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Lateral Ankle Sprain: Diagnosis
This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.
Lead Author(s):
Dwain M. Daniel, D.C.
How this evidence was rated:
Strength of Recommendation Taxonomy (SORT)
Strength of Recommendation Taxonomy (SORT)
Legend:A = consistent, good quality patient oriented evidence;
B = inconsistent or limited quality patient oriented evidence;
C = consensus, disease oriented evidence, usual practice, expert opinion or case series;
D = all or the preponderance of existing evidence is negative.
For more information on the Strength of Recommendation Taxonomy (SORT), please click here.
Published on
May 7, 2008
Text Size:
Ankle injuries are
responsible for 15% of all sports injuries (1) and are commonly
encountered in practice. The diagnostic difficulties surrounding
grading of the injury and ruling out fracture are the greatest
challenges to the physician. Many of the articles located are “how to”
articles and the author’s comments appear very strong in support of
certain diagnostic procedures. However there is very little in the
literature that demonstrates sensitivity and specificity of standard
diagnostic procedures, particularly related to partial ligament tears
and ruptures.
The
reader should also be aware that van Dijk et al (2) reported delayed
examination at five days provided more accurate findings than
examination performed within 48 hours of the injury. When combining all
clinical testing and history, specificity was 84% and sensitivity was
96% at 5 days.
Ankle Sprain Grading
| DESCRIPTION |
GRADE 2 |
GRADE 3 |
GRADE 4 |
| Extent of Injury |
No Tear |
Partial Tear |
Complete Tear |
| Swelling |
Yes, No Ecchymosis |
Yes, with Ecchymosis (30%) |
Yes, with Ecchymosis (70%) |
| Pain on Palpation over ATFL |
Mild |
Moderate |
Intense |
| Anterior Drawer Test |
Negative |
Negative |
Positive |
| Difficulty Weight Bearing |
None |
Usually |
Almost Always |
| Loss of Function |
Minimal |
Some |
Great |
Taken from the combined works of Dijk (2), Ivins (3), Sizer (4), Lynch (5), Rubin (1) and Wexler (6)
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References
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2.
van Dijk CN, Lim LS, Bossuyt PM, Marti RK. Physical examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg Br 1996; 78(6):958-962.
3.
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