What is a High Ankle Sprain?

Since Sidney Crosby suffered a high ankle sprain, I decided to research it and learn about it. It sounds like he will be out for a while.

What is a "high ankle sprain?"
A high a sprain is used to describe a particular type of ankle injury. Normally, when someone sprains their ankle, the ligaments that surround the ankle joint are stretched or torn. This injury causes pain and swelling around the ankle, and can be quite uncomfortable.

A high ankle sprain injures the large ligament above the ankle that joins together the two bones of the lower leg. These two bones, the tibia (shin bone) and fibula, run from the knee down to the ankle. They are joined together by this ligament called the "syndesmosis" or "sydesmotic ligament."

Patients who sustain a high ankle sprain injure this syndesmotic ligament. The ligament can also be an associated injury with more common low ankle sprains, and even ankle fractures.

What are the symptoms of a high ankle sprain?
A high ankle sprain causes symptoms similar to other ankle sprains, but patients often complain of pain when the ankle is externally rotated (turned to the outside) or when the calf is squeezed.

Ankle Pain Self-Help Test

This later finding, the so-called "squeeze test," is the classic test for syndesmotic injuries, but it is not very reliable for diagnosis.
How is a high ankle sprain diagnosed?
When a syndesmotic injury is suspected, your doctor can obtain special x-ray studies of the ankle called stress views. The ankle will usually look normal on routine x-rays even with a syndesmotic injury, but when stressed, there is abnormal motion between the bones the syndesmotic ligament connects.

What is the treatment for a high ankle sprain?
Syndesmotic injuries tend not to heal as well as more common ankle sprain, that is why trainers and coaches of athletes are often concerned about "high ankle sprains." Your orthopedic doctor will first determine if the injury is stable or unstable. If the injury is stable, then the high ankle sprain can be treated in a cast, usually for a period of 6 weeks.

If the injury is unstable, then a "syndesmotic screw" can be placed between the tibia and fibula to hold the bones in proper position while the syndesmotic ligament heals. The are several methods of fixation of syndesmotic injuries, all with potential risks and benefits. It is a relatively safe and well-tolerated surgical procedure.

Patients will have the screw in place for about 3 months while the syndesmotic ligament heals. Patients should understand that if they walk on the leg while the syndesmotic screw is in their leg (even after the ligament has healed) the screw can break. The reason for this is that there is normally some motion between these bones when people walk. Therefore, some doctors prefer a second operation to remove the sydensmotic screw before allowing the patient to walk. Other doctors will leave the screw in and allow it to possibly break. The reason being that there are few reported problems with the broken screw. Either way, you can talk with your doctor about this if you need to have surgery for a high ankle sprain.