 3). […] Recommendation: conservative treatment should be favored over surgery due to comparable results with fewer complications after conservative treatment and significantly lower costs. Surgery should, therefore, be reserved for patients with persistent symptoms, particularly since secondary reconstruction of the ruptured ligaments is possible even years after the injury with results equal to those of primary repair (level I).

• #61 Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3348693/

  Recommendation: there is consistent evidence that functional treatment should be considered the treatment of choice. It leads to a faster recovery with greater patient satisfaction at lower costs (Figure 3) (level I). […] Recommendation: cryotherapy is effective in reducing pain and swelling in acute injuries of the soft tissues, especially when applied soon after the injury for 35 days (Figure 3) (level I). […] Recommendation: NSAIDs reduce pain during short-term follow up. In addition to cryotherapy, they should be applied when treating acute ankle injuries for 37 days (Figure 3) (level I). […] Therefore, they should not be considered as part of the standard regime in treating acute ankle injuries. […] Based on these findings, we developed a comprehensive algorithm (Figure 3) with simple step by step decision rules. Using this algorithm helps to ensure quality of treatment. It can be easily implemented in any emergency department or doctor’s practice.

• #62 Acute Ankle Sprain – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459212/

  Acute ankle sprains are commonly seen in both primary care practices and emergency departments and can result in significant short-term morbidity, recurrent injuries, and functional instability. Appropriate initial evaluation and treatment can decrease the likelihood of these complications. […] Although nonoperative treatment is often successful in achieving satisfactory outcomes, correct diagnosis and treatment is important at the time of initial evaluation to mitigate the risks of recurrent instability. Appropriate treatment can limit the impact of long-term detrimental effect such as chronic recurrent ankle instability, arthritic progression, and long-term disability. […] In the evaluation of an ankle injury, a practitioner should elicit a history of the mechanism of injury. The practitioner should also investigate whether the injury involved inversion, eversion, rotational stressing, or direct contact, and take into account a history of previous ankle injuries and the patient’s ability to bear weight after the injury.

Zobacz więcej