Materiały źródłowe

• #1 Sprains – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sprains/diagnosis-treatment/drc-20377943

  During the physical exam, your doctor will check for swelling and points of tenderness in your affected limb. The location and intensity of your pain can help determine the extent and nature of the damage. […] X-rays can help rule out a fracture or other bone injury as the source of the problem. Magnetic resonance imaging (MRI) also may be used to help diagnose the extent of the injury. […] A physical therapist can help you to maximize stability and strength of the injured joint or limb. Your doctor may suggest that you immobilize the area with a brace or splint. For some injuries, such as a torn ligament, surgery may be considered.

• #2 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).

• #2 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.

• #3 Diagnosing Foot & Ankle Sprains | NYU Langone Health

  https://nyulangone.org/conditions/foot-ankle-sprains/diagnosis

  At NYU Langone Orthopedic Center, our doctors are experts in diagnosing foot and ankle sprains. […] A sprain occurs when a ligament stretches or tears. […] Ankle sprains usually occur in the ligaments on the outside of the ankle. […] Symptoms can include swelling, tenderness, bruising, and pain, especially when you put your weight on the affected foot or ankle. […] Your NYU Langone doctor performs a physical examination, moving the foot or ankle to check for sensitivity and discomfort and to determine whether your range of motion or balance is affected. […] One or more of the following tests may also be recommended. […] Doctors use X-rays to rule out a foot fracture or an ankle dislocation. […] Your doctor may recommend an MRI scan to help pinpoint the cause of your symptoms, particularly if they don’t improve after four to six weeks.

• #3 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. 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.

• #4 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.

• #5 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

  This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. […] The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (45 days post trauma). […] After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme. […] In case of a severe ankle sprain, a fracture should be excluded by proper use of the Ottawa ankle rules (OAR), and if indicated, conventional radiographic imaging should be undertaken.

• #6

  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. […] Ultrasound and MRI can be useful in diagnosing associated injury, but evidence for its usefulness is lacking compared to delayed physical examination.

• #7 Management of Ankle Sprains | AAFP

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

  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. […] 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).

• #8 Management of Ankle Sprains | AAFP

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

  Implementation of the Ottawa rules has reduced unnecessary radiography, decreased waiting time for patients and lowered diagnostic costs. […] 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. […] 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. […] Once complicating features have been excluded, initial management and functional rehabilitation of the ankle sprain can be instituted.

• #9 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 use of functional support and exercise therapy is preferred as it provides better outcomes compared with immobilisation. […] The use of a brace or tape reduces the risk of both recurrent and first-time ankle sprains, especially in those who participate in sports.

• #10 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.

• #11 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.

• #12 Diagnosing Hand Sprains & Strains | NYU Langone Health

  https://nyulangone.org/conditions/hand-sprains-strains/diagnosis

  Your NYU Langone doctor performs a physical examination, moving the hand to check for sensitivity and discomfort and to determine whether your range of motion is impaired. […] One or more of the following tests may also be recommended. […] Your doctor may recommend an X-ray to check for a fracture or the dislocation of a joint. […] If your doctor doesn’t see signs of a sprain, strain, or other injury on an X-ray but notices the injured joint is unstable, an MRI scan may be recommended to help pinpoint the cause of your symptoms. […] Doctors at NYU Langone sometimes use ultrasound to diagnose hand injuries, particularly tears in tendons. […] Your doctor may recommend a CT scan if he or she suspects you have a fracture in the scaphoid bone of the wrist, which is located near the thumb.

• #13 Diagnosing Hand Sprains & Strains | NYU Langone Health

  https://nyulangone.org/conditions/hand-sprains-strains/diagnosis

  Although many people use the words sprain and strain interchangeably, they have different meanings. NYU Langone doctors are experienced in diagnosing and managing both types of injuries. […] A hand sprain is an injury to a ligament, the strong tissue that connects bones. In a hand sprain, the ligament has been stretched or torn. […] Hand sprains and strains are classified in degrees, depending on the severity of the injury. If you develop a first-degree injury, you may experience bruising and mild pain, which can affect your ability to perform usual activities. In a second-degree injury, you may notice prolonged pain, swelling, weakness, and a change in the range of motion at a nearby joint, such as the wrist. In a third-degree injury, the ligament, muscle, or tendon tears completely, causing pain and limited range of motion.

