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CONDITION/DISORDER SYNONYMS

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  • Deltoid ligament sprain

  • Medial ankle sprain

  • Eversion ankle sprain

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ICD-9-CM CODE

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  • 845.01 Sprain of deltoid (ligament), ankle

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ICD-10-CM CODE

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  • S93.429A Sprain of deltoid ligament of unspecified ankle, initial encounter

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PREFERRED PRACTICE PATTERN

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

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PATIENT PRESENTATION

Patient is a 22-year-old collegiate basketball player who landed on another player’s foot when coming down with a rebound. The player felt immediate pain and was taken to the locker room for X-rays. The X-rays were negative for fracture. The patient presents with Grade-2 laxity of the deltoid ligament with a positive medial talar tilt test. The patient has difficulty with weight bearing and is wearing a walking boot. There is pain and tenderness along the medial ankle.

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KEY FEATURES

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Description
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  • Disruption of deltoid ligament complex of the medial ankle

    • May be acute or chronic.

  • Deltoid ligament complex

    • Restricts medial translation of the calcaneus on the talus.

    • Can rupture during forced dorsiflexion of the ankle and eversion of the foot.

    • Can also rupture during excessive external rotation of the talus with or without eversion of the foot.

    • Commonly injured during a lateral malleolus fracture where the talus is rapidly displaced against the fibula during excessive dorsiflexion.

  • Severity of the injury will dictate the signs and symptoms that are observed.

  • In mild to moderate sprains, pain occurs during passive dorsiflexion and eversion.

  • In severe sprains, swelling may be present over the posterior to the lateral malleolus, and deep to the medial in the posteromedial aspect of the distal leg.

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FIGURE 206-1

Medial ligaments of ankle joint. (From Hamilton N, Weimar W, Luttgens K. Kinesiology: Scientific Basis of Human Motion. 11th ed. http://www.accessphysiotherapy.com. Copyright © McGraw-Hill Education. All rights reserved.)

Graphic Jump Location
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Essentials of Diagnosis
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  • First step being to rule out a fracture or syndesmotic ankle sprain

  • Positive Posterior Drawer test and medial talar tilt test

  • Positive Kleiger test (external rotation test)

  • Ultrasonography (US), radiography, or MRI may be utilized in select cases1

    • US or MRI recommended following a medial ankle sprain in a patient with chronic ankle instability1

    • Radiographs utilized within the constraints of Ottawa Ankle Rules2

  • Deltoid ligament complex tears classified based on the anatomical degree of damage or functional stability found on clinical exam2

    • Anatomical:

      • Grade 1: Partial microscopic tearing of the ligament, minimal to no loss of function, mild swelling and pain

      • Grade 2: Partial macroscopic tearing of the ligament, with mild–moderate loss of function, moderate swelling/pain/tenderness

      • Grade 3: Complete rupture with severe loss of function, severe swelling/pain/tenderness

    • Functional stability:

      • Stable: No laxity with talar tilt ...

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