ChiroACCESS Clinical Review



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)



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

1. 

Rubin A, Sallis R. Evaluation and diagnosis of ankle injuries. Am Fam Physician 1996; 54(5):1609-1618.



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. 

Ivins D. Acute ankle sprain: an update. Am Fam Physician 2006; 74(10):1714-1720.



4. 

Sizer PS, Jr., Phelps V, Dedrick G, James R, Matthijs O. Diagnosis and management of the painful ankle/foot. Part 2: examination, interpretation, and management. Pain Pract 2003; 3(4):343-374.



5. 

Lynch S, Renstrom P. Treatment of acute lteral ankle ligament rupture in the athlete:Conservative versus surgical treatment. Sports Med 1999; 27(1):61-71.



6. 

Wexler RK. The injured ankle. Am Fam Physician 1998; 57(3):474-480.



7. 

Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med 1992; 21(4):384-390.



8. 

Yazdani S, Jahandideh H, Ghofrani H. Validation of the Ottawa Ankle Rules in Iran: a prospective survey. BMC Emerg Med 2006; 6:3.



9. 

Derksen RJ, Bakker FC, Geervliet PC, de Lange-de Klerk ES, Heilbron EA, Veenings B et al. Diagnostic accuracy and reproducibility in the interpretation of Ottawa ankle and foot rules by specialized emergency nurses. Am J Emerg Med 2005; 23(6):725-729.



10. 

Leisey J. Prospective validation of the Ottawa Ankle Rules in a deployed military population. Mil Med 2004; 169(10):804-806.



11. 

Fiesseler F, Szucs P, Kec R, Richman PB. Can nurses appropriately interpret the Ottawa Ankle Rule? Am J Emerg Med 2004; 22(3):145-148.



12. 

Papacostas E, Malliaropoulos N, Papadopoulos A, Liouliakis C. Validation of Ottawa ankle rules protocol in Greek athletes: study in the emergency departments of a district general hospital and a sports injuries clinic. Br J Sports Med 2001; 35(6):445-447.



13. 

Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ 2003; 326(7386):417.



14. 

Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA et al. Implementation of the Ottawa ankle rules. JAMA 1994; 271(11):827-832.



15. 

Hatch RL. Differentiating foot fractures from ankle sprains. Am Fam Physician 2003; 67(7):1438.



16. 

Birrer RB, Fani-Salek MH, Totten VY, Herman LM, Politi V. Managing ankle injuries in the emergency department. J Emerg Med 1999; 17(4):651-660.



17. 

Dissmann PD, Han KH. The tuning fork test--a useful tool for improving specificity in "Ottawa positive" patients after ankle inversion injury. Emerg Med J 2006; 23(10):788-790.



18. 

van Dijk CN. Management of the sprained ankle. Br J Sports Med 2002; 36(2):83-84.



19. 

Bahr R, Pena F, Shine J, Lew WD, Lindquist C, Tyrdal S et al. Mechanics of the anterior drawer and talar tilt tests. A cadaveric study of lateral ligament injuries of the ankle. Acta Orthop Scand 1997; 68(5):435-441.



20. 

Beumer A, van Hemert WL, Swierstra BA, Jasper LE, Belkoff SM. A biomechanical evaluation of clinical stress tests for syndesmotic ankle instability. Foot Ankle Int 2003; 24(4):358-363.



21. 

Fujii T, Luo ZP, Kitaoka HB, An KN. The manual stress test may not be sufficient to differentiate ankle ligament injuries. Clin Biomech (Bristol , Avon ) 2000; 15(8):619-623.



22. 

Becker HP, Komischke A, Danz B, Bensel R, Claes L. Stress diagnostics of the sprained ankle: evaluation of the anterior drawer test with and without anesthesia. Foot Ankle 1993; 14(8):459-464.



23. 

Kerkhoffs GM, Blankevoort L, Sierevelt IN, Corvelein R, Janssen GH, van Dijk CN. Two ankle joint laxity testers: reliability and validity. Knee Surg Sports Traumatol Arthrosc 2005; 13(8):699-705.



