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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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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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Essentials of Diagnosis

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  • First step—rule out a fracture or syndesmotic ankle sprain

  • Positive posterior drawer test and medial talar tilt test

  • Positive Kleiger's test (external rotation test)

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

    • Ultrasonography or MRI is 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 are 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 to 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 or anterior drawer testing (Grade I)

      • Unstable: laxity with anterior drawer testing (ATFL, Grade II); laxity with both the anterior drawer and talar tilt (ATFL and CF, Grade III)

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General Considerations

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  • Deltoid ligament is made up of two short bands of ligaments that run superficial and deep to the medial capsule of the ankle joint

  • May occur with a concomitant syndemosis sprain, lateral malleolus fracture, or chondral lesion

  • Medial ankle sprains are not very common. They account for approximately 10% to 15% of all ankle sprains3, 4

  • Medial ankle sprains are usually more severe and result in significantly greater time lost to injury than lateral ankle sprains3, 4

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Demographics

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  • Prevalent in athletes, though ...

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