When the joint suddenly moves to one side under the action of external force and exceeds its normal mobility, it causes lacerations of soft tissues around the joint such as joint capsule, ligaments and tendons, which is called joint sprain. In mild cases, only part of the ligament fibers are torn, while in severe cases, the ligament may be completely ruptured or the bone at the attachment of the ligament and joint capsule may be torn off, and even joint dislocation may occur. Joint sprains are most common on a daily basis, with the ankle joint being the most common, followed by the knee joint and wrist joint.
Clinical manifestations and diagnosis:
1. Lateral ligament injury:
Caused by strong inversion of the foot. Because the outer ankle is longer than the inner ankle and the lateral ligaments are weak, the foot inversion is more active and the lateral ligament injury is more common in clinical practice. Partial tear of the lateral ligament is more common, and its clinical manifestations are pain, swelling and walking limp on the lateral side of the ankle; sometimes subcutaneous petechial hemorrhage is seen; there is pressure pain at the lateral ligament area; when making the foot turn inward, it causes increased pain at the lateral ligament area.
Complete rupture of the lateral ligament: less common, with more pronounced local symptoms. Due to the loss of control of the lateral ligament, abnormal inversion mobility may occur. Sometimes there are small pieces of bone along with ligament avulsion in the lateral ankle, called avulsion fracture. In the inversion position, the inclination of the tibial spine joint surface is far more than the normal range of 5-10°, and the joint space on the injured side is widened. x-ray examination shows the avulsion bone fragment.
2.Medial ligament injury:
Caused by strong foot valgus, which occurs less frequently. Its clinical manifestations and the lateral ligament injury is similar, but the location and direction of the opposite. Manifestation for the medial ligament area pain, swelling, pressure pain, foot valgus, caused by the medial ligament area pain, but also can have avulsion fracture.
Treatment:
Fresh sprain first ice: use crushed ice or ice water in a plastic bag and apply it to the injured area for 20 minutes every 4 hours while awake. Elevation: Elevate the injured ankle when you don’t need to move it, at least higher than the waist to be effective. Compression: Wrap the injured area with an elastic bandage, not too loose or too tight, too loose is ineffective and easy to fall off, too tight the toe will swell and numb, impairing blood circulation. It is best to take crutches when moving: take crutches to help walk, the injured foot can be completely off the ground, or in the range of no pain slightly on the ground to support the weight. However, you should not land toe-first because it is easy to re-inflate the sprain when the foot is facing downward. You must let the heel (i.e., the heel) land first before landing on the entire foot, as in normal walking.
To treat the injury, first fix the ankle joint with an elastic bandage, apply ice to the injured area, and then fix the ice pack and ankle joint with a bandage. After a few minutes of fixation (about 3-5 minutes), the bandage can be removed first. At this time, the swelling of the injured part is not yet obvious and the muscle spasm is light, so a simple examination can be performed first. The purpose of the examination is to determine the possibility of fracture or dislocation and the degree of ligament damage in order to decide the next step of treatment.
Pay attention to the location of pain and pressure points, the degree of swelling, and whether the joint is deformed. Check the inversion and valgus test: turn the ankle inward to check the extent of the lateral ligament injury (whether the lateral range of motion of the ankle joint becomes larger or looser when the foot is turned inward). Turn the ankle joint outward to check the extent of medial ligament injury. Note the front drawer test: hold the upper end of the ankle with one hand and push it backwards while holding the heel with the other hand and pulling it forward to check if the range of motion becomes greater (compared to the uninjured side). Note that if the check is only a mild sprain, continue to ice and apply a compression pack? Elevate the affected limb. If the sprain is more severe, the patient should be taken to a doctor for treatment.
If the medial ligament of the ankle is injured, light, tape fixation, bandage wrapping in the corrected position. If the symptoms are severe, or if the ligament is completely ruptured or there is an avulsion fracture, the affected foot should be fixed with a short leg cast boot to keep it in the “overcorrected” position for about 4 to 6 weeks. A rubber pad or other abrasion resistant material can be added to the bottom of the cast boot to facilitate walking. If the fracture is large and poorly repositioned, the ankle should be cut and repositioned and internally fixed.
If the lateral ankle ligament injury is heavy, the short leg is fixed in a cast with a rubber pad added to the bottom of the foot. In case of old lateral ligament rupture or repeated sprains causing excessive laxity of the lateral ligament resulting in joint instability, reconstruction of the lateral ligament with the short fibular tendon can be considered.
