Ankle Syndesmosis Injuries | Expert Physio Overview
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- Опубліковано 10 лют 2025
- In this tutorial, we use our 3D anatomy model to show you the anatomy of the ankle and syndesmotic ligaments to explain how they can be injured, how they can be diagnosed and how to treat in practice.
References:
Morgan, Konopinski and Dunn (2014): www.aspetar.co...
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Informative thank you. I recently fractured my distal fibula and rupture my pitfl. I needed surgery to fix it.
Wishing you all the very best with your recovery!
Tightrope surgery or screw fixation ?
Brilliant video and clearly presented. Thank you, I now have more knowledge on how to recognise and treat this type of injury.
Thank you so much Jason!
Great presentation. I'm recovering from a grade 3 which required a tightrope procedure. As I'm a older senior football player this is taking 6 weeks just to walk. Football is off the cards now. :)
This is so helpful - I start a new role soon in foot and ankle and this is brilliantly explained- you little lifesaver - thanks so much 🙏🏻 🇬🇧
You're so welcome! Thank you for watching!
@@ClinicalPhysio I had a Weber C fracture, and the dr says that means I must have also torn my syndesmosis and deltoid ligaments. I had surgery to repair the broken fibula, as well as open reduction and internal fixation screwing my tibia and fibula together. The ligaments were NOT repaired through surgery. The dr says that because of the ORIF surgery that they will heal on their own over time. Is this true?
AI课代表的笔记：本视频介绍了踝关节的胫腓骨联接伤（又称高踝扭伤）的解剖结构、成因、症状及治疗方法。胫腓骨联接由前、后胫腓韧带和间骨膜组成，起到连接胫骨和腓骨的重要作用。常见的损伤机制包括踝关节的外旋和背屈，尤其在足球和美式足球运动中。损伤分为1至4级，较严重的伤情可能需要手术治疗。康复期因受伤程度不同而异，轻度损伤可在4至6周内恢复，重度损伤则需更长时间。
00:00 🦵踝关节胫腓联合损伤：本章节介绍了踝关节的胫腓联合损伤（Syndesmosis injury），强调其解剖结构及重要性。胫腓联合通过前后胫腓韧带和骨间膜连接胫骨和腓骨，提供支撑和稳定性。该损伤通常被称为高位踝扭伤，因其影响踝关节上方的韧带，导致踝关节的不稳定性和功能障碍。
03:09 📊韧带损伤分级解析：本章节讨论了韧带损伤，特别是对韧带损伤的分级。韧带损伤分为1至4级，1级为前下胫腓韧带受伤，4级则包括多种韧带的损伤，包括踝部的三角韧带。外部旋转导致的踝部损伤常见于足球和美式橄榄球运动员，诊断时需关注疼痛位置及损伤机制。
06:18 🦶外侧踝部损伤评估：本章节探讨了外侧踝部损伤的评估与管理，重点关注关节间韧带损伤（Syndesmosis injury）。通过压缩测试和Cliger's测试评估疼痛，若阳性则可能需要拍X光确认。轻度损伤可通过常规康复恢复，重度损伤可能需手术修复。未手术患者可通过物理治疗康复，借鉴顶级物理治疗师的经验。
09:28 🏋二三级损伤康复方法：本章节讨论了运动医学中对二级和三级踝关节损伤的康复方法。对于二级损伤，患者初期需穿气垫靴以促进愈合，之后进行基础的运动和力量训练。三级损伤则需更长时间恢复，初四周需保持静止，随后逐步进行水中训练和低重力康复，最终在九周后才能考虑恢复运动。针对不同级别的运动员，康复时间有所不同。
Hi Khalid, what an unbelievable video. You have helped me so much, thanks a lot!!
You’re very welcome! Hope you can enjoy our other content too!
Thank you, this helped me with the clinical conference ;)
I'm so glad! Thank you for watching!
Two weeks ago I tripped down a gutter. Right ankle rolled like you described.
The paramedic described it as an “inversion injury” and the hospital kept this description. My doctor updated it to an “eversion injury” when I described it to her.
The result was an Avulsion fracture medial malleolus - and after a further xray a Proximal fibular fracture.
Apparently this small twist ricocheting up the leg to break the top of the fibula is a strong indicator of sydnesmotic injury - an MRI confirmed this, and I’ve had surgery Thursday to tie the tibula and fibula together.
