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  • Deltoid ligament sprain
  • Medial ankle sprain
  • Eversion ankle sprain

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  • 845.01 Sprain of deltoid (ligament), ankle

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

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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 does occur in sedentary individuals
    • Most common in basketball, soccer, and football athletes5
  • Males between 15 and 24 years old have higher rates of ankle sprains than female counterparts; females ...

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