Ankle Syndesmosis Injuries ( High Ankle Sprain )

Total Page：16

File Type：pdf, Size：1020Kb

Ankle Syndesmosis Injuries ( High ankle sprain ) Anterior inferior tibiofibular ligament Interosseous ligament Posterior inferior tibiofibular ligament What is the syndesmosis? In more subtle injuries a weightbearing CT scan The syndesmosis is the ligaments which stabilise or MRI may be required to confirm the the fibula and the tibia at the ankle joint. diagnosis. They consist of the • Anterior inferior tibiofibular ligament • Posterior inferior tibiofibular ligament • Interosseous ligament When these ligaments get injured or torn this can result in increased movement between the tibia and fibula causing them to separate. This can cause pain and if unrecognised can cause long term problems in the ankle joint How does it get injured? Often associated with a twisting injury to the ankle. Can be caused when the foot is forced upward It can be associated with a fracture of the fibula. What is the treatment? Treatment is dependent on the extent of the What are the symptoms? ligament injury Patients report pain in the ankle which is often If only 1 ligament is injured – usually this is the felt higher up above the joint. anterior ligament then physiotherapy and Pain persists after appropriate rehabilitation activity modification is sufficient from a simple ankle sprain. If 2 ligaments are injured – treatment is Swelling around the front and outside of the dependant on the patient’s symptoms but may ankle. involve a cast for 6 weeks. In some cases surgery may be required if symptoms are persistent. How is it diagnosed? If 3 ligaments are injured and there is no Diagnosis is made from the patients history and instability or widening a cast non weightbearing examination. for 6 weeks then physiotherapy may be Xrays can confirm if there is a separation sufficient. between the bones in more severe injuries. If there is any widening or instability surgery is recommended. What does surgery involve? What are the risks of the procedure? Surgery involves an ankle arthroscopy to inspect General risks of surgery the joint and syndesmosis, to remove any • Infection inflammation and scar tissue. • Wound healing problems The tibia and fibula are then stabilised with • Nerve injury and scar sensitivity either screws or a tightrope anchor device. • Incomplete symptom resolution • Blood clots to the leg • Anaesthetic problems Specific risks for syndesmosis surgery • Stiffness of the ankle due to scarring • Screws requiring removal at 3 months • Screw breakage This information is an overview of the management of syndesmosis injuries and is not all inclusive. What does the rehabilitation involve? If you have any questions regarding this please • 1 night in hospital. contact Mr. Curry’s rooms on (03)9928 6188. • 2 weeks of elevation and rest • Total of 6 weeks in a cast non weightbearing • Driving at 9 weeks • By 3 months back to most recreational activities • Swelling improves by 6- 9 months • 6-9 months for final result How long will I be off work? This is dependent upon your occupation • Seated job 2-3 weeks • Standing job 6-8 weeks • Heavy lifting job 10-12 weeks When can I drive? • Manual car o No driving for 9 weeks • Automatic car o Left foot no driving for 2 weeks o Right foot no driving for 9 weeks .

Copy Link

Recommended publications

Medial Collateral Ligament (MCL) Sprain
INFORMATION FOR PATIENTS Medial collateral ligament (MCL) sprain This leaflet intends to educate you on Knee ligament sprains are graded in the immediate management of your severity from one to three: knee injury. It also contains exercises to prevent stiffening of your knee, Grade one: Mild sprain with ligaments whilst your ligament heals. stretched but not torn. Grade two: Moderate sprain with some What is an MCL injury? ligaments torn. Grade three: Severe sprain with There are two collateral ligaments, one complete tear of ligaments. either side of the knee, which act to stop side to side movement of the knee. The Symptoms you may experience medial collateral ligament (MCL) is most commonly injured. It lies on the inner side Pain in the knee, especially on the of your knee joint, connecting your thigh inside, particularly with twisting bone (femur) to your shin bone (tibia) and movements. provides stability to the knee. Tenderness along the ligament on the inside. Injuries to this ligament tend to occur Stiffness. when a person is bearing weight and the Swelling and some bruising. knee is forced inwards, such as slipping depending on the grade of the injury. on ice or playing sports, e.g. skiing, You may have the feeling the knee will football and rugby. In older people, this give way or some unstable feeling can be injured during a fall. An MCL injury can be a partial or complete tear, or overstretching of the ligament. Knee ligament injuries are also referred to as sprains. It’s common to injure one of your cruciate ligaments (the two ligaments that cross in the middle of your knee which help to stabilise), or your meniscus (cartilage discs that help provide a cushion between your thigh and shin bone), at the same time as your MCL.
