A high ankle sprain , also known as syndesmotic sprain , is a sprain of the syndesmotic ligament that connects the tibia and fibula in the lower leg, thus creating a joint and ankle splint for the ankle. The high ankle wrist is described high because it is located above the ankle. They consist of about 15% of all ankle sprains. In contrast to a common lateral ankle sprain, when the ligaments around the ankle are injured due to an internal sprain, a high ankle sprain occurs when the lower leg and legs spin out (spin out).
Video High ankle sprain
Injury Mechanism
The ankle joint consists of the resting talus in the mortar made by the tibia and fibula as described earlier. Since the talus is wider anteriorly (in front) than behind (behind), since the front of the foot is raised (dorsiflexion) reduces the angle between the leg and the lower leg to less than 90 °, the mortise is confronted. with an increasingly widespread talus. This force increases when the legs are simultaneously forced into external rotation (turned out). This chain of events can occur when the front of a skate hockey player attacks the board and the leg is forced out. This can also happen in football, for example, when a player is on the ground with his legs behind him, feet at right angles, and abrupt apps from a rotational power to heel - like when a person falls on his feet. Overall, the most common mechanism is external rotation and can occur at sufficient speed so that the actual mechanism is not recognized.
In this sequence of events, the most vulnerable structures are the inferior anterior tibio-fibral ligaments, uniting the lower end of the tibia and fibula and plays an important role in the maintenance of the mortise. Injuries to this ligament may vary from simple stretching to perfect rupture. Some restrictions for further injury are offered by structures on the inside of the ankle, medial malleolus and medial collateral ligaments. However, if this structure fails, the force will be transmitted beyond the anterior inferior tibiofibular ligament to a strong membrane that holds the tibia and fibula together for most of its length. This force can then exit through the upper end of the fibula, creating a so-called Maisonneuve fracture.
Maps High ankle sprain
Diagnosis
Those suffering from high ankle sprain usually come with pain in the front of the front of the foot above the ankle, with increased discomfort when rotating (external rotation) is applied. In some cases, the diagnosis is only performed after treatment for a more general, lateral, sprained ankle. Diagnosis can also be delayed because the swelling is usually small or absent and the true nature of the injury is not appreciated. Various diagnostic tests have been described as' squeeze ' (compressing the tibia and fibula above the midpoint of the calf),' dorsiflexion with compression " (patient dorsiflex) of the foot as the examiner suppresses internal maleleus and external), and ' external rotation " (patients sitting with their legs hanging and ankle at 90 ° and external rotation then applied to the leg) etc. None of them perform well enough to allow a diagnosis to be made on a single test, and is usually accomplished by combining multiple tests with appropriate imaging when indicated. Plain radiography, ultrasound or MRI can be used for diagnosis.
In the case of X-rays, demonstrations of tibia widening and fibula 'mortise', medial malleolus fracture, or Maisonneuve fracture, will show an unstable or potentially unstable injury. However, the 'normal' x rays do not exclude significant ligament injuries, and in one study, the ratio of X-ray diagnostics to known syndesmotic injuries was only one in 17. In contrast, ultrasound may allow injury to be visualized while the mortise is being emphasized. As a result, diagnostic modalities such as ultrasound or magnetic resonance imaging (MRI) that show the ligaments themselves may be helpful, if clinical suspicion persists.
Treatment
Treatment depends on the severity and recovery can be as short as a few days or for six months. In all ligament, initial, aggressive injuries, useful swelling controls and RICE techniques are generally applied:
- R est
- I ce
- C compression (wrapper, splint or cast)
- E levation
Two important issues should be addressed early. First, the determination of whether the ankle is stable or unstable. This is usually answered by a clinical assessment along with the results of the imaging modalities described previously. In case of suspected instability, specialist referrals are indicated as operations and some form of internal fixation may be an option, if not a requirement. Second, a decision on the degree of weight, if any, to be allowed. The answer to this is partly related to stability, partly to clinical estimates of ligament injury along with imaging findings, and partially associated with discomfort while withstand the load. The final decision depends largely on the circumstances.
The alternative size consists of H.E.M. (Healthy blood flow, Eliminate swelling and Mobility). This treatment shows an increase in healthy blood flow to the ankle, including the immune cells needed for healing. Treatment also suggests increased range of motion, stability, and healthy strength at the ankle to aid full recovery. Recent research has shown that macrophages (immune cells responsible for repair and muscle growth) are necessary for the muscle to regenerate to the state before the injury. This requires healthy blood flow, but because it has been suggested that "when ice is applied to the body for long periods, nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are 'dead ends' of tubes that usually help carry excess fluid tissue back into the cardiovascular system, when lymphatic permeability is increased, large amounts of fluid begin to flow from the lymphatic 'in the wrong direction' (to the wound area), increase the amount of swelling and local pressure and potentially contribute to greater pain. "As As a result, HEM rehab treatment of the ankle suggests not to injure injuries, and instead, follow a more proactive rehabilitation technique for recovery.
Rehabilitation is important. A significant percentage of these sprains also involve medial and/or lateral ankle ligament injuries and slow recovery and ongoing symptoms are common. However, limiting external rotation to protect ligament healing is a major concern and can usually be achieved with short foot casts, walking boots, and custom orthoses. The allowable load level can depend on individual tolerance and the less injured are able to fully load. However, most use crutches to reduce the load to some extent and those more uncomfortable may be limited to "toe touch" on the affected side for one to two weeks. Some supporters the ability to ascend and descend stairs with minimal discomfort as an indication to allow full, or at least progressive, weight-bearing. Early resistance training minimizes muscle atrophy and weakness and various exercises - elastic bands, ankle weights, increased heel training - can be used in conjunction with calf stretching. In the early stages, isometric strengthening and electrical stimulation will combat muscle atrophy and develop weakness.
See also
- Ankle sprains
References
Source of the article : Wikipedia
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