Sprained ankle: Difference between revisions

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==Historical Perspective==
==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
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==Classification==
==Classification==
*[[Ankle]] [[sprain]] can be graded for functional loss of function.<ref name="pmid22962897">{{cite journal |vauthors=Tiemstra JD |title=Update on acute ankle sprains |journal=Am Fam Physician |volume=85 |issue=12 |pages=1170–6 |date=June 2012 |pmid=22962897 |doi= |url=}}</ref>:
*[[Ankle]] [[sprain]] can be graded for functional loss of function.<ref name="pmid22962897">{{cite journal |vauthors=Tiemstra JD |title=Update on acute ankle sprains |journal=Am Fam Physician |volume=85 |issue=12 |pages=1170–6 |date=June 2012 |pmid=22962897 |doi= |url=}}</ref>:
{| class="wikitable"
{| class="wikitable"
| colspan="3" align="center" style="background: #4479BA; color: #FFFFFF " |'''Grading for functional loss of Ankle sprain'''
| colspan="3" align="center" style="background: #4479BA; color: #FFFFFF " |'''Grading for functional loss of Ankle sprain'''
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|-
|-
|'''Grade I'''
|'''Grade I'''
|Mild stretching  
|Mild stretching
|
|
*[[Joint]] is stable and able to bear weight.  
*[[Joint]] is stable and able to bear weight.
*Mild [[tenderness]] and [[swelling]].
*Mild [[tenderness]] and [[swelling]].
|-
|-
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|Incomplete tear
|Incomplete tear
|
|
*Joint is mild-moderately unstable with a mild range of motion restriction.  
*Joint is mild-moderately unstable with a mild range of motion restriction.
*[[Ecchymosis]], [[tenderness]], [[swelling]] and moderate [[pain]].
*[[Ecchymosis]], [[tenderness]], [[swelling]] and moderate [[pain]].
|-
|-
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==Epidemiology and Demographics==
==Epidemiology and Demographics==


* The prevalence of [[ankle]] sprain is approximately [number or range] per 100,000 individuals worldwide. The most common [[injury|injuries]] suffered from during athletic/recreational activities is lateral [[ankle]] sprains.<ref name="pmid17513688">{{cite journal |vauthors=Fernandez WG, Yard EE, Comstock RD |title=Epidemiology of lower extremity injuries among U.S. high school athletes |journal=Acad Emerg Med |volume=14 |issue=7 |pages=641–5 |date=July 2007 |pmid=17513688 |doi=10.1197/j.aem.2007.03.1354 |url=}}</ref><ref name="pmid17710181">{{cite journal |vauthors=Hootman JM, Dick R, Agel J |title=Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives |journal=J Athl Train |volume=42 |issue=2 |pages=311–9 |date=2007 |pmid=17710181 |pmc=1941297 |doi= |url=}}</ref><ref name="pmid24198549">{{cite journal |vauthors=Hubbard TJ, Wikstrom EA |title=Ankle sprain: pathophysiology, predisposing factors, and management strategies |journal=Open Access J Sports Med |volume=1 |issue= |pages=115–22 |date=July 2010 |pmid=24198549 |pmc=3781861 |doi=10.2147/oajsm.s9060 |url=}}</ref>
*The prevalence of [[ankle]] sprain is approximately [number or range] per 100,000 individuals worldwide. The most common [[injury|injuries]] suffered from during athletic/recreational activities is lateral [[ankle]] sprains.<ref name="pmid17513688">{{cite journal |vauthors=Fernandez WG, Yard EE, Comstock RD |title=Epidemiology of lower extremity injuries among U.S. high school athletes |journal=Acad Emerg Med |volume=14 |issue=7 |pages=641–5 |date=July 2007 |pmid=17513688 |doi=10.1197/j.aem.2007.03.1354 |url=}}</ref><ref name="pmid17710181">{{cite journal |vauthors=Hootman JM, Dick R, Agel J |title=Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives |journal=J Athl Train |volume=42 |issue=2 |pages=311–9 |date=2007 |pmid=17710181 |pmc=1941297 |doi= |url=}}</ref><ref name="pmid24198549">{{cite journal |vauthors=Hubbard TJ, Wikstrom EA |title=Ankle sprain: pathophysiology, predisposing factors, and management strategies |journal=Open Access J Sports Med |volume=1 |issue= |pages=115–22 |date=July 2010 |pmid=24198549 |pmc=3781861 |doi=10.2147/oajsm.s9060 |url=}}</ref>
*The indoor/court sports has a "cumulative [[incidence]] rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h".<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>
*The indoor/court sports has a "cumulative [[incidence]] rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h".<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>


