Sprain, deltoid ligament

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

• 845.01 Sprain of deltoid (ligament), ankle

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

• 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with connective tissue dysfunction

Description

• 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

Essentials of Diagnosis

• 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)

General Considerations

• 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

Demographics

• 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 ...