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Syndesmosis sprain?
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Syndesmosis sprain? - September 9, 2003 5:51:00 PM
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Justin
Posts: 32
Joined: February 15, 2002
From: SD
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Sorry for the ignorance, but getting back into ortho after a long absence, and don't want to miss anything. saw a 17 y/o kid today, was tackled from behind with the ankle in DF / EVE (was cutting)~ 2 weeks ago. No pain with gait (only with pushing off, jogging, etc.), no appreciable swelling / ecchymosis; pain identified just anterior as well as proximal to the lateral malleolus. Tenderness in the sinus tarsi at the ant talofib ligament as well as over the ant tibiofib ligament. Good strength with the exception of resisted inversion, which significantly increases his complaints. Ant. drawer and talar tilt with slightly increased laxity but without pain, as well as not pain with squeezing mid-calf or with fibular ant / post gliding. Mechanism of injurty doesn't really support lat. sprain (which MD dx'd), could this be a mild "high" sprain? Again, I apologize for the lack of knowledge, getting back into the ortho side as best I can......... Any ideas GREATLY apreciated! (By the way, I treated today with pulsed phono to the seemingly injured structures, initiated gentle stretching / strengthening and proprioceptive ex's, all of which he was able to perform with pain)
Thanks........
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Re: Syndesmosis sprain? - September 9, 2003 5:53:00 PM
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Justin
Posts: 32
Joined: February 15, 2002
From: SD
Status: offline
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Sorry - performed exercise without pain. Also, xrays negative per patient / family (wasn't albe to contact MD).
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Re: Syndesmosis sprain? - September 9, 2003 6:13:00 PM
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Sam B
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Joined: August 6, 2003
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Hi Justin!
I am having a hard time picturing the mechanism of injury to his ankle. It sounds like he did not invert his foot? Is that correct?
Sam B
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Re: Syndesmosis sprain? - September 9, 2003 6:19:00 PM
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Justin
Posts: 32
Joined: February 15, 2002
From: SD
Status: offline
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Sam-
Yes, he did not invet his foot (according to the patient). Instead seems to have been in DF and EVE. Doesn't seem classic to a sydesmosis type sprain, but more so than lat sprain.
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Re: Syndesmosis sprain? - September 9, 2003 6:31:00 PM
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PTupdate.com
Posts: 1490
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Go by what you see clinically, not what you think should happen based on their interpretation of the injury mechanism. If tender over the ATF and laxity present, and no past history of sprain, he may have damaged these ligaments.
And accordingly, treat what you see.
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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Re: Syndesmosis sprain? - September 9, 2003 7:08:00 PM
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Sam B
Posts: 73
Joined: August 6, 2003
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Hi Justin,
So, maybe you are looking at a dorsiflexion/ eversion injury. If he was cutting, the he had his weight laterally over the lateral ankle. Talus is wider anteriorly, the foot when forcefull dorsifeled moves in a combination of DF, evr and forefoot abduction. He could've stretched the syndesmosis, torn some anterior capsule. For sure could have nipped and compressed the synovium/ anterolat capsule in the simus tarsi between talus and fibula. The weight was very lateral, so he avoiding pulling at tissues posteriorly too dramatically. Sounds like a chondral injury is possible, but not probable for now?
It sounds like you may not have to worry about things too much from the sounds of your clinical exam. Its always nice to see things clearly though, I know. Thats how you know you are a competent critical thinker.
My very best,
Sam
[This message has been edited by Sam B (edited September 10, 2003).]
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Re: Syndesmosis sprain? - September 10, 2003 1:49:00 PM
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Justin
Posts: 32
Joined: February 15, 2002
From: SD
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Thanks Sam. I'll let you know if I see anything else when I see him tomorrow........
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