• #14 Ankle Sprain Clinical Presentation: History, Physical Examination, Staging

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

  The history of an ankle sprain is usually of an inversion-type twist of the foot followed by pain and swelling. Ask the patient about the mechanism of injury, as well as why, when, where, and how it occurred. Often, however, the patient’s account of the mechanism does not correlate with the structures that have been damaged. […] The physical examination confirms a diagnosis made on the basis of patient history and differentiates an ankle sprain from a fracture. The examiner should look for areas of tenderness and swelling. The maximal points of tenderness for a lateral ankle sprain should be at the ATFL and/or CFL ligament areas. […] Ankle sprains are classified into the following 3 grades: Grade 1 injuries involve a stretch of the ligament with microscopic tearing but not macroscopic tearing. Generally, little swelling is present, with little or no functional loss and no joint instability. The patient is able to fully or partially bear weight. Grade 2 injuries stretch the ligament with partial tearing, moderate to severe swelling, ecchymosis, moderate functional loss, and mild to moderate joint instability. Patients usually have difficulty bearing weight. Grade 3 injuries involve the complete rupture of the ligament, with immediate and severe swelling; ecchymosis; an inability to bear weight; and moderate to severe instability of the joint. Typically, patients cannot bear weight without experiencing severe pain.

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

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

  After a fracture has been ruled out, a careful physical examination should be carried out starting with observation of swelling, deformity and ecchymosis, as they are indicative of acute injury. […] A positive stress test, in addition to pain on palpation at the site of ligament, and sign of hematoma have been shown to have a sensitivity of 96% for diagnosing a ruptured ligament. […] Injury of the syndesmosis requires a longer recovery time and shows more disabling symptoms than a lateral sprain of the ankle. […] Recommendation: in 282 patients, physical examination, and especially delayed examination, demonstrated a sensitivity of 96% when compared to operative findings. […] Ruptures of lateral ligaments of the ankle can be diagnosed on MRI with a sensitivity of 75-100%. […] MRI showed a sensitivity of 100% and a specificity of 70-100% for anterior and posterior syndesmosis compared with arthrography.

• #16 Sprained Knee: Diagnosis and Treatment

  https://euc.ufhealthjax.org/blog/2023/july/sprained-knee-diagnosis-and-treatment/

  An injury to the ligaments connecting the upper and lower limbs at the knee joint is called a knee sprain. […] The diagnosis of a sprained knee depends on the injured ligament. […] When diagnosing a sprained knee, doctors will perform a physical exam and request imaging tests. A doctor may order an X-ray to rule out broken bones or arthritis, and check for fluid around the knee joint. […] Sometimes, an MRI is required when diagnosing a sprained knee to determine the severity of the injury. An MRI will also show whether the ligament is torn or just stretched.

• #17

  https://www.docteurphilipperoure.com/en/hand-surgery/thumb-sprain/

  This joint is crucial to the stability and strength of the thumb grip, and its cohesion is ensured by two main ligaments, which are internal and external. […] This thumb joint can quickly become swollen and painful following a fall or knock. Movement causes extensive pain. During examination, the doctor will observe specific pain at the affected ligament, in general on the inner side of the joint. […] Using adapted manuvres, the doctor will look for signs of instability which are a measure of the extent of the sprain. Indeed, the degree of pain is unrelated to the actual size of the anatomical lesion. This assessment of the seriousness of the condition is fundament in determining the course of treatment. […] X-ray is usually required to investigate the possibility of bone tearing. In cases with severe pain and swelling, examination may prove difficult and this calls for the prescription of a resting splint and a delay in examination which is made several days later.

• #18 Diagnosis of Wrist Sprain

  https://www.sports-health.com/sports-injuries/hand-and-wrist-injuries/diagnosis-wrist-sprain

  Wrist sprains are commonly diagnosed by primary care physicians, hand or orthopedic surgeons, and sports medicine physicians. […] When a wrist sprain suspected, a doctor will take a medical history and conduct a physical examination that includes tests to evaluate the wrists stability. Medical imaging and other advanced tests may be ordered if necessary. […] If a wrist sprain is suspected, the doctor may perform specialized wrist instability tests. […] Imaging diagnostic tests are performed to confirm a suspected wrist sprain. […] While physical examination and imaging tests can be sufficient in diagnosing some wrist sprains, more invasive diagnostic methods may be necessary in other cases, particularly if symptoms do not improve over time. […] Invasive diagnostic procedures are any diagnostic procedures that break the skin, including injections. […] Diagnostic tests also help determine the grade and severity of ligament injury. Ligaments may appear elongated, torn, or torn with a bone attached to it.

• #19 Diagnosis of a Sprain | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/orthopaedics/sprains/diagnosis

  Mild sprains can be treated at home, but see your physician if you cannot move or bear weight on the affected joint, have pain directly over the bones of an injured joint or have numbness in any part of the injured area.

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

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

  Your healthcare provider may recommend physical therapy to help you regain strength and mobility. […] Most sprains heal on their own, but rebuilding strength in your ankle can help prevent future injuries. […] After giving your ankle time to heal and treating the sprain according to your healthcare providers recommendations, you’ll be able to get back to regular activities. […] The recovery time for a sprained ankle varies depending on the severity of your injury. […] 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.