===Age===
===Age===
*A systematic review and meta-analyses of prospective studies reported that children compared with adolescents and adults are more likely to sustain an ankle [[sprain]].<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>
*A systematic review and meta-analyses of prospective studies reported that children compared with adolescents and adults are more likely to sustain an ankle [[sprain]].<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>


===Gender===
===Gender===
*A systematic review and meta-analyses of prospective studies reported that females are more commonly affected with ankle [[sprain]] than males.<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>
*A systematic review and meta-analyses of prospective studies reported that females are more commonly affected with ankle [[sprain]] than males.<ref name="pmid24105612">{{cite journal |vauthors=Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C |title=The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies |journal=Sports Med |volume=44 |issue=1 |pages=123–40 |date=January 2014 |pmid=24105612 |doi=10.1007/s40279-013-0102-5 |url=}}</ref>
   
   
===Race===
===Race===
*There is no racial predilection for [[ankle]] sprain.
*There is no racial predilection for [[ankle]] sprain.


==Risk Factors==
==Risk Factors==
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].


== Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==
*The majority of patients with [disease name] remain asymptomatic for [duration/years].  
 
*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
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*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].
*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


== Diagnosis ==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
:*[criterion 1]
:*[criterion 1]
:*[criterion 2]
:*[criterion 2]
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:*[criterion 4]
:*[criterion 4]
   
   
=== Symptoms ===
===Symptoms===
* [[Acute]] [[injury|injuries]] may not demonstrate any [[signs]] and [[symptoms]]. Ask the [[patient]] to describe [[injury]] mechanism. Most sprains involve [[ankle]] [[inversion]] with some [[plantar]] [[flexion]] and suggest [[lateral]] [[ligament]] injury. Another mechanism, such as [[dorsiflexion]], [[eversion]] suggest some other [[ligament]] involvement.<ref name="pmid22962897">{{cite journal |vauthors=Tiemstra JD |title=Update on acute ankle sprains |journal=Am Fam Physician |volume=85 |issue=12 |pages=1170–6 |date=June 2012 |pmid=22962897 |doi= |url=}}</ref>
 
*[[Acute]] [[injury|injuries]] may not demonstrate any [[signs]] and [[symptoms]]. Ask the [[patient]] to describe [[injury]] mechanism. Most sprains involve [[ankle]] [[inversion]] with some [[plantar]] [[flexion]] and suggest [[lateral]] [[ligament]] injury. Another mechanism, such as [[dorsiflexion]], [[eversion]] suggest some other [[ligament]] involvement.<ref name="pmid22962897">{{cite journal |vauthors=Tiemstra JD |title=Update on acute ankle sprains |journal=Am Fam Physician |volume=85 |issue=12 |pages=1170–6 |date=June 2012 |pmid=22962897 |doi= |url=}}</ref>
*Other symptoms of [[ankle]] [[aprain]] may include the following:
*Other symptoms of [[ankle]] [[aprain]] may include the following:
:*[symptom 1]
:*[symptom 1]
:*[symptom 2]
:*[symptom 2]


