Diagnosis of Ankle sprain
Diagnostic Test list for Ankle sprain:
The list of medical tests
mentioned in various sources as
used in the diagnosis of Ankle sprain
includes:
Ankle sprain Diagnosis: Book Excerpts
Diagnostic Tests for Ankle sprain: Online Medical Books
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ANKLE CLONUS:
Ask the following questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- What other symptoms and signs are present? Ankle clonus rarely occurs by itself. Usually, there are pathologic reflexes such as a Babinski's sign on the lower extremities. The patient usually also will complain of weakness and may be found to have weakness when the muscles are tested. If the ankle clonus is long-standing, there will be atrophy. There will also frequently be sensory findings, as well as sensory complaints. Finally, with bilateral ankle clonus there will often be hyperactive reflexes throughout the lower extremities and sometimes in the upper extremities.
- Is the ankle clonus unilateral or bilateral? If it is unilateral, then it is a sign of either hemiparesis or monoplegia, and if it is hemiplegia or hemiparesis, one should consider the possibility of a cerebral disorder. If there is headache and papilledema, that disorder is most likely a space-occupying lesion of the brain such as a brain tumor, abscess, or hematoma. If there is hemiparesis and it is acute in onset, there is most likely an occlusion of one of the cerebral arteries, whereas if the hemiparesis is gradual in onset, one should consider multiple sclerosis and, once again, a brain tumor. Ankle clonus associated with monoplegia is more likely related to a spinal cord tumor, but a parasagittal tumor could also be present. Bilateral ankle clonus is more likely due to a disorder of the spinal cord such as a spinal cord tumor, amyotrophic lateral sclerosis, or multiple sclerosis. Syringomyelia and Friedreich's ataxia may also present with bilateral ankle clonus. However, if there are cranial nerve signs, one must consider a brain stem tumor as well as other degenerative diseases of the brain and brain stem.
DIAGNOSTIC WORKUP
Ankle clonus is a significant clinical sign, especially when it is unilateral. Therefore, if a brain disorder is suspected, a CT scan of the brain or MRI of the brain should be done. If a spinal cord lesion is suspected, then a CT scan at the appropriate level of the spinal cord should be done. If there are no findings on the examination to indicate a level, then of course the entire spine would have to be covered. MRI is a more cost-effective method for the cervical and thoracic levels of the cord. The spinal tap with analysis of the fluid for myelin basic protein and gamma globulin levels should be done if multiple sclerosis is suspected. In addition, somatosensory evoked potentials (SSEPs) and visual evoked potentials (VEPs) should also be done if multiple sclerosis is suspected. Finally, the most cost-effective approach to a patient with ankle clonus is to refer the patient to a neurologic specialist.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Ankle Pain/Swelling:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Inversion sprain (85% of ankle sprains)
–Results in pain, swelling, and ecchymosis of the lateral malleolar area
–Damage occurs to the three ligaments of inferior fibula (anterior and posterior talofibular and calcaneofibular ligaments) and peroneal muscle
-
Degenerative joint disease
–Pain is present upon waking in the
morning; relieved by mild activity
–Grinding/popping occurs with motion
-
Inversion/eversion injury of subtalar joint
–Results in pain while walking on uneven ground
-
Syndesmosis injury (“high ankle sprain”)
–Stretching of the interosseous membrane
–Results in pain at the lower leg
-
Avulsion fracture of the distal fibula
–Results in persisting lateral malleolar pain
–Difficult to differentiate from the
epiphyseal line on X-ray -
Repetitive injury with disruption of the ankle retinaculum
–Results in chronic pain of the posterior aspect of the ankle
-
Poor shoe alignment
-
Bimalleolar fracture
-
Trimalleolar fracture: Bimalleolar fracture plus a fracture of the lateral aspect of the distal tibia
-
Neoplasm
-
Peroneal nerve entrapment
-
Diabetic (Charcot's) arthropathy
Workup and Diagnosis
- History and physical examination
–Ankle, foot, and lower leg examination
–Always evaluate neurovascular status, including pulses,
color, and capillary refill
–Observation of bones and soft tissues, color, swelling
–Anterior/posterior drawer test: Ankle is held in one hand
and the lower tibia is pushed and pulled to evaluate for instability
–Range of motion should be evaluate both actively and passively (grinding or popping suggests DJD)
-
Ottawa ankle rules are used to determine whether an X-ray of
the ankle is necessary following trauma
–Tenderness of the distal 6 cm of the fibula or tibia
–Tender navicular area
–Tender proximal fifth metatarsal
–Cannot bear weight (at least four steps)
-
Standard three-view ankle X-rays, stress views (inversion or eversion), and consider foot series or lower leg series
-
Lateral X-rays in plantar- or dorsiflexion may help evaluate for anterior or posterior impingement
-
CT or MRI may be indicated to clarify findings on plain films and to evaluate cartilage, nerves, tendons, ligaments
-
Muscle strength and range of motion testing
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
ANKLE CLONUS AND HYPERACTIVE AND PATHOLOGIC REFLEXES:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
A neurologist should be consulted at the outset. The neurologist will be able to determine whether a CT scan or magnetic MRI should be ordered and whether it should be of the brain, brainstem, or spinal cord. If there are obvious cranial nerve signs, the imaging study will include the brain and brainstem. Spinal cord lesions usually require x-ray of the spine and possibly myelography and spinal fluid analysis. In suspected intracranial pathology, a spinal tap should not be done until a CT scan or MRI has ruled out a space-occupying lesion.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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