UMEM Educational Pearls

Title: High ankle sprain

Posted: 11/23/2024 by Brian Corwell, MD
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Ankle sprains are frequently lateral.

They occur less frequently to the medial or “high” ankle.

High ankle sprains without fracture occur in 5-6% of ankle injuries presenting to the ED

Rates of injury are much higher in college and professional hockey and football players

The tibiofibular syndesmosis is primarily injured in high ankle sprains

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

Mechanism: Typically, external rotation or eversion on a dorsiflexed ankle

Example: When a player’s leg is forcefully rotated while foot is planted

Hx: anterior lateral ankle pain. Frequently significant pain with weight bearing.

PE: local tenderness over the syndesmosis ligaments

Two specialized tests may aid in the diagnosis

The Squeeze test – 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.

https://wikism.org/Squeeze_Test#/media/File:Squeeze_test_example.jpg

2. Dorsiflexion-external rotation test – 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.

https://www.dralexjimenez.com/wp-content/uploads/2017/07/external-rotation-test-1.png