Syndesmosis Injury Essay

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The player suffering the syndesmosis injury is an amateur rugby player aged sixteen years old male and is still in high school. The player is young and puberty is still occurring therefore, growing cartilage is more vulnerable to stresses compared to adults where cartilage has formed (Adirim and Cheng, 2003). This suggests that young adolescents are more susceptible to injury because stresses to growth plates can severely affect coordination and balance, resulting in poor motor skills (Wulf and Shea, 2002).
A subjective and objective assessment carried out by the physiotherapist using subjective, objective, assessment and plan (S.O.A.P) notes; this is a standardised medical evaluation for clinical records (Maggs, 1996). SOAP notes are useful because they provide a clear, concise framework documentation of client’s care permitting other health practitioners to interpret concerns and needs (Cameron & Turtle, 2002). A subjective assessment describes the current status of the patient’s function, history, symptoms and disabilities helping to shape an initial impression (Maggs, 1996). The physiotherapist recorded the present complaint as pain on the left side of left ankle. The incident occurred on 20/11/15 in a strongman session when a sand bag exercise handle broke and the bag fell onto his ankle causing him to fall. The player arrived at the physio room with the help of team mates unable to weight bear due to severe pain, tenderness and swelling around the lateral malleolus. This is suggested to be linked to syndesmosis injury (Collins, Teys, and Vicenzino, 2004). The injury also appears to be in the early stages of the inflammation phase where platelets & macrophages release growth factors to stimulate tissue repair (Nurden, 2011). On initial assessment with goniometer active range of motion (AROM) for plantarflexion scored 20°, dorsiflexion scored 14°, inversion scored 15° and eversion scored 5°. The loss in range of motion (ROM), constant pain, severity of pain and redness over the lateral malleolus, are common in acute injuries because inflammation is the body’s protective mechanism to limit tissue damage (Chen & Arayssi, 2006). On passive range of motion (PROM) plantarflexion scored full ROM, dorsiflexion scored almost full ROM and both inversion and eversion had been too painful to assess.
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The direct impact could have damaged the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL) or calcaneofibular ligament (CFL), this is suggested to be linked to high grade II (Orellana et al., 2012). impaired willingness of contractile and non-contractile structures to coordinate efficient response (Bonadies & Sterling, 1998).
Upon palpation the bony lateral malleolus and posteriorly up the fibula appeared tender this could be linked to bimalleolar fracture until x-rays confirm no bones are damaged (Beck, 1981)
Additionally, a talar tilt test done by the physiotherapist recorded the right ankle as 22º and the left affected as 16°. The player also demonstrated pain, reduced ROM and increased joint laxity; this would suggest a positive test because a talar tilt of more than 5°c compared to the unaffected ankle indicates instability in the ligaments (Gaebler et al., 1997). A talar tilt test had been done because it is more specific for detecting injury to the CFL (Rasmussen, 1985). The physiotherapist requested the player to visit A&E for an x-ray to rule out any fractures that might mimic an ankle sprain because high pain levels and the inability to weight bare are commonly mistaken for fractures (Facter, 1987). A magnetic resonance imaging (MRI) scan would have been better to detect the degree of damage to soft tissue injuries (STI) because the beams have a strong magnetic field, to target highly specific tissue (Oborn et al., 2015). X-rays are more cost-effective but only detect fractures by absorbing calcium in bones (Bruyere et al., 2007). The physiotherapist applied a horseshoe compression strapping to the player’s lateral malleolus as compression strapping helps to restrict movement, especially inversion where the ankle is most vulnerable to injury (Capasso, Maffulli, & Testa, 1989). A compression strapping had been done because compression is part of the protection, rest, ice and elevation (PRICE) principle for immediate first aid treatment; it can help reduce swelling and provide additional support (Kraemer et al., 2001). Furthermore, the physiotherapist immobilised the player’s ankle in a fixed boot to allow the

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