1. What happened before and after?

2. He did not pass his boards

3. What is the most commonly injured joint?

4. Ankle is the most commonly sprained joint

9. How many ankle injuries occur each day?

10. 25,000 ankle sprains per day ¼ of all sports related injuries Most common sports related problems

12. What are the risk factors?

13. Risk Factors Poor rehab Poor proprioception Weak muscles Poor ankle instability Lack of warm up Running on uneven surfaces Poor heel support

15. Name how ankle sprains are classified?

16. Ankle sprains First degree Second degree- partial severe tear, moderate instability,,moderate pain Third degree – severe pain and swelling, total tear, gross instability

17. Name three tests used in ankle injuries

18. Ankle Stress test Inversion stress test or talar tilt - Cross leg test Anterior drawer test

19. Cross leg test High ankle sprain Pressure is applied to the medial side of the knee produces pain in syndesmosis area

20. Inversion stress test or talar tilt - Calcaneofibular ligament instability end feel it is grade three

21. Anterior Drawer test Excessive anterior displacement of talus onto the tibia

22. How can you tell if there is a third degree sprain?

23. Grade three (96%) Swelling Hematoma Pain on palpation Positive anterior drawer

24. Functional Ankle instability Balance Impairments

25. Balance Error Scoring System Time-in balance test Foot lift test

26. What is the BESS Test

27. Balance Error Scoring System BESS Three stance conditions and two surface conditions

28. Time-in balance test 60 seconds

29. Foot lift test Single leg tests touch calf

31. High ankle sprain Syndesmotic ankle sprain

33. Syndesmotic ligament Connects the shin to the fibula Tender front Pain worse if foot or leg is twisted outward Positive squeeze test Need surgery

36. Ottawa

37. Ottawa ankle rules Pain in the malleolar region plus Bone tenderness distal 6 posterior edge of tibia or tip of MM Bone tenderness along the distal 6 cmof the posterior edge of fibula or tip of LM Inability to bear weight to bear weight the first 4 steps

38. Treatment depends on the grade

39. General Rehabilitation Principles PRICE NASI ROM Strengthening Proprioception of the ankle joint

40. Cryotherapy Standard Intermittent Outcomes

41. Rehabilitation - PRICE 2 nd degree – immobilization of the ankle 3 rd degree – cast immobilization for 2 to 3 weeks, surgery maybe needed

48. How soon can ankles be rehabilitated?

49. 85% rehab is possible in as little as 7 to 10 days

50. Ligament Tightening Surgery

51. What is the cause and percentage of chronic ankle pain ?

52. Chronic ankle pain and instability after one year 5 to 30%

53. Chronic ankle pain Poor rehab Functional instability Ankle impingement Undx fx Post-traumatic arthritis Osteochondritis dissecans Syndesmotic ligament injury