=== Physical Examination ===
===Physical Examination===
 
*Patients with [[ankle]] sprain usually appear fine.
*Patients with [[ankle]] sprain usually appear fine.
*Physical examination of a typical [[lateral]] [[ankle]] [[sprain]] may be remarkable for:
*Physical examination of a typical [[lateral]] [[ankle]] [[sprain]] may be remarkable for:
:*[[Tenderness]], [[swelling]], and [[ecchymosis]] over [[anterior]] [[talofibular ligament|talofibuar]] and [[calcaneofibular ligament]]s. [[Swelling]] and [[bruise|bruising]] of the whole [[foot]] and [[toe]] may be demonstrated if no proper treatment has been applied and the [[patient]] has been [[ambulating]].<ref name="pmid22962897">{{cite journal |vauthors=Tiemstra JD |title=Update on acute ankle sprains |journal=Am Fam Physician |volume=85 |issue=12 |pages=1170–6 |date=June 2012 |pmid=22962897 |doi= |url=}}</ref>
:*[[Tenderness]], [[swelling]], and [[ecchymosis]] over [[anterior]] [[talofibular ligament|talofibuar]] and [[calcaneofibular ligament]]s. [[Swelling]] and [[bruise|bruising]] of the whole [[foot]] and [[toe]] may be demonstrated if no proper treatment has been applied and the [[patient]] has been [[ambulating]].<ref name="pmid22962897">{{cite journal |vauthors=Tiemstra JD |title=Update on acute ankle sprains |journal=Am Fam Physician |volume=85 |issue=12 |pages=1170–6 |date=June 2012 |pmid=22962897 |doi= |url=}}</ref>
:*[finding 4]
:*[finding 4]
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:*[finding 6]
:*[finding 6]


=== Laboratory Findings ===
===Laboratory Findings===
 
*There are no specific laboratory findings associated with [[ankle]] sprain.
*There are no specific laboratory findings associated with [[ankle]] sprain.


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===X-ray===
===X-ray===
*An x-ray may be helpful in the diagnosis of [[ankle]] sprain. The Ottawa criteria (100% sensitivity) helps indicate of the radiography is indicated. According to the criteria, in case of [[pain]] in the [[Medial malleolus|malleolar]] or mid[[foot]] region, or [[tenderness]] of the [[bone]] over the potential [[fracture]] region, or [[weight]] bearing inability for four steps right after the [[injury]] warrants [[radiography]].<ref name="pmid12595378">{{cite journal |vauthors=Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G |title=Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review |journal=BMJ |volume=326 |issue=7386 |pages=417 |date=February 2003 |pmid=12595378 |pmc=149439 |doi=10.1136/bmj.326.7386.417 |url=}}</ref><ref name="pmid19187397">{{cite journal |vauthors=Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, Wright RB |title=Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis |journal=Acad Emerg Med |volume=16 |issue=4 |pages=277–87 |date=April 2009 |pmid=19187397 |doi=10.1111/j.1553-2712.2008.00333.x |url=}}</ref>
*An x-ray may be helpful in the diagnosis of [[ankle]] sprain. The Ottawa criteria (100% sensitivity) helps indicate of the radiography is indicated. According to the criteria, in case of [[pain]] in the [[Medial malleolus|malleolar]] or mid[[foot]] region, or [[tenderness]] of the [[bone]] over the potential [[fracture]] region, or [[weight]] bearing inability for four steps right after the [[injury]] warrants [[radiography]].<ref name="pmid12595378">{{cite journal |vauthors=Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G |title=Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review |journal=BMJ |volume=326 |issue=7386 |pages=417 |date=February 2003 |pmid=12595378 |pmc=149439 |doi=10.1136/bmj.326.7386.417 |url=}}</ref><ref name="pmid19187397">{{cite journal |vauthors=Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, Wright RB |title=Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis |journal=Acad Emerg Med |volume=16 |issue=4 |pages=277–87 |date=April 2009 |pmid=19187397 |doi=10.1111/j.1553-2712.2008.00333.x |url=}}</ref>
*Lateral, anteroposterior, and mortise views of the [[ankle]] help visualize the lesion.
*Lateral, anteroposterior, and mortise views of the [[ankle]] help visualize the lesion.
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===Ultrasound===
===Ultrasound===
There are no ultrasound findings associated with [[ankle]] sprain.
There are no ultrasound findings associated with [[ankle]] sprain.




