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<h2><strong>Title:</strong> <a href="https://umem.org/educational_pearls/4657/">High ankle sprain</a></h2>
<p><strong>Category:</strong> <a href="https://umem.org/educational_pearls/?category=2">Orthopedics</a></p>
<p>
<strong>Posted:</strong> 11/23/2024 by <a href="https://umem.org/educational_pearls/?author=294">Brian Corwell, MD</a>
<br/>
<a href="https://umem.org/profiles/faculty/294/">Click here to contact Brian Corwell, MD</a>
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<p>Ankle sprains are frequently lateral. </p>
<p>They occur less frequently to the medial or “high” ankle.</p>
<p>High ankle sprains without fracture occur in 5-6% of ankle injuries presenting to the ED</p>
<p>Rates of injury are much higher in college and professional hockey and football players</p>
<p>The <em>tibiofibular syndesmosis</em> is primarily injured in high ankle sprains</p>
<p><a href="https://static.wixstatic.com/media/33808e_9b9406f4104142eeafe3447bd73e0d0cmv2.jpg/v1/fill/w_785,h_540,al_c,q_85,usm_0.66_1.00_0.01,enc_auto/33808e_9b9406f4104142eeafe3447bd73e0d0cmv2.jpg">https://static.wixstatic.com/media/33808e_9b9406f4104142eeafe3447bd73e0d0cmv2.jpg/v1/fill/w_785,h_540,al_c,q_85,usm_0.66_1.00_0.01,enc_auto/33808e_9b9406f4104142eeafe3447bd73e0d0cmv2.jpg</a></p>
<p>Mechanism: Typically, external rotation or eversion on a dorsiflexed ankle </p>
<p>Example: When a player’s leg is forcefully rotated while foot is planted</p>
<p><strong>Hx</strong>: anterior lateral ankle pain. Frequently significant pain with weight bearing.</p>
<p><strong>PE</strong>: local tenderness over the syndesmosis ligaments </p>
<p>Two specialized tests may aid in the diagnosis</p>
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<strong>The Squeeze test</strong> – This test attempts to reproduce the pain from the tear/instability. Have patient sitting on edge of bed with leg hanging off end to gravity. Examiner squeezes mid calf to create medial lateral compression. Reproduced pain is a positive test. Low sensitivity high specificity.</li>
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<p><a>https://wikism.org/Squeeze_Test#/media/File:Squeeze_test_example.jpg</a></p>
<p><strong>2. Dorsiflexion-external rotation test</strong> – This test attempts to reproduce the forces commonly involved in the original injury. Positive test is reproduction of pain. Position patient similar to above test. Grasp the upper calf with one hand while the other hand grasps the midfoot and places the foot in dorsiflexion and external rotation. </p>
<p><a href="https://www.dralexjimenez.com/wp-content/uploads/2017/07/external-rotation-test-1.png">https://www.dralexjimenez.com/wp-content/uploads/2017/07/external-rotation-test-1.png</a></p>
<h3>View this pearl on the University of Maryland, Department of Emergency Medicine's website: <a href="https://umem.org/educational_pearls/4657/">https://umem.org/educational_pearls/4657/</a></h3>
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