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The document discusses the examination of ankle injuries. It outlines a 12 step evaluation process to assess various ankle ligaments and structures. This includes tests like the anterior drawer test to evaluate the anterior talofibular ligament and syndesmosis. The evaluation also involves examining the Achilles tendon, bones of the foot, and applying pressure to check for fractures in the fifth metatarsal or calcaneus. Palpating the medial and lateral malleoli helps identify fractures or ligament tears in those areas.
The document discusses the examination of ankle injuries. It outlines a 12 step evaluation process to assess various ankle ligaments and structures. This includes tests like the anterior drawer test to evaluate the anterior talofibular ligament and syndesmosis. The evaluation also involves examining the Achilles tendon, bones of the foot, and applying pressure to check for fractures in the fifth metatarsal or calcaneus. Palpating the medial and lateral malleoli helps identify fractures or ligament tears in those areas.
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The document discusses the examination of ankle injuries. It outlines a 12 step evaluation process to assess various ankle ligaments and structures. This includes tests like the anterior drawer test to evaluate the anterior talofibular ligament and syndesmosis. The evaluation also involves examining the Achilles tendon, bones of the foot, and applying pressure to check for fractures in the fifth metatarsal or calcaneus. Palpating the medial and lateral malleoli helps identify fractures or ligament tears in those areas.
Copyright:
Attribution Non-Commercial (BY-NC)
Verfügbare Formate
Als PPT, PDF, TXT herunterladen oder online auf Scribd lesen
Initial Examination Most common injury is the inversion ankle sprain, which stresses the lateral ligament complex. If the patient is unable to bear weight and/or walk 4 steps immediately after the injury and at time of presentation, that is a significant observation. Previous ankle injuries are important. Laxity makes repeat injuries more likely.
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Elements of the History Patient's age Occupation Comorbid conditions Osteoporosis Neuropathy
Step #1 Interosseous membrane/syndesmosis ligament binding the tibia and fibula Head of the fibula Shaft of the fibula or tibia.
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Achilles Tendon Examination Keep the foot in a 90 degree position.
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Drawer Test Anterior Drawer Test 1. First put the patient's foot in the 90-degree (neutral) position. 2. Let the foot rest along your forearm. 3. The hand cupping the heel pulls anteriorly while the opposing one stabilizes the lower leg. 4. More than 0.5 cm of movement or lack of a firm end point signals a positive drawer test. Problem with the ATF ligament or the syndesmosis at the distal tibia-fibula joint. 5. You can also validate instability of the interosseus membrane and/or syndesmotic joint by hyperdorsiflexion of the foot. 6. Extreme pain locally over the area during hyperflexion signals a positive result. 7. Important Note: Avoid letting the foot slip into plantar flexion, which leads to instability and produces erroneous clinical information.
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Step #4 Apply pressure from the hypothenar eminence of your hand cupping the heel against the base of the fifth metatarsal. This maneuver may illicit pain if a fracture is present.
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Step #5 Palpate over the tarsal navicular bone with your thumb.
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Step #6 Compress the calcaneus. Pain indicates the possibility of a fracture in these areas. Achilles tendon rupture Sprain of the ATF ligament Fracture at the base of the fifth metatarsal Tarsal navicular fracture Calcaneal compression fracture.
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Step #7 and #8 Keep the ankle in the 90-degree neutral position. Attempt the talar tilt test by everting and inverting the ankle mortice, noting excessive motion. Motion that is 10% greater than that in the normal comparison ankle or the lack of a solid end point indicates possible damage to the deltoid (medial) or the calcaneofibular (lateral) ligaments. Pain alone is not a sufficient basis for the diagnosis: A mild sprain might produce pain, but a complete rupture might be nearly painless.
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Step #7 and #8 (continued) Complete the palpation of the distal medial malleolus, then move to the lateral malleolus. Palpations of the posterior aspects of the distal malleoli are the most productive maneuvers for eliciting pain caused by fractures. Subluxation of the peroneal tendon may be suspected in a patient with a hyperdorsiflexion injury, pain, and ecchymoses along the posterior lateral malleolus in the absence of tenderness of the ATF ligament. Examination for: Medial malleolar avulsion fracture or deltoid ligament tear Lateral malleolar avulsion or lateral complex/ calcaneofibular ligament tear Subluxation of the peroneal tendon.
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Step #9 Peroneal tubercle is a protuberance that gives the appearance of slight puffiness and bluish color to an area that coincidentally overlies the ATF. Most commonly injured structure in a sprained ankle.