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===MRI===
===MRI===
*An [[ankle]] MRI may be helpful for ankle injuries involving [[crepitus]] or locking, as these [[symptoms]] may indicate a displaced osteochondral fragment.<ref name="pmid11195774">{{cite journal |vauthors=Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC |title=Management of ankle sprains |journal=Am Fam Physician |volume=63 |issue=1 |pages=93–104 |date=January 2001 |pmid=11195774 |doi= |url=}}</ref>
*An [[ankle]] MRI may be helpful for ankle injuries involving [[crepitus]] or locking, as these [[symptoms]] may indicate a displaced osteochondral fragment.<ref name="pmid11195774">{{cite journal |vauthors=Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC |title=Management of ankle sprains |journal=Am Fam Physician |volume=63 |issue=1 |pages=93–104 |date=January 2001 |pmid=11195774 |doi= |url=}}</ref>
* An [[MRI]] may help identify syndesmosis [[sprain]]s and [[peroneal]] [[tendon]] involvement.<ref name="pmid10416542">{{cite journal |vauthors=Lazarus ML |title=Imaging of the foot and ankle in the injured athlete |journal=Med Sci Sports Exerc |volume=31 |issue=7 Suppl |pages=S412–20 |date=July 1999 |pmid=10416542 |doi=10.1097/00005768-199907001-00002 |url=}}</ref>
*An [[MRI]] may help identify syndesmosis [[sprain]]s and [[peroneal]] [[tendon]] involvement.<ref name="pmid10416542">{{cite journal |vauthors=Lazarus ML |title=Imaging of the foot and ankle in the injured athlete |journal=Med Sci Sports Exerc |volume=31 |issue=7 Suppl |pages=S412–20 |date=July 1999 |pmid=10416542 |doi=10.1097/00005768-199907001-00002 |url=}}</ref>


===Other Imaging Findings===
===Other Imaging Findings===
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[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


=== Other Diagnostic Studies ===
===Other Diagnostic Studies===
 
*[Disease name] may also be diagnosed using [diagnostic study name].
*[Disease name] may also be diagnosed using [diagnostic study name].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].


==Treatment==
==Treatment==
*Although treatment decisions must be made on an individual basis, functional support for most ankle sprains is the first step.<ref name="pmid21655420">{{cite journal |vauthors=Lin CW, Hiller CE, de Bie RA |title=Evidence-based treatment for ankle injuries: a clinical perspective |journal=J Man Manip Ther |volume=18 |issue=1 |pages=22–8 |date=March 2010 |pmid=21655420 |pmc=3103112 |doi=10.1179/106698110X12595770849524 |url=}}</ref> Brace, tape, elastic bandage, or softcast are preferred over immobilization.<ref name="pmid12137710">{{cite journal |vauthors=Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly K, Struijs PA, van Dijk CN |title=Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD003762 |date=2002 |pmid=12137710 |doi=10.1002/14651858.CD003762 |url=}}</ref>
 