Seems a complicated injury. All focus is on the syndesmotic injury, nothing on the ankle or fibula - apparently the Fibuka is only mildly displaced so it will heal on its own. I got DVT too.
The biggest problem for me now is that the advice I’m given assumes a high ankle sprain, and contradicts advice for Fibula fracture and DVT. Makes it hard to manage.
I’m learning. Appreciate your video. I’m not an athlete, just a 51yo teacher who didn’t look where he was stepping.
So sorry to hear about your troubles, I hope you are making your first steps of recovery. Absolutely do ask your medical team if you are unsure about what you should be doing for rehab 🙏🏼
Have two anchors (syndesmosis) from my tib to fib from a platform fracture ORIF, thankfully they are coming out because they were suppose to break and allow more flex
Wishing you all the best!
I injured my syndesmosis and got a close bimalleolar fractured dislocation, and I did this by just falling off a skateboard and it’s commonly the back foot that lands and then gets injured I needed an ORIF surgery and a hardware removal surgery to get me walking again. I’m still recovering from the removal of syndesmosis screws
I tore mine two years ago, and it was initially diagnosed as a sprain.
Hi Khalid, thanks a lot for the work you are doing ,am PT student in Ethiopia. i am suffering for lower back pain for one year duration and my x ray result show that i do have a schmorl' s node , i hade try some exercise but no help, what do you think i have to do next?.
Hi, great video! I was wondering what app did you use for the 3d anatomy
Hi! We had this app created for us by software developers so that we could use it for our teaching 😊
Hi, do you have a clinic where you provide treatment?
Hi Khalid, very interesting videos as usual. Are you a Liverpool football fan :)?
Thank you! No not a Liverpool fan 😂
Hello,
I hope u're fine and doing okay.
Please if u may help understand my case, lately ( this past 8 months ), i've been dealing with pain in my right rib cage+ tightness and pain in the right side of my neck+ problems with my trachea+ twisted and rotated pelvis ( i'm not sure if it's rotation or a lateral tilt). I'm tired of searching for the main diagnosis and treatment.
I can't afford to go see a specialist so can u please help me?!
What about grade four😭 so frustrating cannot find anything out there for someone who’s went through tight rope fixation and aims to return to sport. Struggling with dorsiflexion and no one can give me any ideas on how to improve it other than general mobility and knee to wall exercises! So so frustrating
I would absolutely suggest that you see a physiotherapist for this!
@@ClinicalPhysio oh my god thanks so much for the reply! Going to a physio every week to try get my R.O.M back. But such a slow process and feel like I’m making little to no progress ( in terms of dorsiflexion).
I also read the whole report you cited and linked - it unfortunately doesn’t delve into grade 4. However still found this video so beneficial, as I had a very poor understanding of what exactly I got surgery on and this video explains it so well and eased some of my concerns.
You’ve earned a subscriber 🙂🫡
@@danielward4485if it is type 4 I won’t able to move like normal again??
@danielward4485 how is ur ankle doing ?
So u went tightrope surgery ?
I’ve had an Syndesmosis Injury back in december 2021 and it’s healed a little bit but I still have very bad dorsiflexion and external rotation,Its been very long and nhs take long too do everything and I just want to get back to football💔.
🙏🏼🙏🏼🙏🏼 wishing you all the very best
Hi, may I ask what software you use to show the 3D models of the body and injuries? great videos btw, always very helpfull!!
Thank you so much! It’s our own individual model that was made for us by software developers, we’re very grateful for it!
@@ClinicalPhysio thanks for the reply, keep up the great work!
Would this typically show up with bruising or swelling? My ankle is sprained with the calcaneus and talus ligaments but no bruising or swelling
Hi! If you are concerned I would always suggest getting assessed properly by Dr or a physio
@@ClinicalPhysio I did that, that’s how I know it’s sprained. Was just interested in the fact that I have no bruising
Sir i am from India
Trans syndesmotic frature of the left lateral malleous is noted (weber type B)
Does i need surgery
Of course his explanation of practical causes of such injuries had to be football/soccer related.
Just look at the book title in bold red behind him .🙂
I had a grade 4 syndesmosis injury. I'm still not great on my feet now
So sorry to hear this
Surgery done ?
If there is fracture then it is type 4 ??
@ClinicalPhysio I had a Weber C fracture, and the dr says that means I must have also torn my syndesmosis and deltoid ligaments. I had surgery to repair the broken fibula, as well as open reduction and internal fixation screwing my tibia and fibula together. The ligaments were NOT repaired through surgery. The dr says that because of the ORIF surgery that they will heal on their own over time. Is this true?