[Show full text]
About Your Knee
OrthoInfo Basics About Your Knee What are the parts of the knee? Your knee is Your knee is made up of four main things: bones, cartilage, ligaments, the largest joint and tendons. in your body Bones. Three bones meet to form your knee joint: your thighbone and one of the (femur), shinbone (tibia), and kneecap (patella). Your patella sits in most complex. front of the joint and provides some protection. It is also vital Articular cartilage. The ends of your thighbone and shinbone are covered with articular cartilage. This slippery substance to movement. helps your knee bones glide smoothly across each other as you bend or straighten your leg. Because you use it so Two wedge-shaped pieces of meniscal cartilage act as much, it is vulnerable to Meniscus. “shock absorbers” between your thighbone and shinbone. Different injury. Because it is made from articular cartilage, the meniscus is tough and rubbery to help up of so many parts, cushion and stabilize the joint. When people talk about torn cartilage many different things in the knee, they are usually referring to torn meniscus. can go wrong. Knee pain or injury Femur is one of the most (thighbone) common reasons people Patella (kneecap) see their doctors. Most knee problems can be prevented or treated with simple measures, such as exercise or Articular cartilage training programs. Other problems require surgery Meniscus to correct. Tibia (shinbone) 1 OrthoInfo Basics — About Your Knee What are ligaments and tendons? Ligaments and tendons connect your thighbone Collateral ligaments. These are found on to the bones in your lower leg.
[Show full text]
Opso Summer 2014
The Lower Extremity OPSO Summer Primary Care CME Conference August 15, 2014 K. Turner Slicho, DO Case Presentation 53-year-old Caucasian female complains of left sided SI pain described as an ache w/o radiation Initial onset of pain was 25 years ago, when her back “seized up” bending over to put her toddler to bed. Infrequent issues over the next 10-15 years, then began to be more problematic Now, constant pain over the last 2 years Numbness in a small area of left shin. Denies weakness, tingling Case Presentation Unable to sit for long periods, bend over, cross legs comfortably Does not lift her grandson Does not brush teeth bending over without holding the sink No longer exercising due to pain 15 chiropractic session with two different providers over 2 years with “absolutely zero effect” on her pain 12 physical therapy sessions with marginal effect Case Presentation PMHx: Unremarkable** FHx: Cancer, DM, Food Allergies, Meniere’s Disease, Restless leg syndrome, Ulcerative colitis PSHx: C-section 1990, Appendectomy 2009, Hernia repair 2005 Meds: Diclofenac 100mg BID Case Presentation X-Ray: L4-L5 degenerative changes. Normal pelvis and SI joints bilaterally MRI: mild degenerative changes L3-S1 without significant neuroforaminal or spinal stenosis Neurosurgical evaluation : non-surgical back Case Presentation Gen: NAD, A&O x 3 Neuro: 2+/4 DTR’s, Strength 5/5, no motor deficits, mild sensory loss in left superio-lateral shin Extremities: no edema, ecchymosis, peripheral pulses normal Case Presentation: Somatic Dysfunction findings Cervical: Left posterior OA facet restriction Lumbar: L5 ERSl, left iliolumbar ligament hypertonicity, mild left psoas spasm and left erector spinae m.