*Although treatment decisions must be made on an individual basis, functional support for most ankle sprains is the first step.<ref name="pmid21655420">{{cite journal |vauthors=Lin CW, Hiller CE, de Bie RA |title=Evidence-based treatment for ankle injuries: a clinical perspective |journal=J Man Manip Ther |volume=18 |issue=1 |pages=22–8 |date=March 2010 |pmid=21655420 |pmc=3103112 |doi=10.1179/106698110X12595770849524 |url=}}</ref> Brace, tape, elastic bandage, or soft cast are preferred over immobilization.<ref name="pmid12137710">{{cite journal |vauthors=Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly K, Struijs PA, van Dijk CN |title=Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD003762 |date=2002 |pmid=12137710 |doi=10.1002/14651858.CD003762 |url=}}</ref> It gives the leg an exercise and yet keeps the damaged part from moving. [[Crutches]] and air-braces while conventionally used, are currently out of vogue.
*Immediately following the injury it is important the follow the [[PRICE]] protocol – Protection, Rest, Ice, Compression, and Elevation (also known as RICE: Rest, Ice, Compress, and Elevate).<ref name="pmid22889660">{{cite journal |vauthors=van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM |title=What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? |journal=J Athl Train |volume=47 |issue=4 |pages=435–43 |date=2012 |pmid=22889660 |pmc=3396304 |doi=10.4085/1062-6050-47.4.14 |url=}}</ref>
*Immediately following the injury it is important the follow the [[PRICE]] protocol – Protection, Rest, Ice, Compression, and Elevation (also known as RICE: Rest, Ice, Compress, and Elevate).<ref name="pmid22889660">{{cite journal |vauthors=van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM |title=What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? |journal=J Athl Train |volume=47 |issue=4 |pages=435–43 |date=2012 |pmid=22889660 |pmc=3396304 |doi=10.4085/1062-6050-47.4.14 |url=}}</ref>
*Cold therapy for 12 to 20 minutes together with compression until the [[swelling]] settles or 48 hours, is found to be helpful.<ref name="pmid2712981">{{cite journal |vauthors=Sloan JP, Hain R, Pownall R |title=Clinical benefits of early cold therapy in accident and emergency following ankle sprain |journal=Arch Emerg Med |volume=6 |issue=1 |pages=1–6 |date=March 1989 |pmid=2712981 |pmc=1285549 |doi=10.1136/emj.6.1.1 |url=}}</ref><ref name="pmid2334279">{{cite journal |vauthors=Airaksinen O, Kolari PJ, Miettinen H |title=Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains |journal=Arch Phys Med Rehabil |volume=71 |issue=6 |pages=380–3 |date=May 1990 |pmid=2334279 |doi= |url=}}</ref><ref name="pmid22889660">{{cite journal |vauthors=van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM |title=What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? |journal=J Athl Train |volume=47 |issue=4 |pages=435–43 |date=2012 |pmid=22889660 |pmc=3396304 |doi=10.4085/1062-6050-47.4.14 |url=}}</ref>  
*Cold therapy for 12 to 20 minutes together with compression until the [[swelling]] settles or 48 hours, is found to be helpful.<ref name="pmid2712981">{{cite journal |vauthors=Sloan JP, Hain R, Pownall R |title=Clinical benefits of early cold therapy in accident and emergency following ankle sprain |journal=Arch Emerg Med |volume=6 |issue=1 |pages=1–6 |date=March 1989 |pmid=2712981 |pmc=1285549 |doi=10.1136/emj.6.1.1 |url=}}</ref><ref name="pmid2334279">{{cite journal |vauthors=Airaksinen O, Kolari PJ, Miettinen H |title=Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains |journal=Arch Phys Med Rehabil |volume=71 |issue=6 |pages=380–3 |date=May 1990 |pmid=2334279 |doi= |url=}}</ref><ref name="pmid22889660">{{cite journal |vauthors=van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM |title=What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? |journal=J Athl Train |volume=47 |issue=4 |pages=435–43 |date=2012 |pmid=22889660 |pmc=3396304 |doi=10.4085/1062-6050-47.4.14 |url=}}</ref>
*An [[ankle]] brace can be very helpful for the treatment and prevention of a sprained [[ankle]]. [[Crutches]] and air-braces while conventionally used, are currently out of vogue. Complete [[immobilization]] is currently the most preferred option among specialists in the form of the plastic [[casts]] also known as a walker. It gives the leg an exercise and yet keeps the damaged part from moving.
*Severe ankle sprains should be assessed by an [[orthopedic]] specialist, although [[physical therapy]] is extremely effective for most sprained [[ankle]]s.
*Severe ankle sprains should be assessed by an [[orthopedic]] specialist, although [[physical therapy]] is extremely effective for most sprained [[ankle]]s.  
 
===Medical Therapy===


=== Medical Therapy ===
*[[NSAIDS]] are helpful for [[analgesia]] (both [[oral]] or [[topical]] are effective).<ref name="pmid20556778">{{cite journal |vauthors=Massey T, Derry S, Moore RA, McQuay HJ |title=Topical NSAIDs for acute pain in adults |journal=Cochrane Database Syst Rev |volume= |issue=6 |pages=CD007402 |date=June 2010 |pmid=20556778 |pmc=4163964 |doi=10.1002/14651858.CD007402.pub2 |url=}}</ref><ref name="pmid1864448">{{cite journal |vauthors=Morán M |title=Double-blind comparison of diclofenac potassium, ibuprofen and placebo in the treatment of ankle sprains |journal=J Int Med Res |volume=19 |issue=2 |pages=121–30 |date=1991 |pmid=1864448 |doi=10.1177/030006059101900205 |url=}}</ref>
*[[NSAIDS]] are helpful for [[analgesia]] (both [[oral]] or [[topical]] are effective).<ref name="pmid20556778">{{cite journal |vauthors=Massey T, Derry S, Moore RA, McQuay HJ |title=Topical NSAIDs for acute pain in adults |journal=Cochrane Database Syst Rev |volume= |issue=6 |pages=CD007402 |date=June 2010 |pmid=20556778 |pmc=4163964 |doi=10.1002/14651858.CD007402.pub2 |url=}}</ref><ref name="pmid1864448">{{cite journal |vauthors=Morán M |title=Double-blind comparison of diclofenac potassium, ibuprofen and placebo in the treatment of ankle sprains |journal=J Int Med Res |volume=19 |issue=2 |pages=121–30 |date=1991 |pmid=1864448 |doi=10.1177/030006059101900205 |url=}}</ref>
   
