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SportsAnkle Sprain Evaluation
Twenty flashcards on how an athletic trainer evaluates an ankle sprain: history, observation, range of motion, special tests and imaging.
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20 cards
- Most common mechanism of a lateral ankle sprain?
- Inversion with plantar flexion (supination) of the foot, often with internal rotation of the foot.
- Three lateral ankle ligaments?
- Anterior talofibular, calcaneofibular and posterior talofibular.
- Most commonly sprained lateral ligament?
- The anterior talofibular ligament (ATFL), followed by the calcaneofibular.
- How are ankle sprains graded?
- Grade I (mild) to grade III (severe): from no major structural damage to full rupture.
- Only consistent risk factor for an ankle sprain?
- A previous ankle sprain.
- What gives the first clues to the injured structures?
- History (mechanism and past injuries), plus observation and palpation.
- What do you look for when observing the ankle?
- Deformity, swelling and discoloration.
- Does the amount of swelling predict function?
- No: swelling size does not match self-reported function.
- How can swelling be tracked during recovery?
- A figure-8 girth measurement or water volumetrics.
- Why ask if the athlete could bear weight or keep playing?
- It helps rule out a fracture.
- Tenderness over the fibular attachment of the ATFL: suspect fracture?
- No, it should not raise suspicion of a fracture.
- Which range of motion is assessed?
- Active, passive and resistive, in both the sagittal and frontal planes.
- Passive vs. active and resistive range: what does each reveal?
- Passive finds structures under tension; active and resistive find muscle-tendon damage or inhibition.
- Most common test of ATFL integrity?
- The anterior drawer test.
- Reported sensitivity of the anterior drawer test?
- 32% to 80%; specificity 80% in the one study that measured it.
- Anterior drawer and talar tilt: more accurate at day 2 or day 5?
- At 5 days after injury (evidence category B).
- Why test the ligaments soon after injury?
- Tests done before joint effusion builds up may be more accurate.
- Special tests for a high ankle sprain?
- Squeeze test, Cotton test, external-rotation test and fibular translation test.
- Is stress radiography reliable for acute ligament rupture?
- No, it is unreliable (evidence category B).
- Reliable imaging for acute ATFL and calcaneofibular tears?
- MRI.
Official sources
National Athletic Trainers' Association (PubMed Central, National Library of Medicine)
National Athletic Trainers' Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes (J Athl Train 2013)
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