Nerve injury and Grades II and III ankle sprains

Abstract

Nerve injuries associated with inversion sprains of the ankle have been mentioned in the literature on a case presentation basis only. Sixty-six consecutive patients with Grade II (30) and Grade III (36) ankle sprains were examined by electromyography 2 weeks after injury to determine the presence and distribution of nerve injuries. Ankle active range of motion (AROM) and the number of weeks postinjury when the patient could heel/toe walk and return to full activity were also noted. Five patients (17%) with Grade II sprains had mild peroneal nerve injury and three (10%) injured the tibial nerve. Clinical measurements were normal by the end of the second week. Thirty-one patients (86%) with Grade III sprains injured their peroneal nerve, while 30 (83%) incurred posterior tibial nerve injury. Ankle AROM was impaired, and heel/toe walking (5.1 weeks) and return to full activity (5.3 weeks) were markedly prolonged. The likely cause of this injury is considered to be a mild nerve traction or a hematoma in the epineural sheath at the bifurcation of the sciatic nerve into peroneal and posterior tibial branches. This report indicates that a consistently high percentage of patients with Grade III ankle sprains sustain a significant injury to both motor nerves in the leg and that rehabilitation time is markedly prolonged.

Peroneus longus and tibialis anterior muscle activity in the stance phase: A quantified electromyographic study of 10 controls and 25 patients with chronic ankle instability

“…The finding of a prolonged peroneal reaction time and increased postural sway seems to substantiate this theory (Tropp 1985, Karlsson 1989, Konradsen and Ravn 1990. Peroneal muscle weakness (Bosien et al 1955, Tropp 1985 after immobilization of the muscle or due to overstretching of the peroneal nerves at the time of inversion trauma have been described (Hyslop 1941, Nitz et al 1985. Kleinrensink et al (1994) found a prolonged peroneal reaction time as a result of such overstretching.…”

“…Numerous factors, such as proprioceptive deficit, prolonged peroneal reaction time, increased postural sway, weakness of the peroneal muscles and damage to the peroneal nerves, have been related to functional instability of the ankle/foot (Hyslop 1941, Bosien et al 1955, Freeman et al 1965, Nitz et al 1985, Tropp 1985, Karlsson 1989, Konradsen and Ravn 1990). Whether these factors result in changes in the activity of the peroneal muscles during walking is still unknown.…”

Force sense deficits in functionally unstable ankles

“…Ankle sprain damage is thought to occur not only to ligaments, but also muscles and nerves that cross the ankle. 11,20 This idea has provoked additional research related to proprioceptive deficits believed to be derived from muscular sources, that is, force sense. The instability model that we are proposing is not the traditional feedback (i.e., neuromuscular response) model.…”

“…5 The recurrent instability could be due to factors such as muscular and proprioceptive deficits or neurological dysfunction. [6][7][8][9][10][11] Although each factor may contribute to the presence of functional ankle instability, the current investigation evaluated prorioceptive capabilities. Generally, the proprioceptive system assists in the perception and control of human movement by obtaining information from a variety of peripheral afferents.…”

Effect of Coordination Training on Proprioception of the Functionally Unstable Ankle

“…Isn't it possible that muscle and tendon mechanoreceptors could also become damaged following joint injury? Nitz et al (50) reported damage to the tibial and peroneal nerves following grade II and III ankle inversion sprains. If these large nerves are damaged, wouldn't neuromuscular interaction be affected?…”