[Show full text]
Anterior (Cranial) Cruciate Ligament Rupture
Cranial Cruciate Ligament Rupture in Dogs The cruciate ligaments are tough fibrous bands that connect the distal femur (thigh bone) to the proximal tibia (shin bone). Two cruciate ligaments, the cranial (anterior) and the posterior cruciate ligaments, are found in the knee joint of dogs and cats (and most other domestic animals). These ligaments work like a hinge joint in the knee and are responsible for providing anterior-posterior stability to the knee joint. Normal Knee Joint of a Dog Rupture of the cranial cruciate ligament is rare in cats. It occurs frequently in overweight, middle- and older-aged dogs. Certain dog breeds appear to be predisposed to cranial cruciate ligament rupture. Most commonly, the cocker spaniel and rottweiler are affected. The miniature and toy poodle, Lhasa apso, bichon frise, golden retriever, Labrador retriever, German shepherd and mastiff seem to be predisposed as well. The normal knee joint works as a hinge, keeping the knee stable as it bends. Tearing of the cranial cruciate ligament causes instability of the knee joint and it ceases to function properly. Most cranial cruciate ligament tears in dogs occur gradually, resulting in a low-level lameness that may or nay not improve over time. After the ligament tears, inflammation occurs within the joint. Continued use and weight bearing by the dog often causes the ligament to rupture completely. Dogs that rupture one cruciate ligament have about a fifty percent chance of rupturing the other. Normal Knee Joint of a Dog Rupture of the cranial cruciate ligament in dogs can also occur acutely. Similar to cranial cruciate ligament rupture in humans, resulting from athletic injuries to the knee, dogs can tear this ligament by jumping up to catch a ball or Frisbee or by jumping out of a truck or off a porch.
[Show full text]
Joints Classification of Joints
Joints Classification of Joints . Functional classification (Focuses on amount of movement) . Synarthroses (immovable joints) . Amphiarthroses (slightly movable joints) . Diarthroses (freely movable joints) . Structural classification (Based on the material binding them and presence or absence of a joint cavity) . Fibrous mostly synarthroses . Cartilagenous mostly amphiarthroses . Synovial diarthroses Table of Joint Types Functional across Synarthroses Amphiarthroses Diarthroses (immovable joints) (some movement) (freely movable) Structural down Bony Fusion Synostosis (frontal=metopic suture; epiphyseal lines) Fibrous Suture (skull only) Syndesmoses Syndesmoses -fibrous tissue is -ligaments only -ligament longer continuous with between bones; here, (example: radioulnar periosteum short so some but not interosseous a lot of movement membrane) (example: tib-fib Gomphoses (teeth) ligament) -ligament is periodontal ligament Cartilagenous Synchondroses Sympheses (bone united by -hyaline cartilage -fibrocartilage cartilage only) (examples: (examples: between manubrium-C1, discs, pubic epiphyseal plates) symphesis Synovial Are all diarthrotic Fibrous joints . Bones connected by fibrous tissue: dense regular connective tissue . No joint cavity . Slightly immovable or not at all . Types . Sutures . Syndesmoses . Gomphoses Sutures . Only between bones of skull . Fibrous tissue continuous with periosteum . Ossify and fuse in middle age: now technically called “synostoses”= bony junctions Syndesmoses . In Greek: “ligament” . Bones connected by ligaments only . Amount of movement depends on length of the fibers: longer than in sutures Gomphoses . Is a “peg-in-socket” . Only example is tooth with its socket . Ligament is a short periodontal ligament Cartilagenous joints . Articulating bones united by cartilage . Lack a joint cavity . Not highly movable . Two types . Synchondroses (singular: synchondrosis) . Sympheses (singular: symphesis) Synchondroses . Literally: “junction of cartilage” . Hyaline cartilage unites the bones . Immovable (synarthroses) .