24. 

Spahn G. The ankle meter: an instrument for evaluation of anterior talar drawer in ankle sprain. Knee Surg Sports Traumatol Arthrosc 2004; 12(4):338-342.



25. 

Lahde S, Putkonen M, Puranen J, Raatikainen T. Examination of the sprained ankle: anterior drawer test or arthrography? Eur J Radiol 1988; 8(4):255-257.



26. 

Funder V, Jorgensen JP, Andersen A, Andersen SB, Lindholmer E, Niedermann B et al. Ruptures of the lateral ligaments of the ankle. Clinical diagnosis. Acta Orthop Scand 1982; 53(6):997-1000.



27. 

Tohyama H, Yasuda K, Ohkoshi Y, Beynnon BD, Renstrom PA. Anterior drawer test for acute anterior talofibular ligament injuries of the ankle. How much load should be applied during the test? Am J Sports Med 2003; 31(2):226-232.



28. 

Gaebler C, Kukla C, Breitenseher MJ, Nellas ZJ, Mittlboeck M, Trattnig S et al. Diagnosis of lateral ankle ligament injuries. Comparison between talar tilt, MRI and operative findings in 112 athletes. Acta Orthop Scand 1997; 68(3):286-290.



29. 

Seligson D, Gassman J, Pope M. Ankle instability: evaluation of the lateral ligaments. Am J Sports Med 1980; 8(1):39-42.



30. 

Bleichrodt RP, Kingma LM, Binnendijk B, Klein JP. Injuries of the lateral ankle ligaments: classification with tenography and arthrography. Radiology 1989; 173(2):347-349.



31. 

Cerezal L, Abascal F, Garcia-Valtuille R, Canga A. Ankle MR arthrography: how, why, when. Radiol Clin North Am 2005; 43(4):693-707, viii.



32. 

Chou MC, Yeh LR, Chen CK, Pan HB, Chou YJ, Liang HL. Comparison of plain MRI and MR arthrography in the evaluation of lateral ligamentous injury of the ankle joint. J Chin Med Assoc 2006; 69(1):26-31.



33. 

Muwanga CL, Hellier M, Quinton DN, Sloan JP, Dove AF. Grade III injuries of the lateral ligaments of the ankle: the incidence and a simple stress test. Arch Emerg Med 1986; 3(4):247-251.



34. 

Sauser DD, Nelson RC, Lavine MH, Wu CW. Acute injuries of the lateral ligaments of the ankle: comparison of stress radiography and arthrography. Radiology 1983; 148(3):653-657.



35. 

Breitenseher M, Trattnig S, Kukla C, Gabler C, Helbich T, Haller J et al. [Trauma of the ligaments and tendons. Examination technique and detection in MRI]. Radiologe 1995; 35(7):456-462.



36. 

Frost SC, Amendola A. Is stress radiography necessary in the diagnosis of acute or chronic ankle instability? Clin J Sport Med 1999; 9(1):40-45.



37. 

Breitenseher MJ. [Injury of the ankle joint ligaments]. Radiologe 2007; 47(3):216-223.



38. 

Nikken JJ, Oei EH, Ginai AZ, Krestin GP, Verhaar JA, van Vugt AB et al. Acute peripheral joint injury: cost and effectiveness of low-field-strength MR imaging--results of randomized controlled trial. Radiology 2005; 236(3):958-967.



39. 

Breitenseher MJ. [Acute ankle injuries]. Radiologe 1999; 39(1):16-24.



40. 

Ahmad MA, Pandey UC, Crerand JJ, al Shareef Z, Lapinsuo M. Magnetic resonance imaging of the normal and injured lateral collateral ligaments of the ankle. Ann Chir Gynaecol 1998; 87(4):311-316.



41. 

Guillodo Y, Riban P, Guennoc X, Dubrana F, Saraux A. Usefulness of ultrasonographic detection of talocrural effusion in ankle sprains. J Ultrasound Med 2007; 26(6):831-836.