MOST COMMON INJURY

1

2
MOST COMMON INJURY
In Sports
3
GROSS AND FUNCTIONAL ANATOMY OF THE ANKLE JOINT
4
JOINT STABILITY
Shape of Bones
Ligaments
Strength of Muscles
5
BONY ANKLE JOINT
F
T
Ta
6
Flex. Hallucis Longus
Achilles Tendon
Flex. Digitorum Longus
P. Longus
Tib. Posterior
P. Brevis
P. Tertius
Tib. Anterior
Ext. Digitorum Longus
Ext. Hallucis Longus
7
SYNOVIAL JOINTS
8
(No Transcript)
9
LATERAL LIGAMENTS
10
(No Transcript)
11
MEDIAL ANKLE
Tibia
Talus
Deltoid Ligament
Navicular
Sustentaculum Tali
Calcaneus
12
ANKLE MOVEMENT AND THE EFFECTS ON LIGAMENTS
Plantar Neutral Dorsi
13
INVERSIONSPRAIN
14
(No Transcript)
15
BOTH INVERSIONS?
A
B
16
INVERSION SPRAIN
85 of all sprains Happens during loading and
unloading of the ankle.
17
What ligament is the first line of defence?
Depends on ankle position
18
Peroneus Brevis
Base 5th
19
Lateral Structures Ankle
Post. Talofib.
Anterior Inf. Tib-fib.
Ant. Talofibular.
Calcaneofibular
P. Brevis
Base 5
20
MANDATE ON PLAYING SURFACE
HOW SEVERE IS THE INJURY.
HOW DO WE REMOVE THEM FROM THE FIELD
21
ASSESSMENT
S. O. A. P.
Subjective
Objective
Analysis
Plan
22
Subjective Information that is gathered from
the athlete.
Objective Observable or measurable findings.
23
WEIGHT BEARING
OR
NON-WEIGHT BEARING
24
PAIN RESPONSE OF DAMAGED TISSUE
1. Damaged muscle and ligaments are painful
when stretched.
2. Damaged muscle is painful to contract.
25
PAIN RESPONSE .. Cont
3. Both structures are painful if palpated at
the site of tear.
26

FIELD ASSESSMENT Ankle Sprains - General
Mechanism of Injury Pain where? Hear/feel
anything? Injured before? Continue with activity?
27
PALPATION
Anterior Inferior Tibiofibular Ligament
1
2
Anterior Talofibular
3
Calcaneofibular Lig.
4
Base of 5th Metatarsal
28
INVERSION SPRAINS
One area of tenderness. No sensation of tearing
or feeling unstable. Full ROM with discomfort
on active plantar flexion and inversion.
.. 2
29

.. 2
Stand athlete to check for pain in ankle or
leg. Walk to the sideline if athlete can walk
without a limp.
30
INVERSION SPRAIN
At least two areas of pain. Hear/feel of
tearing. Painful ankle. Limitation of pl. flexion
and inversion.
2..
31
2
Check to see if the athlete can stand. Determine
where the pain is located (leg pain N.W.B.). If
they can walk, but limp, remove N.W.B.
32
EVERSION SPRAIN

• Least common sprain.
• Most fractures happen in eversion.
• Stability of the medial ankle depends upon the
  Deltoid Ligament and the lateral malleolus.

33
EVERSION

• Slight medial tenderness.
• Pain and slight limitation on active eversion.
• Stand to determine if there is leg pain.
• Walk off playing surface if not antalgic.

34

ANKLE SPRAIN SEVERE

• Rigid, high footwear.
• Unable to continue on with the activity.
• Leg pain on standing.

35
(No Transcript)
36
(No Transcript)
37
Eversion and External Rotation of the ankle
without Deltoid Ligament tear.
38
(No Transcript)
39
3. Fracture
1. Deltoid
2. Ant. Inf. Tib-fib.
40
(No Transcript)
41
Hockey Player Inversion Minimal Pain Mild
swelling Mild bruising Return in five days
42
Day 6
43

SIDE LINE
EVALUATION
44
THE MINOR SPRAIN
Can this athlete return to play during this
contest?
Definition Discomfort versus pain?
Pain changes the way you do things!
45
Dissect the sport into its components starting
from the most simple on the ankle and progress to
the most difficult. If they can perform the test
without pain then return. (Following taping?)
46
NON-RETURNING ATHLETE
C.I.C.E.R.
Crutches for proper gait.
Referral for physio.
Prepare for return.
47
(No Transcript)
48
(No Transcript)
49
ANKLE
REPAIR
50
PREPARE FOR RETURN
Aside from the formal rehabilitation, the
athlete must work on maintaining conditioning and
doing whatever sport skills they can.
51
(No Transcript)
52
WHEN DO I KNOW THAT I AM READY TO RETURN?????
53
WALK
Pain
JOG
FIGURE 8
SHUTTLE RUN
54
Figure 8 and Shuttle Run
½ Speed
FIGURE 8
¾ Speed
SHUTTLE
R
L
25 m
55
???