[Show full text]
The Ligament Anatomy of the Deltoid Complex of the Ankle: a Qualitative and Quantitative Anatomical Study
e62(1) COPYRIGHT Ó 2014 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED The Ligament Anatomy of the Deltoid Complex of the Ankle: A Qualitative and Quantitative Anatomical Study Kevin J. Campbell, BS, Max P. Michalski, MSc, Katharine J. Wilson, MSc, Mary T. Goldsmith, MS, Coen A. Wijdicks, PhD, Robert F. LaPrade, PhD, MD, and Thomas O. Clanton, MD Investigation performed at the Department of Biomedical Engineering, Steadman Philippon Research Institute, and the Steadman Clinic, Vail, Colorado Background: The deltoid ligament has both superficial and deep layers and consists of up to six ligamentous bands. The prevalence of the individual bands is variable, and no consensus as to which bands are constant or variable exists. Although other studies have looked at the variance in the deltoid anatomy, none have quantified the distance to relevant osseous landmarks. Methods: The deltoid ligaments from fourteen non-paired, fresh-frozen cadaveric specimens were isolated and the ligamentous bands were identified. The lengths, footprint areas, orientations, and distances from relevant osseous landmarks were measured with a three-dimensional coordinate measurement device. Results: In all specimens, the tibionavicular, tibiospring, and deep posterior tibiotalar ligaments were identified. Three additional bands were variable in our specimen cohort: the tibiocalcaneal, superficial posterior tibiotalar, and deep anterior tibiotalar ligaments. The deep posterior tibiotalar ligament was the largest band of the deltoid ligament. The origins from the distal center of the intercollicular groove were 16.1 mm (95% confidence interval, 14.7 to 17.5 mm) for the tibionavicular ligament, 13.1 mm (95% confidence interval, 11.1 to 15.1 mm) for the tibiospring ligament, and 7.6 mm (95% confidence interval, 6.7 to 8.5 mm) for the deep posterior tibiotalar ligament.
[Show full text]
High Ankle Sprain
SYNDESMOSIS INJURY (HIGH ANKLE SPRAIN) A syndesmosis injury, also known as a high WHAT ARE THE SYMPTOMS ● Restore joint proprioception ankle sprain, is an injury to the ligaments OF A SYNDESMOSIS and balance at the top of your ankle. These high ankle INJURY? ● Restore normal function ligaments connect your tibia (shin bone) and ● Pain felt above the ankle that increases ● Walking fi bula (outside leg bone) to your calcaneum with outward rotation of the foot ● Running (heel bones), and form part of your ankle. ● Pain with walking and often signifi cant ● Jumping and landing The injury involves the syndesmosis, a bruising and swelling across the higher ● Speed and agility ligament that holds the lower part of your ankle rather than around the malleolus ● Sport-specifi c skills tibia and fi bula together just above your (ankle bones) ● Resume sport. ankle joint. ● Inability to perform a one-legged calf High ankle sprains are much less raise (going up onto your toes) Phase 1 of treatment is focused around common but are more disabling than your ● Feeling of instability/‘no confi dence’ pain relief and reducing infl ammation. traditional lower ankle sprain (when you jumping on the injured leg. This includes the RICE protocol - rest, ice, roll over the outside of your ankle). They compression and elevation. Treatments must be diagnosed early and appropriate The severity of the symptoms will depend may also include electrotherapy, strapping treatment started, which differs from a on the grade of ankle sprain. Patients with and gentle massage after the fi rst 48 hours. traditional ankle sprain, in order to get best a high ankle sprain without fracture may be Phase 2 of treatment, the therapist will results.
[Show full text]
Rehabilitation Guidelines for Knee Multi-Ligament Repair/Reconstruction
UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Knee Multi-Ligament Repair/Reconstruction The knee joint is comprised of an A B articulation of three bones: the femur Medial (thigh bone), tibia (shin bone), Collateral Ligament Lateral and patella (knee cap). The femur (MCL) Collateral has a medial (inside) and a lateral Ligament (outside) condyle that forms a radial (LCL) or rounded bottom that comes together, forming a trochlear groove for the patella to move. The medial and lateral condyle sit on top of the Fat LM Fat Pad tibia, which has a flat surface called Pad MM the tibial plateau. The knee also is comprised of two Fibula menisci, which are fibro-cartilaginous structures and each meniscus Figure 1 a: Medial or inner view of the knee showing the medial collateral ligament, is thinner towards the center of b: Lateral or outer view of the knee showing the lateral collateral ligament. the knee and thicker toward the Image property of Primal Pictures, Ltd., primalpictures.com. Use of this image without authorization from Primal Pictures, Ltd. is prohibited. periphery of the knee, giving it a wedge-shaped appearance. The Femur medial meniscus forms a “c” shape and is located between the medial ACL femoral condyle and the medial ACL LCL aspect of the tibia. The lateral meniscus forms an oval shape and is PCL located between the lateral femoral condyle and the lateral aspect of the MM LM tibia. The menisci act to improve stability between the tibia and the Menisci MCL Tibia femur secondary to its wedge shape that acts to limit translation.
