Brief Outline of Wrist Sprain

Wrist sprains involve injury to the ligaments of the wrist. Such sprains are a common occurrence when the hand is extended to break a fall. Ligaments are necessary for stabilisation of the hand and control of motion. Wrist sprains vary from moderate to severe, with the latter involving complete tearing of the ligaments and instability of the accompanying joint. The injury is common to athletes engaged in football, basketball, skiing, snowboarding, rollerblading, and a variety of other sports in which the hands are vulnerable.

Anatomy and physiology

The eight carpal bones of the wrist are connected together via ligaments – fibrous bands of tissue. Such ligaments also connect the bones of the wrist with the radius, ulna and metacarpal bones. The smooth coordination of these bones required for proper hand movement is impaired when one or more ligaments are injured.

Wrist Anatomy BonesCause of Wrist Sprain

Engaging in sports where falls are common, e.g. in-line skating, snowboarding, cycling, soccer, football, baseball, and volleyball. Lack of protective equipment, including wrist guards. Muscle weakness or atrophy.

Signs and symptoms

Pain with movement of the wrist. Burning of tingling of feeling at the wrist. Bruising or discolouraion of the skin.

Complications if left unattended

Moderate to severe wrist sprains left untreated can lead to ongoing deficit of movement and strength in the wrist as well as developing arthritis at the region of the injury.

Treatment

  • RICE
  • Immobilisation using Fibreglass cast or wrist guard.
  • Physiotherapy
  • Injection
  • Surgery if ligament is torn

Rehabilitation and prevention

Flexibility and range of motion exercises may be encouraged by a physical therapist, following initial recovery of the ligament. Should the ligament be torn completely, or if fracture accompanies the sprain, surgery may be required. Use of protective guards for wrists and concentration on balance during sport may help to avoid this injury.

Long-term prognosis

Most wrist sprains undergo full recovery given proper initial care and necessary healing time.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat your wrist sprain today.

 

Ankle Sprain

Brief Outline of Ankle Sprain

Anyone involved in athletics is susceptible to an ankle sprain, an acute injury to any or all of the ligaments that support that support the ankle structure. Tearing or stretching of the ligaments can occur when the foot is rolled either medially or laterally, or twisted forcefully. High impact sports involving jumping, sprinting or running on changing or uneven surfaces often lead to ankle sprains. Basketball, football, cross country, and hockey are a few of the sports commonly associated with ankle sprains.

Anatomy and Physiology of Ankle Sprain

Lateral ankle sprains commonly occur when stress is applied to the ankle during plantar flexion and inversion, injuring the anterior talofibular ligament. The medial malleolus may  act as a fulcrum to further invert the calcaneofibular ligament if the strain continues. The peroneal tendons may absorb some of this strain. Medial ankle sprains are less common, because of the strong deltoid ligament and bony structure of the ankle. The ligaments are stretched beyond their normal range and some tearing of the fibres may occur. Forceful twisting or rolling of the ankle, as with landing on the outside of the foot, can stretch the ligaments past their stretch point.

Cause of Ankle Sprain

Sudden twisting of the foot. Rolling or force to the foot, most common laterally.
Ankle Sprain

 

Signs and Symptoms of Ankle Sprain

First-degree sprains: Result in little or no swelling, mild pain, and stiffness in joint.

Second-degree sprains: Commonly exhibit more swelling and stiffness, moderate to severe pain, difficult with weight bearing,  and some instability in the joint.

Third-degree sprains: Result in severe swelling and pain, inability to bear weight, instability in the joint, and loss of function in the joint.

Complication if Left Ankle Sprain Unattended

Chronic pain and instability in the ankle joint may result if left unattended. Loss of strength and flexibility, and possible loss of function may also result. Re-injuring the joint is much more likely as well.

Immediate Treatment for Ankle Sprain

R.I.C.E. Second- and third-degree sprains may require immobilisation and should seek medical attention immediately.

Rehabilitation and Prevention for Ankle Sprain

Strengthening the muscles of the lower leg is important to prevent future sprains. Balance activities will help to increase proprioception (the body’s awareness of movement and position of the body), and strengthen the weakened ligaments. Flexibility exercises to reduce stiffness and improve mobility are needed also. Bracing during the initial return to activity may be needed but should not replace the strengthening and flexibility development.

Long-term Prognosis for Ankle Sprain

With proper rehabilitation and strengthening, the athlete should not experience any limitations. A slight increase in the probability of injuring that ankle may occur. Athletes who continue to experience difficulty with the ankle may need additional medical interventions, including, in rare cases, possible surgery to tighten the ligaments.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat Ankle Sprain today.

Ankle Sprain

Ankle sprains account for 12% of sports injuries in schools and 11% of all football injuries. While the majority of ankle sprains recover without long-term implications, up to 30% give rise to residual pain, and 20% result in an unstable ankle.