   
=== Surgery ===
===Surgery===
 
*Surgical repair can be performed for [[patient]]s with ruptured [[ankle]] [[ligaments]]. Operative treatment has been shown to have a better long-term outcome for residual [[pain]], recurrent [[sprains]] and stability in a randomised clinical trial.<ref name="pmid12793557">{{cite journal |vauthors=Pijnenburg AC, Bogaard K, Krips R, Marti RK, Bossuyt PM, van Dijk CN |title=Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial |journal=J Bone Joint Surg Br |volume=85 |issue=4 |pages=525–30 |date=May 2003 |pmid=12793557 |doi=10.1302/0301-620x.85b4.13928 |url=}}</ref>
*Surgical repair can be performed for [[patient]]s with ruptured [[ankle]] [[ligaments]]. Operative treatment has been shown to have a better long-term outcome for residual [[pain]], recurrent [[sprains]] and stability in a randomised clinical trial.<ref name="pmid12793557">{{cite journal |vauthors=Pijnenburg AC, Bogaard K, Krips R, Marti RK, Bossuyt PM, van Dijk CN |title=Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial |journal=J Bone Joint Surg Br |volume=85 |issue=4 |pages=525–30 |date=May 2003 |pmid=12793557 |doi=10.1302/0301-620x.85b4.13928 |url=}}</ref>


=== Prevention ===
===Prevention===
 
*There are no primary preventive measures available for [disease name].
*There are no primary preventive measures available for [disease name].
   
   
Line 171: Line 191:


==Prognosis==
==Prognosis==
*[[Acute]] ankle [[sprain]]s have been reported to have a high recurrence rate and may also lead to [[chronic]] ankle instability.<ref name="pmid31135209">{{cite journal |vauthors=Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA |title=Epidemiology of Ankle Sprains and Chronic Ankle Instability |journal=J Athl Train |volume=54 |issue=6 |pages=603–610 |date=June 2019 |pmid=31135209 |pmc=6602402 |doi=10.4085/1062-6050-447-17 |url=}}</ref>
*[[Acute]] ankle [[sprain]]s have been reported to have a high recurrence rate and may also lead to [[chronic]] ankle instability.<ref name="pmid31135209">{{cite journal |vauthors=Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA |title=Epidemiology of Ankle Sprains and Chronic Ankle Instability |journal=J Athl Train |volume=54 |issue=6 |pages=603–610 |date=June 2019 |pmid=31135209 |pmc=6602402 |doi=10.4085/1062-6050-447-17 |url=}}</ref>


==Related Chapters==
==Related Chapters==
* [[Sprain]]
 
*[[Sprain]]


==References==
==References==

Revision as of 20:10, 2 March 2021

Sprained ankle
Lateral view of the human ankle

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]

Synonyms and keywords: Ankle sprain; ankle injury; ankle ligament injury

Overview

A sprained ankle is a common medical condition where one or more of the ligaments of the ankle is/are stretched, partially or completely torn. Ankle sprains are more common among physically active individuals. The anterior talofibular ligament is one of the most commonly involved ligaments. Sprains to the lateral aspect of the ankle account for 85% of ankle sprains.

Historical Perspective

  • [Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
  • In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
  • In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].