Massage therapy: 3 days after the sprain, light massage can be performed: (1) massage the Xiexi point (the center of the transverse line of the ankle joint on the back of the foot, between the long thumb extensor tendon and the long toe extensor tendon) for 1 min; (2) massage the Kunlun point (the midpoint of the line between the outer ankle and the Achilles tendon) for 1 min; (3) massage the Hanging Bell point (3 inches below the tip of the outer ankle, the posterior edge of the fibula) for 1 min; (4) massage the Yanglingquan point (the depression below the small head of the fibula) for 1 min. All the above points should be massaged to the extent that the patient feels soreness and swelling. Tendon management method: When the ligaments of the affected ankle joint are in a relaxed state, comb the local ligaments longitudinally, and then do small flexion and extension and circular rotation activities of the ankle joint according to the injured area, and then fix the ankle joint in a neutral position.
Post-injury exercises
After the swelling and pain are reduced, you should walk on the ground or walk with the help of crutches under the fixation of adhesive plaster support band. After 1 to 2 weeks, you can perform muscle strength and coordination exercises, jogging on the sand or walking or jumping exercises on the bumpy slope, and gradually enter into formal exercises.
Move your feet: Within the scope of no pain, try to move your ankle in all directions, such as up and down or left and right, or as if you were practicing the letters of the alphabet such as ABCD.
Protection: The ankle should be protected with a fixed patch when walking. In general, you can use a brace instead.
Opposing force: Use your own hand to apply force to the ankle, and use the strength of the ankle to oppose it. Do not be wrenched by the hand.
Isotonic exercise: use the strength of the ankle to counteract the applied resistance of the rubber band, which is equivalent to a plyometric exercise.
Isometric exercise: Use a special “isometric exercise” training machine to strengthen the foot plate upward, downward, inward, and outward in all directions of muscle strength.
Brisk walking: You can walk as fast as you want without pain or limp, but you still need to land on your heel first.
Running: Start with jogging, gradually increase the speed of running, and finally sprinting.
Run around: (turn 45 degrees) with a distance of 20 meters as a length of eight, do a turn 45 degrees around the circle, the speed from slow to fast.
Run around: (turn 90 degrees) with a distance of 10 meters as the length of a figure of eight, do a turn 90-degree circle, the speed from slow to fast.
Other treatments.
Hydrotherapy: Use alternating hot and cold hydrotherapy, the method is as follows.
1. Immerse the affected area in 38-40 degrees Celsius for 4-6 minutes without pain.
2. Immediately change to cold water at 10-16 degrees Celsius for 1-2 minutes.
3, then return to hot water activity (as described in 1).
4. Do this 5 times alternating between hot and cold.
5, the last time must be immersed in hot water.
6.After finishing, elevate the affected part and move it for 5 minutes, then put on an elastic bandage.
7.The above 1-6 is a complete (hot and cold alternating hydrotherapy), after doing 2-3 times a day, about 1-2 weeks can completely reduce the swelling.
There are three principles.
(1) The first and the last time should be immersed in warm water.
(2) It is best to move the ankle while immersed in warm water, but still within the range of painless movement.
(3) The duration of warm water immersion should be longer than the duration of cold water immersion.
There are seven different stages from ankle injury to full recovery.
Stage 1: From the time of injury until the swelling no longer increases.
Stage 2: From when the swelling stops increasing to when there is no pain from normal walking.
Stage 3: From normal walking without pain to the complete disappearance of swelling.
Stage 4: From the complete disappearance of swelling to 75 degrees of ankle mobility in all directions without pain.
Stage 5: From no pain in all directions of movement of the ankle joint at 75 until 75 muscle strength is restored.
Stage 6: From the restoration of 75 muscle strength to the complete absence of pain in all directions of ankle mobility.
Stage 7: From no pain in all directions of ankle mobility until 100 muscle strength is restored.
Sprain precautions.
Ankle injury is a common clinical condition, mostly caused by a sudden inversion or valgus or rotation of the foot when a person is walking or running on an uneven road, or going downhill or downstairs, and the gravity is out of balance. In daily life, injured patients are used to scalding the affected area with hot water or hot towels, or rubbing the affected area with alcohol, while some people consider it a minor problem and insist on walking and working, which will not only aggravate the symptoms but also delay the treatment time.
After ankle injury, the first thing you should do is to judge yourself whether it is a soft tissue sprain or a fracture. In the case of sprains, the pain is felt immediately after the injury, the activity is limited, and you cannot walk or can barely walk, followed by swelling of the ankle joint; if the ankle is swollen and painful after the injury, the pressure pain in the inner and outer ankle is obvious, the bone rubbing sound can be heard, and there is functional impairment or even deformity, then it is an ankle fracture.