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High Ankle Sprain
Aka: High Ankle Sprain, Syndesmotic Sprain, Syndesmosis Sprain, Syndesmotic Injury, Sprain of Distal Tibiofibular Ligament, Distal Tibiofibular Sprain
- See Also
- Ankle Sprain
- Ankle Sprain Management
- Epidemiology
- Accounts for up to 10% of Ankle Sprains in high risk populations
- Most common sports associated with High Ankle Sprain
- Football
- Downhill Skiing
- Mechanism
- Eversion and Rotation injury
- Hyper-dorsiflexion
- Anatomy
- Tibiofibular Syndesmosis injury
- Interosseous membrane (IM)
- Anterior Inferior tibiofibular ligament (AITF)
- Separation of Tibia from fibula
- Symptoms
- Medial ankle pain
- Difficulty bearing weight
- 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
- Associated conditions
- Maisonneuve Fracture
- Proximal Fibula Fracture
- Palpate full length of fibula and tibia on exam
- 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
- Management
- No early mobilization
- May require internal fixation
- Prognosis
- More disabling than other Ankle Sprains
- May require 4-5 months to return to prior functional capacity
- Risk of ankle Degenerative Joint Disease
- References
- Molinari (2009) Iowa Orthop J 29:130-8 [PubMed]
- Rifat (1996) Am Fam Physician 53(8):2491-8 [PubMed]
- Rubin (1996) Am Fam Physician 54(5):1609-18 [PubMed]
- Sitler (1995) Sports Med 20(1):53-7 [PubMed]
- Swain (1993) Postgrad Med 90(3):91-100 [PubMed]
- Wolfe (2001) Am Fam Physician 63(1):93-104 [PubMed]