II. Epidemiology

  1. Accounts for up to 10% of Ankle Sprains in high risk populations
  2. Most common sports associated with High Ankle Sprain
    1. Football
    2. Downhill Skiing

III. Mechanism

  1. Eversion and Rotation injury
  2. Hyper-dorsiflexion

IV. Anatomy

  1. Tibiofibular Syndesmosis injury
    1. Interosseous membrane (IM)
    2. Anterior Inferior tibiofibular ligament (AITF)
  2. Separation of Tibia from fibula

V. Symptoms

  1. Medial ankle pain
  2. Difficulty bearing weight

VI. Signs

  1. Minimal external signs of injury (e.g. swelling)
  2. Pain and Disability out of proportion with injury
  3. Ankle may feel spongy
  4. Ankle Squeeze Test positive
  5. Ankle External Rotation Test positive
  6. Crossed-Leg Test positive
  7. Point tenderness over anterior and proximal ankle
    1. Pain at distal tibiofibular joint

VII. Associated conditions

  1. Maisonneuve Fracture
    1. Proximal Fibula Fracture
    2. Palpate full length of fibula and tibia on exam

VIII. Imaging

  1. Ankle XRay
    1. Tibiofibular clear space widening >6 mm indicates complete syndesmotic rupture
  2. Tibia-Fibula XRay
    1. Exclude Proximal Fibula Fracture (Maisonneuve Injury)
  3. Ankle MRI
    1. Persistent Disability in an injury suggestive of High Ankle Sprain

IX. Management

  1. No early mobilization
  2. May require internal fixation

X. Prognosis

  1. More disabling than other Ankle Sprains
    1. May require 4-5 months to return to prior functional capacity
  2. Risk of ankle Degenerative Joint Disease

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Related Studies

Ontology: Sprain of distal tibiofibular ligament (C0160091)

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