Classification

Grading for functional loss of Ankle sprain
Grade Degree of ligament damage Symptoms and signs
Grade I Mild stretching
Grade II Incomplete tear
Grade III Complete tear

Pathophysiology

  • The pathogenesis of ankle sprain is characterized by ankle movement beyond the elastic limits of its supporting structures causing acute ankle pathology.
  • Lateral ankle sprain injury is usually caused by forefoot adduction, hindfoot inversion, and tibial external rotation with ankle in plantar flexion. Depending on the amount and direction of the force, one or more of the lateral ligaments can be involved.[2]
  • On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
  • On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Causes

A lateral ankle sprain occurs when the ankle is inverted beyond the elastic limits of its supporting structures causing acute ankle pathology.

Differentiating [disease name] from other Diseases

For further information about the differential diagnosis, click here.

Epidemiology and Demographics

  • The prevalence of ankle sprain is approximately [number or range] per 100,000 individuals worldwide. The most common injuries suffered from during athletic/recreational activities is lateral ankle sprains.[3][4][5]
  • The indoor/court sports has a "cumulative incidence rate of 7 per 1,000 exposures or 1.37 per 1,000 athlete exposures and 4.9 per 1,000 h".[6]

Age

  • A systematic review and meta-analyses of prospective studies reported that children compared with adolescents and adults are more likely to sustain an ankle sprain.[6]

Gender

  • A systematic review and meta-analyses of prospective studies reported that females are more commonly affected with ankle sprain than males.[6]

Race

  • There is no racial predilection for ankle sprain.

Risk Factors

  • Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

  • The majority of patients with [disease name] remain asymptomatic for [duration/years].
  • Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
  • If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
  • Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
  • Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].

Diagnosis

Diagnostic Criteria

  • The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
  • [criterion 1]
  • [criterion 2]
  • [criterion 3]
  • [criterion 4]

Symptoms

  • [symptom 1]
  • [symptom 2]

Physical Examination

  • Patients with ankle sprain usually appear fine.
  • Physical examination of a typical lateral ankle sprain may be remarkable for:

Laboratory Findings

  • There are no specific laboratory findings associated with ankle sprain.

Electrocardiogram

There are no ECG findings associated with ankle sprain.

X-ray

  • An x-ray may be helpful in the diagnosis of ankle sprain. The Ottawa criteria (100% sensitivity) helps indicate of the radiography is indicated. According to the criteria, in case of pain in the malleolar or midfoot region, or tenderness of the bone over the potential fracture region, or weight bearing inability for four steps right after the injury warrants radiography.[7][8]
  • Lateral, anteroposterior, and mortise views of the ankle help visualize the lesion.
  • Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Ultrasound

There are no ultrasound findings associated with ankle sprain.


CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

  • [Disease name] may also be diagnosed using [diagnostic study name].
  • Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

  • Although treatment decisions must be made on an individual basis, functional support for most ankle sprains is the first step.[11] Brace, tape, elastic bandage, or soft cast are preferred over immobilization.[12] It gives the leg an exercise and yet keeps the damaged part from moving. Crutches and air-braces while conventionally used, are currently out of vogue.
  • Immediately following the injury it is important the follow the PRICE protocol – Protection, Rest, Ice, Compression, and Elevation (also known as RICE: Rest, Ice, Compress, and Elevate).[13]
  • Cold therapy for 12 to 20 minutes together with compression until the swelling settles or 48 hours, is found to be helpful.[14][15][13]
  • Severe ankle sprains should be assessed by an orthopedic specialist, although physical therapy is extremely effective for most sprained ankles.

Medical Therapy

Surgery

  • Surgical repair can be performed for patients with ruptured ankle ligaments. Operative treatment has been shown to have a better long-term outcome for residual pain, recurrent sprains and stability in a randomised clinical trial.[18]

Prevention

  • There are no primary preventive measures available for [disease name].
  • Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
  • Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

Prognosis

  • Acute ankle sprains have been reported to have a high recurrence rate and may also lead to chronic ankle instability.[19]