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

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

  While it is widely agreed that a slight injury to the lateral ligament complex recovers quickly with non-operative management and have an excellent prognosis, there is still controversy about the best treatment for severe ankle sprains. […] Since ankle injuries are common, and there are numerous residual symptoms after ankle sprains, it is crucial to institute a standardized and evidence-based approach to diagnosis and treatment, based on the current literature, in order to provide the best treatment available. […] The questions addressed were the following: i) which diagnostic tools are required to identify fractures of the ankle, and ligament injuries? ii) how should injuries of the lateral complex be classified? iii) should injuries of the lateral ligament complex be treated surgically, by immobilization or with functional treatment? iv) which functional treatment is the most beneficial? v) what other treatments can positively influence the course of acute ankle ligament injuries?

• #22 Sprain – what is it? Causes and treatment | medi

  https://www.medi.de/en/diagnosis-treatment/ankle-pain/sprain/

  Sprains are one of the most common painful sports injuries. It occurs when the joint capsule or the surrounding ligaments and muscles are excessively overstretched due to an unfavourable movement. This often leads to bleeding, swelling and small cracks in these structures. […] Usually, treating sprains is uncomplicated. The pain usually subsides by itself, and the joint is fully resilient again as soon as the sprain has healed up, and there are no more serious concomitant injuries. […] In some cases, ligament, capsule or muscle injuries caused by sprains can lead to chronic joint instability. To avoid this, you should consider the following aspects. […] Chronic ligament instabilities can lead to severe wear and tear of the cartilage in the joint and to arthrosis. Therefore, even in the case of an apparently harmless sprain, a visit to an orthopaedist or sports doctor is recommended.

• #23 Get the jump on ankle sprains: Ankle sprain diagnosis | BayCare Clinic

  https://baycareclinic.com/news-and-more/get-the-jump-on-ankle-sprains-ankle-sprain-diagnosis/

  Diagnosing an ankle sprain includes understanding how the injury occurred and determining the severity of the injury. Your doctor will need to examine your foot and ankle to properly diagnose the injury. […] The history of the rolled ankle what you tell the doctor along with the physical examination findings of tenderness, swelling and bruising over the ankle ligaments is enough to make the diagnosis of an inversion ankle sprain. […] Although an MRI is often not needed to the make the diagnosis, in cases of a severe injury or an injury that fails to heal in an appropriate time period, your orthopedic surgeon may order an MRI in order evaluate all the bony and soft tissue structures around the ankle in greater detail. […] Ankle sprains are classified based on the severity of the injury to the ligament as grade 1, grade 2 or grade 3.

• #24 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. […] A classification should allow reproducible and easy grading of the injury without elaborate techniques and also provide relevant information for treatment. […] Recommendation: conservative treatment should be favored over surgery due to comparable results with fewer complications after conservative treatment and significantly lower costs. […] 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. […] Recommendation: cryotherapy is effective in reducing pain and swelling in acute injuries of the soft tissues, especially when applied soon after the injury for 3-5 days.

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

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

  Recommendation: NSAIDs reduce pain during short-term follow up. In addition to cryotherapy, they should be applied when treating acute ankle injuries for 3-7 days. […] 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 with simple step by step decision rules. Using this algorithm helps to ensure quality of treatment.

• #26 Ankle Sprains Diagnosis & Treatment – Multispeciality Hospital

  https://www.kimssunshine.co.in/conditions/ankle-sprains/diagnosis-test-treatments/

  Diagnosing an ankle sprain involves a thorough evaluation by a medical professional to determine the extent of the injury and develop an appropriate treatment plan. […] The first step in diagnosing an ankle sprain is a detailed discussion of your symptoms and the circumstances surrounding the injury. […] To confirm the diagnosis and rule out more severe injuries, imaging tests may be ordered. […] In some cases, your doctor might perform functional tests to gauge the impact of the sprain on your ankles ability to bear weight and support movement. […] Early and accurate diagnosis is essential for effective treatment and a swift return to your normal activities.

• #27 Ankle Sprain: Symptoms, Diagnosis, and Treatment. recommendation

  https://www.acefootandankle.com/ankle-sprain-symptoms-diagnosis-and-treatment

  An ankle sprain occurs when the ligaments that support the ankle are overstretched or torn, typically as a result of twisting, rolling, or an awkward landing on the foot. This injury is one of the most common musculoskeletal injuries, particularly in athletes and active individuals. […] Diagnosis: A thorough physical examination is essential for diagnosing an ankle sprain. […] In some cases, imaging studies such as X-rays or an MRI may be ordered to rule out fractures, ligament tears, or other associated injuries. […] Early diagnosis and proper management are critical to prevent chronic ankle instability, long-term pain, and recurrent injuries.

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