II. Epidemiology
- Accounts for up to 10% of Ankle Sprains in high risk populations
- Most common sports associated with High Ankle Sprain
III. Mechanism
- Eversion and Rotation injury
- Hyper-dorsiflexion
IV. Anatomy
- Tibiofibular Syndesmosis injury
- Interosseous membrane (IM)
- Anterior Inferior tibiofibular ligament (AITF)
- Separation of Tibia from fibula
V. Symptoms
- Medial ankle pain
- Difficulty bearing weight
VI. Signs
- Minimal external signs of injury (e.g. swelling)
- Pain and Disability out of proportion with injury
- Ankle may feel spongy
- Ankle Squeeze Test positive
- Ankle External Rotation Test positive
- Crossed-Leg Test positive
- Point tenderness over anterior and proximal ankle
- Pain at distal tibiofibular joint
VII. Associated conditions
- Maisonneuve Fracture
- Proximal Fibula Fracture
- Palpate full length of fibula and tibia on exam
VIII. Imaging
-
Ankle XRay
- Tibiofibular clear space widening >6 mm indicates complete syndesmotic rupture
- Tibia-Fibula XRay
- Exclude Proximal Fibula Fracture (Maisonneuve Injury)
-
Ankle MRI
- Persistent Disability in an injury suggestive of High Ankle Sprain
IX. Management
- No early mobilization
- May require internal fixation
X. Prognosis
- More disabling than other Ankle Sprains
- May require 4-5 months to return to prior functional capacity
- Risk of ankle Degenerative Joint Disease
XI. References
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Related Studies
Concepts | Injury or Poisoning (T037) |
ICD9 | 845.03 |
SnomedCT | 74383007 |
English | Tibiofibular (ligament) sprain, distal, Sprain distal tibiofibul, Sprain of tibiofibular (ligament), distal of ankle, Sprain of distal tibiofibular ligament, Sprain of distal tibiofibular ligament (disorder), Tibiofibular ligament sprain, distal |
Dutch | tibiofibulaire (ligament)verstuiking, distaal |
French | Entorse du ligament tibio-péronier distal |
German | tibiofibulare (Band) Verstauchung, distal |
Italian | Distorsione del (legamento) tibiofibulare distale |
Portuguese | Estiramento do ligamento tibioperonial distal |
Spanish | Esguince (ligamentoso) tibioperoneo distal, esguince del ligamento tibioperóneo distal (trastorno), esguince del ligamento tibioperóneo distal, estrema del ligamento tibioperóneo distal |
Japanese | 遠位脛腓(靱帯)捻挫, エンイケイヒジンタイネンザ |
Czech | Podvrtnutí distálního tibiofibulárního vazu |
Hungarian | Tibiofibularis (szalag) húzódás, distalis |
Ontology: Distal tibiofibular sprain (C0434455)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 209533005 |
English | Distal tibiofibular sprain, Distal tibiofibular sprain (disorder), Tibiofibular sprain, distal |
Spanish | esguince tibioperoneo distal (trastorno), esguince tibioperoneo distal |
Ontology: Syndesmotic Injuries (C3661498)
Concepts | Injury or Poisoning (T037) |
MSH | D016512 |
English | Syndesmotic Injury, Syndesmotic Injuries, Injury, Syndesmotic, Injuries, Syndesmotic |