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How To Diagnose A Grade 3 Ankle Sprain

Upbeat music The most common causes of ankle sprains are typically injuries with athletes and people who are walking on uneven surfaces. The most common ankles sprain that people see is often one where the ankle rolls inwards and it causes a tearing or stretching of the ligaments on the outside of the ankle. Ankle sprains could be classified in two ways. The first is a lateral ankle sprain. Which is the most common ankle sprain. And there are typically three grades to those. A Grade I is just a mild ligament injury.

To the main ligament of the ankle, called the anterior talofibular ligament. The Grade II is typically a tearing or stretching of that ligament plus another injury to a ligament called the calcaneofibular ligament. And then the Grade III sprain is typically when there’s severe tearing to the lateral ankle structures where all three of the main ligaments to the ankle on the outside of the joint are affected. The second type of injury is called a high ankle sprain. And that’s typically when an injury occurs to the ankle where the foot will turn outward.

And the ligaments are damaged that connect the two bones of the leg called the tibia and the fibula together. And those ligaments can either stretch or tear. And that can be somewhat of a more debilitating injury than your typical lateral ankle sprain. And if those ligaments get torn those two bones will piston and separate when you walk. And that can cause a significant injury to the point where it can need surgical correction. Ankle sprains and the symptoms associated with them are often very very similar. You can see a Grade I ankle sprain.

Ankle Sprains Part 2 Symptoms Evaluation

Which will often appear with some swelling on the outside of the ankle. And obviously some bruising there. The bruising can even extend to the toes and even up in the leg and calf. Depending on how much force the injury was sustained upon. A stage two injury where there’s some tearing of the ligaments can lead to the point where you have swelling which almost looks like a golf ball or a grapefruit on the outside of the ankle. And obviously that bruising will cause much more significant color changes to the extremity.

And it’ll cause a lot more swelling to the extremity. And the reason that that will swell much more is because when the ligament’s tear the joint fluid can actually leave the ankle and start to collect underneath the skin and will cause a focal amount of swelling. High ankle sprains will also show that amount of swelling but oftentimes a high ankle sprain will even cause a fracture to the upper bone of the leg called a fibula, just below the knee. So you can often see swelling from the knee.

Or the lower thigh down to the toes. And the bruising can kind of follow that swelling path as well. Other symptoms include patient having a difficulty walking. Especially on incline or decline. Patient’s will often describe a situation where they have a difficult time going downstairs but going up up the stairs they have ability to be comfortable. Many times with a Grade I or Grade II injury the patient can walk flatfooted without pain it’s when they try to do any hyperextension or hyperflexion that’s when the injury can become very very noticeable.

And it’s often noted that when people have ankle injuries the first three or four days are the most painful because that’s when the swelling is really starting to penetrate the joint. And as the body starts to adjust for the amount of swelling, that’s when the ankle injury will start to settle down. And people can have these chronic ankle sprains where they become repetitive injuries and actually have no pain where their ankle will buckle or turn and they’ll be sore for 24 to 48 hours. Then after that they feel quite comfortable.

So we’re gonna start our exam by looking at the outside of your ankle. Now the first thing we’re gonna do is palpate the three main ligaments on the lateral aspect of the ankle. The first one is here. Called the anterior talofibular ligament. And we’re typically looking to see if the patient has pain running from the outer knuckle of the ankle to the main bone of the ankle called the talus. And that’s typically found where the patient has a Grade I, Grade II, or Grade III ankle sprain.

The second spot that we’re typically feeling for is called the calcaneofibular ligament. Which is immediately below the fibula, and it runs behind a tendon called a peroneal tendon structure. So oftentimes the physician has to discern whether the patient’s having tendon pain or ligament pain when we’re palpating this area. And finally we’re gonna palpate the back of the joint for the posterior talofibular ligament. This ligament is the least common ligament associated with an ankle sprain. And it’s typically only damaged in a severe Grade III injury. When somebody comes in with an ankle sprain.

Or a suspected ankle sprain. The first question we always ask them is what activity were they doing and how did they feel or how did they interpret that their ankle twisted when they came down on their ankle. And most often patient’s will state that the ankle twisted inwards. And again, that is kind of descriptive of a lateral ankle sprain. And once we get an idea of what activity they were doing and the type of force that was placed upon that ankle for the injury, that will give us an idea of what structures were damaged.

After we look at these ligaments, we’re then gonna palpate our peroneal tendon structure. And the peroneal tendons are two tendons that run behind the ankle and they start from a muscle on the upper outer portion of the leg called the peroneal muscle. And the peroneal muscle will form two tendons that run behind the ankle. And typically when a patient twists their ankle inwards, this tendon can hit this bone and can cause a tendon injury. And then we’ll work our way to the inside of the ankle where the deltoid ligament is.

It runs along the inner side of the ankle joint. And we’ll palpate those structures. We’ll then make sure that all of their tendons and ligaments are intact. And we’ll do things such as an anterior drawer sign. Where we’ll pull their foot against their leg to see if it slides. And if it slides it’s often indicative of a ligament tear. And typically when we see a positive anterior drawer sign, that’s also the same patient that will come in with a swelling to the outside of their ankle that looks like a grapefruit or a golf ball.

Once we evaluate the outside and inside of the joint I’ll then test the patient’s strength. And we’ll start out by having the patient push down against my hand as hard as he or she can. Then we’ll have the patient pull up as hard as he or she can. Then push in. And push out. Often when a patient has an inside or an outside ankle sprain or a lateral ankle sprain, the patient will have a hard time pushing in and out. And that can elicit pain. And that’s again, a pretty good indicator.

Of a soft tissue structure damage to the ankle. One of the other least less common injuries that people can see with an inversion injury or twisting of the ankle is a cartilage tear. And sometimes those don’t show up on an xray. So it’s important to get a scan to see if the cartilage is damaged as well as if the the ligaments or tendons are torn. Male This is the front view of the left ankle. This is a xray of the ankle. This is the tibia. This is the talus.

And this is the fibula. These three bones are connected by three sets of ligaments. There is a ligament on the inner side here, connecting the talus to the tibia. There is a ligament here that connects the tibia to the fibula. And then finally there is a ligament on the outside here that connects the fibula to the talus. It is this ligament, the anterior talofibular ligament that is the most commonly injured or torn ligament of the ankle. This occurs by what we call an inversion injury to the ankle.

It is this ligament that we’ll now look at on an MRI. This is an MRI of an ankle, looking from the top down, that is a cross section. They chose a tear of a ligament in the front of the ankle. This is the leg bone. And this is the bone called the fibula. The ligament is in the front here and the ligament should be a dark black. This is normal ligament. A tear, which is illustrated by the yellow arrow. Is represented by a more greyish and white area.

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