ChiroACCESS Clinical Review

Lateral Ankle Sprain: Diagnosis

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.


How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)

Published on

May 7, 2008

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Ankle injuries are responsible for 15% of all sports injuries (1) and are commonly encountered in practice. The diagnostic difficulties surrounding grading of the injury and ruling out fracture are the greatest challenges to the physician. Many of the articles located are “how to” articles and the author’s comments appear very strong in support of certain diagnostic procedures. However there is very little in the literature that demonstrates sensitivity and specificity of standard diagnostic procedures, particularly related to partial ligament tears and ruptures.

The reader should also be aware that van Dijk et al (2) reported delayed examination at five days provided more accurate findings than examination performed within 48 hours of the injury. When combining all clinical testing and history, specificity was 84% and sensitivity was 96% at 5 days.

Ankle Sprain Grading
Extent of Injury No Tear Partial Tear Complete Tear
Swelling Yes, No Ecchymosis Yes, with Ecchymosis (30%) Yes, with Ecchymosis (70%)
Pain on Palpation over ATFL Mild Moderate Intense
Anterior Drawer Test Negative Negative Positive
Difficulty Weight Bearing None Usually Almost Always
Loss of Function Minimal Some Great

Taken from the combined works of Dijk (2), Ivins (3), Sizer (4), Lynch (5), Rubin (1) and Wexler (6)

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