[Show full text]
Nomina Histologica Veterinaria, First Edition
NOMINA HISTOLOGICA VETERINARIA Submitted by the International Committee on Veterinary Histological Nomenclature (ICVHN) to the World Association of Veterinary Anatomists Published on the website of the World Association of Veterinary Anatomists www.wava-amav.org 2017 CONTENTS Introduction i Principles of term construction in N.H.V. iii Cytologia – Cytology 1 Textus epithelialis – Epithelial tissue 10 Textus connectivus – Connective tissue 13 Sanguis et Lympha – Blood and Lymph 17 Textus muscularis – Muscle tissue 19 Textus nervosus – Nerve tissue 20 Splanchnologia – Viscera 23 Systema digestorium – Digestive system 24 Systema respiratorium – Respiratory system 32 Systema urinarium – Urinary system 35 Organa genitalia masculina – Male genital system 38 Organa genitalia feminina – Female genital system 42 Systema endocrinum – Endocrine system 45 Systema cardiovasculare et lymphaticum [Angiologia] – Cardiovascular and lymphatic system 47 Systema nervosum – Nervous system 52 Receptores sensorii et Organa sensuum – Sensory receptors and Sense organs 58 Integumentum – Integument 64 INTRODUCTION The preparations leading to the publication of the present first edition of the Nomina Histologica Veterinaria has a long history spanning more than 50 years. Under the auspices of the World Association of Veterinary Anatomists (W.A.V.A.), the International Committee on Veterinary Anatomical Nomenclature (I.C.V.A.N.) appointed in Giessen, 1965, a Subcommittee on Histology and Embryology which started a working relation with the Subcommittee on Histology of the former International Anatomical Nomenclature Committee. In Mexico City, 1971, this Subcommittee presented a document entitled Nomina Histologica Veterinaria: A Working Draft as a basis for the continued work of the newly-appointed Subcommittee on Histological Nomenclature. This resulted in the editing of the Nomina Histologica Veterinaria: A Working Draft II (Toulouse, 1974), followed by preparations for publication of a Nomina Histologica Veterinaria.
[Show full text]
Medial Meniscus Anatomy
Quantitative and Qualitative Assessment of the Posterior Medial Meniscus Anatomy Defining Meniscal Ramp Lesions Nicholas N. DePhillipo,*y MS, ATC, OTC, Gilbert Moatshe,yz§ MD, PhD, Jorge Chahla,z MD, PhD, Zach S. Aman,z BA, Hunter W. Storaci,z MSc, Elizabeth R. Morris,z BA, Colin M. Robbins,z BA, Lars Engebretsen,§ MD, PhD, and Robert F. LaPrade,*k MD, PhD Investigation performed at Steadman Philippon Research Institute, Vail, Colorado, USA Background: Meniscal ramp lesions have been defined as a tear of the peripheral attachment of the posterior horn of the medial meniscus (PHMM) at the meniscocapsular junction or an injury to the meniscotibial attachment. Precise anatomic descriptions of these structures are limited in the current literature. Purpose: To quantitatively and qualitatively describe the PHMM and posteromedial capsule anatomy pertaining to the location of a meniscal ramp lesion with reference to surgically relevant landmarks. Study Design: Descriptive laboratory study. Methods: Fourteen male nonpaired fresh-frozen cadavers were used. The locations of the posteromedial meniscocapsular and meniscotibial attachments were identified. Measurements to surgically relevant landmarks were performed with a coordinate measuring system. To further analyze the posteromedial meniscocapsular and meniscotibial attachments, hematoxylin and eosin and alcian blue staining were conducted on a separate sample of 10 nonpaired specimens. Results: The posterior meniscocapsular attachment had a mean 6 SD length of 20.2 6 6.0 mm and attached posteroinferiorly to the PHMM at a mean depth of 36.4% of the total posterior meniscal height. The posterior meniscotibial ligament attached on the PHMM 16.5 mm posterior and 7.7 mm medial to the center of the posterior medial meniscal root attachment.
