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CONDITION/DISORDER SYNONYMS
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Deltoid ligament sprain
Medial ankle sprain
Eversion ankle sprain
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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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Disruption of deltoid ligament complex of the medial ankle
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 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
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: