MSK clinical application- grade II lateral ankle sprain

Question 1

the vast majority of ankle sprains occur due to significant __ stress and involve the __ ligament complex

Answer 1

inversion; lateral

Question 2

what is the lateral ligament complex of the ankle comprised of?

Answer 2

ATFL
CFL
PTFL

Question 3

what motion/stress does the lateral ligament complex of the ankle resist?

Answer 3

varus stress (forcing ankle into combined PF and inversion)

Question 4

what ligament supports the medial ankle and is the strongest of the ankle ligaments?

Answer 4

the deltoid ligament

Question 5

what motion/stress does the deltoid ligament resist

Answer 5

valgus stress

Question 6

because the deltoid ligament attaches in part to the medial malleolus, significant valgus stress typically causes the __ __ to fracture before the deltoid ligament fails mechanically

Answer 6

medial malleolus

Question 7

what ligament is the strongest of the lateral ligaments of the ankle?

Answer 7

PTFL

Question 8

which ligament of the lateral ligament complex of the ankle is most likely to sustain damage during a lateral ankle sprain gr II?

Answer 8

ATFL

Question 9

what sports involving high levels of agility and jumping are typically associated with lateral ankle sprains gr II?

Answer 9

agility: soccer
jumping: volleyball, basketball

Question 10

what other factors increase individual risk for lateral ankle sprain grade II

Answer 10

deconditioning
poor proprioception
obesity

Question 11

recurrent ankle sprains are common and are attrivuted to a combination of…

Answer 11

residual ligamentous laxity and decreased proprioceptive responses

Question 12

what is the most common clinical presentation of a grade II lateral ankle sprain?

Answer 12

significant pain and tenderness along the lateral aspect of the ankle (especially at the ATFL)
pain limited strength assessment
pain elicited with passive inversion and end range PF (puts max stretch on ATFL)
discernibl laxity with ligamentous testing and joint mobility
antalgic gait pattern
persistent mod-severe edema and ecchymosis

Question 13

what assessment should be performed during evaluation of a suspected grade II lateral ankle sprain to rule out achilles tendon rupture?

Answer 13

active ROM

Question 14

what combined ankle ROM assessment maximally stretches the ATFL?

Answer 14

passive inversion combined with end range PF

Question 15

what type of imaging is not typically used with suspected lateral ankle ligament involvement without other extenuating circumstances due to the prohibitive cost?

Answer 15

MRI

Question 16

what additional special tests and objective measures should be utilized to obtain info to confirm the dx of lateral ankle sprain?

Answer 16

anterior drawer test of the ankle
talar tilt test
distal pulses and sensory integrity to assess for neurovascular complications

Question 17

the anterior drawer test of the ankle should be performed when there is suspected lateral ankle sprain to assess the integrity of what ankle ligament during what type of translation?

Answer 17

ATFL during anterior translation of the talus on the tibia

Question 18

the talar tilt test of the ankle should be performed when there is suspected lateral ankle sprain to assess the integrity of what ankle ligament during what type of motion?

Answer 18

CFL as the talus is moved into inversion

Question 19

though rare, neurovascular complications can accompany ligamentous injury, so what objective assessments should be performed when there is suspected lateral ankle sprain?

Answer 19

distal pulses and sensory integrity

Question 20

what information (9) is important to document during the subjective history when there is suspected lateral ankle sprain?

Answer 20

PMH
medications
family history
current symptoms
current health status
social history and habits
occupation
leisure activities
social support systems

Question 21

what objective tests and measures (10) are important to obtain during assessment of suspected lateral ankle sprain?

Answer 21

anthropometrics: circumferential measurements for edema, palpation to determine ankle effusion

arousal, attention, cognition: mental status, learning ability, memory, motivation

pain: pain perception assessment scale

A/PROM
muscle performance: strength assessment, characteristics of muscle contraction

integumentary integrity: sensation assessment
sensory integration: proprioception and kinesthesia

joint integrity and mobility: special tests like Thompson test- differential

gait, locomotion and balance: safety w/ w/o an AD during gait, gait biomechanics
self-care and home management: assessment of functional capacity
AD: potential use of crutches

Question 22

what other structural injuries (3) may also accompany a grade II lateral ankle sprain?

Answer 22

talar dome injuries
neurovascular disruption
achilles tendon rupture

Question 23

what deficits are common with grade II lateral ankle sprains and should be addressed in the POC as warranted by exam findings in order to limit the risk of recurrent injury?

Answer 23

proprioceptive deficits

Question 24

medical management of a grade II lateral ankle sprain typically involves what kind of management?

Answer 24

conservative

Question 25

pharmacological management of a grade II lateral ankle sprain is directed towards pain management using __ or __

Answer 25

acetaminophen or NSAIDs

Question 26

surgical management of a grade II lateral ankle sprain is not typically indicated unless..

Answer 26

complications like fx or neurovascular disruption are identified

Question 27

following a gr II lateral ankle sprain, an individual may use what type of AD to limit WB through the involved extremity until full WB is tolerated?

Answer 27

crutches

Question 28

in the acute phase of a grade II lateral ankle sprain, __ or __ may be used to assist with healing

Answer 28

bracing, taping

Question 29

physical therapy intervention for a gr II lateral ankle sprain should be focused on..

Answer 29

increasing ROM and proprioceptive responses decreasing edema beginning light resistive exercises w/ the involved LE

Question 30

what type of stretching is recommended to prevent muscle shortening in individuals with gr II lateral ankle sprains

Answer 30

passive

Question 31

if capsular restrictions are noted in individuals with gr II lateral ankle sprains, what type of intervention should be used to increase ROM?

Answer 31

joint mobilizations

Question 32

resistive exercises for individuals with gr II lateral ankle sprains should include a combination of __, __ and __ exercises

Answer 32

isometric, closed chain and open chain

Question 33

resistive exercises for individuals with gr II lateral ankle sprains should include the __ muscles as they provide the ankle with dynamic stability

Answer 33

fibularis (peroneal)

Question 34

why should resistive exercises for individuals with gr II lateral ankle sprains include the fibularis muscles

Answer 34

the provide the ankle with dynamic stability

Question 35

what specific proprioceptive and balance straining activity should be incorporated into physical therapy for individuals with gr II lateral ankle sprains?

Answer 35

SL stance activities on variable surfaces

Question 36

what specific functional activities should be incorporated into physical therapy for individuals with gr II lateral ankle sprains?

Answer 36

gait training stair management

Question 37

agility training should be physical therapy for individuals with gr II lateral ankle sprains based on __-__ individual needs

Answer 37

sport-specific

Question 38

prior to returning to unrestricted functional activity, individuals with gr II lateral ankle sprains should be required to complete a __ __

Answer 38

functional progression

Question 39

what types of modalities can be used to address pain, edema, inflammation and soft tissue restrictions in individuals with gr II lateral ankle sprains

Answer 39

superficial modalities like e-stim

Question 40

once inflammation subsides, what type of massage can be applied to the healing ligament to assist in preventing adherence of scar tissue to adjacent structures in individuals with gr II lateral ankle sprains?

Answer 40

transverse friction massage

Question 41

home exercise programs for individuals with gr II lateral ankle sprains should initially include..

Answer 41

rest ice compression elevation ROM, strengthening, palliative care, functional activities as warranted based on results of pt assessment

Question 42

if no other structures are involved, a grade II lateral ankle sprain should heal fairly __ and a patient should be able to return to their prior functional level within __-__ weeks

Answer 42

quickly; 2-6

Question 43

for patients with healed grade II lateral ankle sprains who are preparing to return to recreational/competitive athletics, what is typically recommended to prevent injury recurrence?

Answer 43

supportive taping or bracing

Question 44

a patient with a grade II lateral ankle sprain is able to return all forms of activity once they can demonstrate..

Answer 44

full pain-free ROM minimal pain/tenderness with palpation normalized gait pattern normalized proprioception competency with agility testing

Question 45

residual __ following a grade II lateral ankle sprain increases an individuals risk of injury recurrence

Answer 45

laxity

Question 46

what type of injury should be considered as a differential diagnosis when evaluating/treating a patient with suspected grade II lateral ankle sprain?