[Show full text]
High Ankle Sprains: Diagnosis & Treatment
High Ankle Sprains: Diagnosis & Treatment Mark J. Mendeszoon, DPM, FACFAS, FACFAOM Precision Orthopaedic Specialties University Regional Hospitals Advanced Foot & Ankle Fellowship- Director It Is Only an Ankle Sprain Evaluate Degree of Ecchymosis & Edema If Not Properly Treated Chronic Pain & Ankle Instability Epidemiology Waterman et al. JBJS 2010 states: 2 million ankle sprains per year = 2 billion in health care cost Injury results in time lost and disability in 60% of patients 30% of all sport injury Epidemiology Syndesmotic Injuries: •1% to 18% of all ankle sprains • 32% develop calcification and chronic pain •High incidence of post traumatic arthritis Greater source of impairment than the typical lateral ankle sprain Anatomy Inferior Tibiofibular Joint: defined as a syndesmotic articulation which consists of five separate portions Motion in all three planes Anatomy “Syndesmotic Ligaments: • Anterior Inferior Tibio Fibular Ligament • Posterior Inferior Tibio Fibular Ligament • Transverse Tibio Fibular Ligament • Interosseous Ligament • Interosseous Membrane Deltoid Ligament The deep portion of the deltoid ligament also contributes to syndesmotic stability Acting as a restraint against lateral shift of the talus Biomechanics of Syndesmosis RELEVANT ASPECTS OFANKLE: A considerable clearance takes place between the talus and the distal fibula, which is limited by the tibiofibular syndesmosis With normal stance, almost no twisting and shearing forces act on the ankle joint= static tibfib tension Axial loading tensions AITF and PITF with increase of 10 -17% of body weight intact syndesmosis, the intermalleolar distance increases with dorsiflexion of the talus by 1.0 to 1.25 mm Haraguchi et al. 2009 Intact syndesmosis Fibula ROTATES 2 * externally Equals ~ 2.4 mm distally 0.2-0.4 mm Anterior -posteriorly THUS Fibula moves in 3 D Ogilvie & Harris 1994 Study on Individual Ligaments for Syndesmotic Stability 35% ATIFL 33% TRANSVERSE LIG.
[Show full text]
Sports Injuries of the Foot and Ankle
Sports Injuries of the Foot and Ankle Dr. Travis Kieckbusch August 7, 2014 Foot and Ankle Injuries in Athletes • Lateral ankle sprains • Syndesmosis sprains “high ankle sprain” • Achilles tendon injuries • Lisfranc injuries • Fifth metatarsal fractures • Plantar plate injury Foot and Ankle Injuries in Athletes • Lateral ankle sprains • Syndesmosis sprains “high ankle sprain” • Achilles tendon injuries • Lisfranc injuries • Fifth metatarsal fractures • Plantar plate injury Lateral Ankle Sprains • Most common injury in sports • Mechanism of injury is inversion • Injury to ATFL and CFL most commonly • Lateral ankle ligaments • Deltoid (medial)involved in more severe cases • Significant variability in severity Ankle Ligaments Lateral Ankle Sprains • Most common injury in sports1 Lateral Ankle Sprains • Physical exam • Swelling and ecchymosis laterally • Possibly medially as well • Limited motion • Tenderness over ATFL, CFL • Variable ability to bear weight Ottawa Ankle Rules Lateral Ankle Sprains • Treatment • Most treated non-operatively • Brace/splint until pain tolerable • Edema control • Most important is rehabilitation including proprioception • Most common cause of recurrent sprain is failure to rehab correctly Lateral Ankle Sprains • Treatment • Operative treatment for chronic instability following injury • No indication for acute surgery • Beware of lateral process talar fracture in lateral ankle sprain that won’t resolve Lateral Ankle Sprains • Treatment • Operative treatment for chronic instability following injury Lateral Ankle
[Show full text]