The Anatomy and Mechanics of an Ankle Sprain

Ankle Sprain

An inversion injury is the most common mechanism by which an ankle is sprained. In this situation, the ankle rolls inwards while the toes are pointed downwards towards the ground. In a mild injury, ligaments are stretched but not torn. In more severe inversion ankle sprain, the most commonly torn ligament is the anterior talofibular ligament or ATFL. In addition, the calcaneofibular ligament or CFL may also be torn.

The most commonly understood function of a ligament is to keep the joint stable (mechanical function). The ligament prevents the joint from moving in directions it is not designed to, and also keeps the range of motion of the joint within normal limits. What is less commonly appreciated is that the ligament also has a sensory function. In the example of an ankle, as the ankle starts to roll over, the ligament tightens and nerve signals are sent to the nervous system to alert it that an ankle sprain is about to occur. Nerve impulses are then sent to the appropriate muscles (peroneal muscles) to contract, in order to prevent an ankle sprain.

Unlike some ligaments of the knee which have no ability to heal, ankle ligament tears do routinely heal.

However, healing usually results in a ligament which is elongated and too lax to serve its mechanical function effectively.

The sensory function is also impaired resulting in disruption of the ligament.

Treatment for an Ankle Sprain

With an inversion as a mechanism of injury, besides an ankle ligament injury, fractures around the ankle or foot may also result. When a healthcare professional is consulted after an ankle sprain, he or she will assess for the likelihood of a fracture and if this is suspected, X-rays may be necessary.

Once it has been ascertained that the sprain has resulted only in a ligament injury, immediate treatment is with RICE therapy:

  • Rest
  • Ice
  • Compression
  • Elevation

These measures reduce swelling and inflammation at the injury site. Early return to daily activity has been found to reduce the duration of rehabilitation necessary before resumption of sports. As such, unless pain and swelling preclude walking, immobilisation in a case and the use of crutches is usually avoided.

Once initial pain and swelling has been managed, rehabilitation with physiotherapy will begin. Bearing in mind the mechanical and sensory function of ankle ligaments, physiotherapy focuses on restoring these. For the mechanical function, strengthening of the peroneal muscles allows to compensate for lax ankle ligaments. In order to restore the sensory function, balance training is insituted.

Once satisfactory rehabilitation has been achieved, return to sports with a brace or ankle taping is allows. The function of the brace or tape is two-fold. Firstly, these devices prevent the ankle from excessive range of motion which may predispose to an ankle sprain. The second role is to augment the sensory function of the ankle ligaments. Information regarding the position of the ankle is transmitted to the nervous system through the skin as the brace or tape heightens the skin’s ability so sense ankle motion as different areas tighten with different ankle positions.

Approximately 80% of people who suffer ankle sprains return to their chosen sport at the preinjury level. The remaining 20% continue to have ankle instability and suffer frequent sprains despite adequate physiotherapy. This group would benefit from ankle ligament reconstruction (ankle stabilisation).

Ankle Ligament Reconstruction

Many different methods have been described for ankle ligament reconstruction. The method usually employed is termed an “anatomic reconstruction” as it recreates the position of the native ATFL and CFL, usually using the actual ligaments themselves. This method gives the best outcome in terms of ankle stability and ability to return to sports.

Recalling how ankle ligaments heal in an elongated fashion, surgery aims to shorten the ligaments to the original length.

The stretched-out ligament is divided in the mid-portion and stitched in a shortened position with the ends overlapping each other.

After surgery, the ankle is protected first in a plaster cast then a walking boot for a total of six weeks. This is the time it takes the shortened ligament to heal. Following this, physiotherapy is started with a protocol similar to that of an ankle sprain to restore the mechanical and sensory function of the ankle. Return to sports is expected, usually, in three months.

Conclusion

The majority of ankle sprains recover without long-term consequences. Some persist to give chronic ankle instability and recurrent sprains. For this group, ankle ligament reconstruction is an effective method of stabilising the ankle to allow return to sport.

Do

  • Tape or brace an ankle that has recovered from an ankle sprain or return to sport as this reduces the risk of further injuries.
  • Seek medial attention for an ankle that is unstable or if you experience frequent ankle sprains. Recurrent ankle sprains may result in cartilage damage, which is a precursor to ankle arthritis.

Don’t

  • Ignore a severe ankle sprain especially if walking is difficult. It could be an indication of a problem more severe than a ligament tear, for example an ankle fracture.
  • Resume sports without adequate recovery and rehabilitation following an ankle sprain. This could lead to long-term problems such as pain and recurrent sprains.

Call +65 6471 2674 (24 hr) to fix an appointment to see our orthopaedic specialist for your ankle sprain today.