Abstract

PINTO, Francisco RL Guerra; CORTE-REAL, Nuno  and  CONSCIENCIA, José A. Guimarães. Entorse lateral do tornozelo: capacidade diagnóstica do exame objectivo e exames imagiológicos. Rev. Port. Ortop. Traum. [online]. 2016, vol.24, n.1, pp.37-50. ISSN 1646-2122.

Introduction: Ankle sprain is the most frequent musculoskeletal injury. A supination ankle trauma might cause lateral ligaments’ rupture and several associated lesions. The weakest of the lateral ankle ligaments is the anterior talo-fibular ligament (ATFL), and it’s the first to rupture. Recognizing this rupture has prognostic impact because one third of patients with ATFL rupture report restriction on long-term follow-up. Material and Methods: In this narrative review paper we outline the most relevant evidence regarding the clinical examination and imaging modalities in the diagnosis of ATFL rupture. Results: The clinical examination should identify the swelling, haematoma, tenderness over the ATFL and a positive anterior drawer. A significant swelling has an important positive predictive value and sensitivity. The presence of a hematoma over the lateral ligaments suggests an ATFL rupture while absence of tenderness on its insertion practically excludes it. The anterior drawer test is controversial but might be useful if performed 4 to 7 days after the injury. The imaging modalities include x-rays, sonography and magnetic resonance imaging. The sonography is cost effective and definitely a first line exam to confirm the diagnosis. It can also detect ankle effusion, which is a sign for other existing intra-articular lesions. MRI should be used in patients in which there are clinical or imaging signs of lesions other than the lateral ligaments. Conclusion: The presence of swelling, haematoma and positive drawer might assist in the diagnosis of severe ankle sprain, in whom there’s evidence to ask for a sonography or other exams.

Keywords : Ankle lateral ligament; diagnosis; ultrasonography; radiography; magnetic resonance imaging.

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