Ankle Sprain Assessment
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A thorough assessment is required to properly diagnose a sprained ankle and we outline some techniques that a therapist may use to assess and diagnose the injury.
The following examples are for information purposes only. We highly recommend seeing a sports injury professional or Doctor to receive a full assessment of your injury.
Ankle sprains are fairly easy to diagnose as there is always a mechanism of injury. The patient will always remember when the injury occurred (“rolling” the ankle) and therefore the type of injury will be obvious to the therapist. However, there are other serious associated injuries that can occur at the same time as a sprained ankle and need be ruled out by a professional therapist or doctor.
In addition to the ligament damage in ankle sprains, there may also be associated damage to tendons, the joint capsules, the bones, the cartilages, the nerves or other soft tissues. Severely sprained ankles result in complete or almost complete ruptures of the ligaments and may be associated with dislocations and fractures of the ankle bones.
Types of bone / joint injuries in ankle sprains
- An avulsion fracture occurs when an overstretched ligament pulls a small piece of bone away with it. This is not always obvious initially but should be suspected if the injury fails to heal and the ankle remains tender to touch after a number of weeks.
- Osteochondral lesions are tears of the cartilage that lines the bony surfaces of the ankle joints and often occurs in moderate to severe injuries. If missed or not treated this may lead to osteoarthritis developing later on and therefore in severe cases this may require surgery to fix.
- Ankle Fractures may also occur as a result of severe ankle sprains. These can occur in both INVERSION and EVERSION injuries and diagnosis is only confirmed using x-rays.
In view of the above, moderate (grade 2) and severe (grade 3) ankle injuries should always be assessed by a doctor to decide if an x-ray is required, especially if a fracture is suspected. However, it should be noted that X-rays are not required for all ankle sprains (especially minor injuries) as fractures are rare.
Assessment of any injury should include questions concerning the patient’s general health, any previous injuries and more focused questions on the current injury. The aim of these questions is to determine which structure may be causing the pain and which treatment is appropriate.
Following this, the therapist will perform a series of tests which may include the following;
- Observation is usually the first stage of any injury assessment.
- The therapist will usually observe the patient in both standing and lying down and will be looking closely for swelling, bruising and deformity, as well as postural issues such as overpronation of the feet or problems putting the foot on the floor.
- The therapist will then palpate the entire ankle joint and surrounding area to assess if the joint is warm (due to acute inflammation) and swollen and if the ligaments are painful to touch.
Range of Motion
- The therapist will usually assess both active (the patient moves) and passive (the therapist moves the joint) movements of the ankle with the knee both straight and then bent.
- The ankle is often painful to move after an ankle sprain.
- Passive range of motion is usually pain-free as the muscles are not contracting, although the end of range into dorsiflexion (toes pointing upwards) may be painful as the muscles stretch.
Assessing Ankle flexibility
- Depending on the severity of the ankle injury, the therapist may assess the patient in standing to test the movement of the ankle when weight bearing.
Resisted Muscle Tests
- These tests are used to assess strength of the muscles around the ankle joint compared to the other side.
- They may be tested with the knee straight and then bent.
- Special tests are used to assess the integrity of the ligaments and how badly damaged they are.
- Anterior drawer test will be used to assess the ATFL ligament
- “Talar Tilt” test will be used to test the CFL ligament
- External rotation and squeeze tests will be used to assess the high ankle ligaments (syndesmosis complex)
- Functional tests are used to asses how the patient moves and how the ankle injury affects walking, hopping, jumping. The severity of the ankle injury will dictate which tests are selected.
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