Related Chapters

References

  1. ↑ 1.0 1.1 1.2 Tiemstra JD (June 2012). "Update on acute ankle sprains". Am Fam Physician. 85 (12): 1170–6. PMID 22962897.
  2. ↑ McGovern RP, Martin RL (2016). "Managing ankle ligament sprains and tears: current opinion". Open Access J Sports Med. 7: 33–42. doi:10.2147/OAJSM.S72334. PMC 4780668. PMID 27042147.
  3. ↑ Fernandez WG, Yard EE, Comstock RD (July 2007). "Epidemiology of lower extremity injuries among U.S. high school athletes". Acad Emerg Med. 14 (7): 641–5. doi:10.1197/j.aem.2007.03.1354. PMID 17513688.
  4. ↑ Hootman JM, Dick R, Agel J (2007). "Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives". J Athl Train. 42 (2): 311–9. PMC 1941297. PMID 17710181.
  5. ↑ Hubbard TJ, Wikstrom EA (July 2010). "Ankle sprain: pathophysiology, predisposing factors, and management strategies". Open Access J Sports Med. 1: 115–22. doi:10.2147/oajsm.s9060. PMC 3781861. PMID 24198549.
  6. ↑ 6.0 6.1 6.2 Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C (January 2014). "The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies". Sports Med. 44 (1): 123–40. doi:10.1007/s40279-013-0102-5. PMID 24105612.
  7. ↑ Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G (February 2003). "Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review". BMJ. 326 (7386): 417. doi:10.1136/bmj.326.7386.417. PMC 149439. PMID 12595378.
  8. ↑ Dowling S, Spooner CH, Liang Y, Dryden DM, Friesen C, Klassen TP, Wright RB (April 2009). "Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis". Acad Emerg Med. 16 (4): 277–87. doi:10.1111/j.1553-2712.2008.00333.x. PMID 19187397.
  9. ↑ Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC (January 2001). "Management of ankle sprains". Am Fam Physician. 63 (1): 93–104. PMID 11195774.
  10. ↑ Lazarus ML (July 1999). "Imaging of the foot and ankle in the injured athlete". Med Sci Sports Exerc. 31 (7 Suppl): S412–20. doi:10.1097/00005768-199907001-00002. PMID 10416542.
  11. ↑ Lin CW, Hiller CE, de Bie RA (March 2010). "Evidence-based treatment for ankle injuries: a clinical perspective". J Man Manip Ther. 18 (1): 22–8. doi:10.1179/106698110X12595770849524. PMC 3103112. PMID 21655420.
  12. ↑ Kerkhoffs GM, Rowe BH, Assendelft WJ, Kelly K, Struijs PA, van Dijk CN (2002). "Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults". Cochrane Database Syst Rev (3): CD003762. doi:10.1002/14651858.CD003762. PMID 12137710.
  13. ↑ 13.0 13.1 van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM (2012). "What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults?". J Athl Train. 47 (4): 435–43. doi:10.4085/1062-6050-47.4.14. PMC 3396304. PMID 22889660.
  14. ↑ Sloan JP, Hain R, Pownall R (March 1989). "Clinical benefits of early cold therapy in accident and emergency following ankle sprain". Arch Emerg Med. 6 (1): 1–6. doi:10.1136/emj.6.1.1. PMC 1285549. PMID 2712981.
  15. ↑ Airaksinen O, Kolari PJ, Miettinen H (May 1990). "Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains". Arch Phys Med Rehabil. 71 (6): 380–3. PMID 2334279.
  16. ↑ Massey T, Derry S, Moore RA, McQuay HJ (June 2010). "Topical NSAIDs for acute pain in adults". Cochrane Database Syst Rev (6): CD007402. doi:10.1002/14651858.CD007402.pub2. PMC 4163964. PMID 20556778.
  17. ↑ Morán M (1991). "Double-blind comparison of diclofenac potassium, ibuprofen and placebo in the treatment of ankle sprains". J Int Med Res. 19 (2): 121–30. doi:10.1177/030006059101900205. PMID 1864448.
  18. ↑ Pijnenburg AC, Bogaard K, Krips R, Marti RK, Bossuyt PM, van Dijk CN (May 2003). "Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial". J Bone Joint Surg Br. 85 (4): 525–30. doi:10.1302/0301-620x.85b4.13928. PMID 12793557.
  19. ↑ Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA (June 2019). "Epidemiology of Ankle Sprains and Chronic Ankle Instability". J Athl Train. 54 (6): 603–610. doi:10.4085/1062-6050-447-17. PMC 6602402 Check |pmc= value (help). PMID 31135209.


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