Injuries to the ankle ligaments are One of the most frequent types of
injuries in athletes. They constitute the largest number of injuries
ligaments, and they accounted for 19% of all sports injuries
.
most common mechanism of injury is podvertyvanie
foot inwards or outwards at the time the load on the limb (asnning, dismount from
shells, jumping, etc.) . However, there is another mechanism of injury,
cause of which is the rotation of the foot relative to the longitudinal axis of the tibia.
Such injuries aremorecommon in skiers, when downhill skiing socks
suddenly asbs some obstacle, and the skier continues
coasting. At this point, stop, flat boot, remains in place
and tibia continues to make steady progress, resulting in violent
appears Evers foot (turn foot in the ankle joint
around the longitudinal axis of the tibia outwards), leading to damage ligaments (Fig. 1).
Depending on the mechanism of injury damaged various
ligamentous components of the ankle. For example, the external lateral ligament
damaged during supination and inversion of foot, and the deltoid and tibiofibular ligament
could be affected by pronation and Evers. On injury severity should
distinguish tears (sprains), and asptures of ligaments. If tears ligaments are not
severe trauma and usually end in complete recovery
victims, the tears ligaments, especially the wrong medication,
can often cause permanent disability damaged limbs and
permanently remove the athlete from the system. Given all these circumstances,
necessary to carry out a thorough differential diagnosis of different
severity of ligament damage golenostopnogosustava.
Fig. 1. kinds of movements that cause damage to the ligaments
ankle: a) Evers, b) inversion c) supination and d) pronation.
Diagnostics ankle ligament damage
Since the strain and torn ligaments suffered one and the same anatomical
education (only in varying degrees), the number of clinical signs
characteristic for both types of damage. These signs are
local pain with palpation in the locations damaged ligaments attach to bone,
increased pain when playing a mechanism for injury, swelling in the area
injuries, basising in the ankle joint, hemarthrosis
(bleeding into the cavity joint). Characteristic sign of damage to the front portions of the lateral ligaments
is increased pain when checking symptom "
drawer box." This symptom is verified as follows: researching one hand
fix a sick calf in the lower third, while the second hand is created
anterior displacement of the foot by putting pressure on the heel area at the back (Fig. 2).
When tibiofibular ligament injuries, most patients can be noted
strengthening of local pain associated with straightening of the foot at the ankle joint.
Fig. 2. Check symptoms of a drawer »
particular attention when examining patients with injuries
ankle ligaments should be given proper palpation of
damage. Often, the exact location of pain can be detected only when
gentle, careful palpation. Often incorrectly
this study leads to diagnostic errors that result in injury outside
lateral ligament damage taken tibiofibular syndesmosis, and sometimes even tear
tuberosity fractures of the metatarsal bone V.
Increased pain when playing mechanism
injury due to the tension of soft tissues in the area of damage. With tears and asptures
external lateral ligament pain intensifies during injection of the foot in
position of supination and inversion, and trauma deltoid and tibiofibular ligament-
pronation and Evers.
In hemarthrosis ankle appears
elastic swelling in the anterior-lateral corners of the joint, palpation
which is determined by fluctuation (of course, that such a diagnosis can be made only with the appropriate
history).
However, as reported above, all these features are characteristic and
to tears and torn ligaments ankle. To
to the differential diagnosis of various severity of ligamentous injuries
system, requires knowledge of other attributes, allowing time to identify
or at least suspected aspture ankle ligaments.
In the torn ligaments patients often feel a casnch or crack in
the ankle. Typically, such affected notes
significant swelling of injury, hemarthrosis and pronounced
pain.
In the case of insolvency of the front portions of the lateral ligaments in
checking symptom "drawer" stop easily displaced anteriorly, as
it is not fixed damaged cords coming from the ankles to the bone anteriorly
foot. Displacement of the foot can be seen on the nomination block talus of the ankle
"fork».
with aspture of lateral ligaments are often unable to determine
increase lateral mobility of the talus in the ankle fork in the direction of supination or pronation
. Determination of the lateral mobility of the talus
as follows: researching one hand captures the shin
patient in the lower third and the second displays the position of the foot in supination or pronation
(Fig. 3).
Fig. 3. Determination of the lateral mobility of the talus
Checking symptom "drawer" and the definition
lateral mobility of the talus should be checked with a relatively healthy
limb.
In those cases when the initial examination appears
suspected aspture ankle ligaments or such a diagnosis is established
accurately, the victim should be sent to a specialized
facility (emergency station, casualty department)
for further diagnosis and treatment.
First aid and treatment of ankle ligament damage
arthroplasty
When straining ligaments are not accompanied by a sharp pain
syndrome and hemarthrosis ankle, treatment is reduced to the imposition of tight
8-shaped bandage and apply a cold, but after 1-2 days, the heat on the area
damage. The patient was allowed to walk, loading the damaged limb.
Particular attention should be paid to proper technique of bandaging
joint. Necessary to impose a bandage so that each
tour bandage promote closer all the damaged ligaments. When strain
external lateral ligament in the foot-binding must be displayed in the status
pronation and Evers (Fig. 4a), while damage to the deltoid ligament - in
position of supination and inversion
(Fig. 4.6). In cases of damage to ligaments of the distal tibiofibular articulation
should be imposed tight bandage on the ankle in position
flexion of the foot in the ankle joint. Since the soft bandage often
weakens, it is necessary to teach proper techniques of bandaging of the affected.
Fig. 4. correct bandaging technique: a)
damage to the external lateral ligament, b) with deltoid ligament injury.
Sports disabled when straining ligaments, not
accompanied by a pronounced pain syndrome and hemarthrosis usually
restored in 7-10 days.
In cases where the ligament tear ankle
accompanied by sharp pain, there is considerable swelling in the area
damage and hemarthrosis, therapeutic tactics must be different. When hemarthrosis
necessary to make a puncture with evacuation of the ankle streamed from
his blood and the introduction of the joint cavity of 10-15 ml 1.2% solution of novocaine or
trimecaine. Damaged limb in such cases, immobilized deep
plaster bus from the toes to the knee for 2-3 weeks (indication for
the dressing is disappearance of pain in the area of damage and wears
edema). The load on the injured limb is appointed the first days after injury
(in plaster bus). In order to reduce edema and resorption of hemorrhages in
of damage assigned UHF therapy. From the earliest days of immobilization
recommended active finger movement of the foot, the motion of the knee joint
, to static muscle tension leg and foot. Such
exercises help maintain muscle tone and elasticity, improve the trophic
in damage and is a stimulating factor for early
recovery of muscle strength of the injured extremity. By eliminating
immobilization appointed warm baths, therapeutic exercises classes, massage
muscle damaged limbs, tight bandaging of the joint for the entire period
aftercare and during the first 2-3 weeks after the resumption of sporting activities.
If resistant, long-term pain of a good therapeutic effect of physiotherapy has
(paraffin baths, diadynamic currents at the site of injury), the introduction
novocaine solution and hydrocortisone in the point of maximum tenderness. Before
as to allow the victim to sports, to teach him the tricks
correct bandaging injured joint.
Sports disabled with severe straining ligaments
ankle recovered in 4-5 weeks.
torn ligaments ankle to be treated in
specialized medical institutions.