U okay now ?
@@flower_road_21 I am. The ligaments have healed well, I'm still building strength and flexibility but am moving great and feeling great. I had the screw that holds the fibula/tibia together removed but left the rest of the hardware. You have any questions?
@Hammer.J.Helmer did u completely torn ur ligaments ?
@@flower_road_21 I never got a straight answer on that because we didn't do an MRI, but the dr said it was likely and that they will still heal. I admit I don't quite get how that can happen, but I guess through the orif they are still touching and your body heals them.
@@Hammer.J.Helmer okay thank u
Thanks
Most welcome!
Doesn’t the squeeze trees bring the ligaments together and not apart???
It does indeed push the tibia and Fibular together… but if the ligaments are not intact, it will push the talus away from the fibula which may be what causes pain with the test. That’s why we squeeze at mid tibia rather than at the ankle joint
@@ClinicalPhysio 😊
Hi. My name is Andrew (I was in med school for a couple years and then had to quit for many reasons so if I call something on my knowledge it comes from there, I’m not a doctor so I may be wrong, please excuse me and feel free to correct me)
I had grade 3 syndesmosis injury almost 2 months ago. The pain was incredibly terrible and I’ve had ankle injuries before due to sports but after two weeks it didn’t seem to be healing properly.
Also I may add that the space between my first two toes was numb, with time I’ve recovered the sensitivity in it, but it still feels funny. (I am assuming I somehow damaged the deep fibular nerve)
My injury was a trauma due to fall, I fell on another’s person foot and my feet had a sudden and very violent inversion (as most ankle rolls)
The Xray revealed I had an avulsion fracture the size of a needle head in the tip of the fibula.
Doctors said that was gonna hurt for a while but they couldn’t do anything about that and it would heal by itself, same as the lower ankle ligaments, they would heal by themselves.
They said I needed fixation surgery because of the syndesmosis, and the plan is 12-14 weeks of non-weight bearing after the surgery with a boot 24/7 only allowed to take it out in the shower.
After that , another surgery to take the screws out, followed by rehab training
A month after the surgery I got cleared to do physical activity as long as it didn’t involve my leg so still non-weight bearing.
My concerns/questions are…
I am really feeling the desire of walking on my feet. The pain is gone and I haven’t tried to move my ankle at all, I want to go back to sports and to my normal life so, what can I do to help the healing process during this non-weight bearing time?
And also what can I do to have a great rehab and stronger ankles after they take the screws out?
Also I feel like 12-14 weeks of absolute no use of the leg is crazy, isn’t it too much? I am at 6 weeks so far and feel like I count start doing some crutch walking or something.
Is the funny feeling of the DFN innervation something I should be concerned about?
This was a great video, very useful and complete.
Thank you.
So how re u now ? Did ur ligaments healed ?
Great thabks
Most welcome!
Good video i had a weber c with syndesmotic screw through both bones..6 months still swollen and stiff.i think mine must be a grade 5 😂
How re u now ? Can u walk ?
@flower_road_21 not great at all but I can walk ok now.have you got this?
@@pickup000 i had my surgery 3 weeks ago for syndesmosis but it failed and yesterday again i had my another surgery wid 1 tightrope and 1 screw ...damn lifes too hard and i hope i will be able to walk again sooner
Thank you again Khalid for the great contect. Can you test the SM without making a dorsalflexion in the ankle (like the Dorsiflexion External Rotation Stress Test)?
Hi! Yes you can always try Kleiger’s test without DF if you wish and then compare to with DF
Amazing! Big thanks from Berlin! @ClinicalPhysio. I was diagnosed with "Rupture of the anterior syndesmosis + Avulsion fracture of the anterior talofibular ligament" Your video really helped understand what this is. I had most pain in mz Achilles tendon in the days/weeks after the injury, any ideas why this might be? (No achilles damaged was mentioned in the MRI results)
Hi! Thank you so much for your kind words, and im sorry to hear about your injury 🙏🏼
It may have been just due to overload in the initial stages where Achilles may have had to work harder to compensate for your injury? But if you have further concerns then I would suggest getting it reviewed 🙏🏼
Tschuss!
What about ankle fracture
Absolutely! We have a webinar on this in November!
Why didn’t you talked about the period of recovery time for grade 4 ?🥲😂
Period depends with management..