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High Ankle SprainAka: Syndesmotic Sprain, Syndesmosis Sprain

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  1. Epidemiology
    1. Accounts for 10% of Ankle Sprains
  2. Mechanism
    1. Eversion and Rotation injury
    2. Hyper-dorsiflexion
  3. Anatomy
    1. Tibiofibular Syndesmosis injury
      1. Interosseous membrane (IM)
      2. Anterior Inferior tibiofibular ligament (AITF)
    2. Separation of Tibia from fibula
  4. Symptoms
    1. Medial ankle pain
    2. Difficulty bearing weight
  5. 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
  6. Associated injuries
    1. Maisonneuve Fracture
      1. Proximal fibula Fracture
      2. Palpate full length of fibula and tibia on exam
  7. Imaging
    1. Ankle XRay
      1. Tibiofibular clear space widening >6 mm
    2. Ankle MRI
  8. Management
    1. No early mobilization
    2. May require internal fixation
  9. Prognosis
    1. More disabling than other Ankle Sprains
    2. Risk of ankle Degenerative Joint Disease
  10. References
    1. Rifat (1996) Am Fam Physician 53(8):2491
    2. Rubin (1996) Am Fam Physician 54(5):1609
    3. Sitler (1995) Sports Med 20(1):53
    4. Swain (1993) Postgrad Med 90(3):91
    5. Wolfe (2001) Am Fam Physician 63(1):93

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