Case Study: Deltoid Sprain

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Case Study Deltoid Sprain

• By Tracy Brewer

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Background

• Rowan womens soccer player
• Previous contusion to medial lower leg
• Complaining of leg pain

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Initial Evaluation

• Swelling
• Ecchymosis
• Pain
• Where did these symptoms come from?

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Initial Evaluation (cont.)

• Deficits in ROM
• PT on medial malleolus Deltoid
• - MTs Navicular Tubercle

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Special Tests

• Anterior Drawer test
• Kleigers test
• Talor Tilt test
• Posterior Drawer test

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Differential Diagnosis

• Maleolar Fx
• Tarsal Tunnel Syndrome
• Ligamentous Injury
• Syndesmosis Sprain

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Radiological Results

• X-ray came up negative
• Ruling out malleolar fracture

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Diagnosis

• Grade 1 Deltoid Sprain
• Difficult to grade due to symptoms

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Deltoid ligament

• Made up of 4 ligaments ? Anterior Tibiotalor,
  Tibiocalcaneal, Posterior Tibiotalor,
  Tibionavicular

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Treatment

• Athlete removed for 2 weeks
• Edema reduction and pain
• E-Stim, Ultrasound, effleurage massage, Cryo-cuff
• Cardiovascualr endurance, ROM, strengthening,
  balance

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Electrical Stimulation

• A computer based modality used for pain control,
  edema reduction, muscle re-education

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Cryocuff

• A modality that used cyrotherapy in order to
  reduce pain and apply compression
• Can be used with E-Stim

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Effleurage Massage

• Used deep light strokes
• Increases circulation
• Activates nerve receptors in order to decrease
  pain
• Milks edema up

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Ultrasound

• A therapeutic modality used to reduce pain and
  increase healing

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Cardiovascular Endurance

• Very important especially when sitting out of
  practice
• Bike

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Range of Motion

• Range of motion deficits need to be worked on
  before anything else

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Strengthening

• Once ROM is back, strengthening can begin

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Balance

• Worked on after ROM and strengthening have
  progressed

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Functional Testing

• Done in order to decide whether an athlete should
  go back into activity or not
• Sport specific
• This athlete passed functional testing after 2
  weeks and was allowed to practice/play as
  tolerated

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Return to Play

• This athlete was allowed to return to play only
  if taped with an eversion ankle sprain taping
  only if she used an ankle brace

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Uniqueness

• Make up 5-6 sprains
• Where did symptoms come from? Playing an entire
  game vs. contusion symptoms moving downward

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Conclusion

• Dont jump to conclusions!
• It may be more serious than it looks!
• It may look more serious than it is!

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Questions?