Answer 46

high ankle sprain

Question 47

what is the definition of a high ankle sprain

Answer 47

a grade II sprain of one or more of the syndesmotic ligaments

Question 48

what structures do the syndesmotic ligaments attach to and what is their function?

Answer 48

they attach to the tibia and fibula and function to stabilize the ankle mortise

Question 49

the ankle mortise is stabilized by what ligaments?

Answer 49

the syndesmotic ligaments

Question 50

the syndesmotic ligaments are often injured in conjunction with what other type of ankle injury?

Answer 50

in conjunction with ankle fracture

Question 51

because the syndesmotic ligaments are __ within the LE, __ a amount of force is required to cause injury

Answer 51

deep; large

Question 52

if a tear to the syndesmotic ligaments goes unrecognized and is; therefore, left untreated, what condition will likely result?

Answer 52

severe, post-traumatic arthritis

Question 53

severe, post-traumatic arthritis will likely result if a tear to the __ ligaments is unrecognized and untreated

Answer 53

syndesmotic

Question 54

a significant tear to the syndesmotic ligaments sill likely require what type of medical management/intervention?

Answer 54

surgical repair

Question 55

is surgical repair typically required for significant tears to other ligaments at the ankle excluding the syndesmotic ligaments?

Answer 55

no

Question 56

what does medical management of a significant syndesmotic ligament tear focus on?

Answer 56

associated injuries post-operative recovery

Question 57

do the syndesmotic ligaments require specific intervention once surgically repaired?

Answer 57

no

Question 58

lateral ankle surgical reconstruction is typically performed secondary to what type of injury?

Answer 58

a complete tear of the ATFL or CFL OR chronic ankle instability

Question 59

how many methods for lateral ankle reconstruction are there? what type of surgical approach do both methods use?

Answer 59

2 methods that both use an open approach

Question 60

what is the first method for lateral ankle reconstruction surgery?

Answer 60

involves actual repair of the torn ligaments via suturing them back together

Question 61

what is the second method for lateral ankle reconstruction?

Answer 61

harvesting an autograft (usually from the fibularis brevis) to replace the torn ligaments

Question 62

when is the second method for lateral ankle reconstruction that involves harvesting an autograft typically performed/indicated?

Answer 62

when the original ligaments cannot be repaired due to deterioration

Question 63

why might the second method for lateral ankle reconstruction that involves harvesting an autograft also include arthroscopy or subchondral drilling?

Answer 63

a high percentage of unstable ankles have chondral lesions within the joint

Question 64

what muscle is typically harvested for autograft when the second method for lateral ankle reconstruction is performed?

Answer 64

fibularis brevis

Question 65

immediately following lateral ankle reconstruction, the patient is typically placed in what type of cast? for how long?

Answer 65

a protective cast for 1 week

Question 66

after a patient status post lateral ankle reconstruction has been in a protective cast for 1 week and the cast is removed, what is the next step in the rehab process?

Answer 66

they will be placed in a walking cast or boot for several weeks

Question 67

after a patient status post lateral ankle reconstruction has been in a walking boot or cast for several weeks, what is the next step in the rehab process?

Answer 67

they will be placed in a brace

Question 68

what is the weight bearing status of a patient status post lateral ankle reconstruction in a protective cast?

Answer 68

nonweightbearing

Question 69

when can a patient status post lateral ankle reconstruction progress to partial and full weightbearing status?

Answer 69

when they are in a walking boot/cast

Question 70

when does a patient status post lateral ankle reconstruction usually begin physical therapy

Answer 70

immediately after surgery

Question 71

early physical therapy rehab for a patient status post lateral ankle reconstruction focuses on..

Answer 71

increasing ROM while protecting the repaired tissues

Question 72

caution should be taken during the early physical therapy rehab phase for a patient status post lateral ankle reconstruction when ranging the ankle into __ as this will stress the repaired tissues

Answer 72

inversion

Question 73

ankle __ may be required long term following lateral ankle reconstruction if a patient plans to return to sports/higher level activities

Answer 73

bracing