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Synovial joints are the most common type of joint in the body. A key structural characteristic for a synovial joint is the presence of a joint cavity. This fluid-filled space is where the articulating surfaces of the bones contact each other. Also, unlike fibrous or cartilaginous joints, the articulating bone surfaces at a synovial joint are not directly connected to each other with fibrous connective tissue or cartilage. This gives the bones of a synovial joint the ability to move smoothly...
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The ankle is formed by the talocrural joint (crural = leg). It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg. The superior aspect of the talus bone is square-shaped and has three areas of articulation. The top of the talus articulates with the inferior tibia. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations...
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Fibrous joints are a type of joint where the bones are connected by fibrous connective tissue. These joints provide stability and minimal to no movement between the articulating bones. There are three types of fibrous joints.
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Functional Classification of Joints
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Subtle Syndesmotic Instability.

Paul M Ryan1, John L Eakin, Jason T Goodrum

  • 1From the Lake Tahoe Sports Medicine Fellowship, Department of Surgery, Barton Memorial Hospital, South Lake Tahoe, CA (Ryan, Eakin, Goodrum), University of Nevada, Reno School of Medicine, Reno, NV (Ryan), Uniformed Services University, Bethesda, MD (Ryan).

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Summary

Subtle syndesmotic instability, or high ankle sprains, often present with normal initial X-rays. Diagnosis relies on physical exams and advanced imaging, guiding treatment for return to function.

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Radiology

Background:

  • Latent or subtle syndesmotic instability involves injuries to the ankle syndesmosis not visible on standard X-rays.
  • These injuries, commonly termed high ankle sprains, often result from external rotation forces during collision sports.
  • Delayed diagnosis is frequent due to initially negative imaging findings.

Purpose of the Study:

  • To review diagnostic methods for subtle syndesmotic instability.
  • To discuss advanced imaging and physical examination techniques for diagnosis.
  • To outline management strategies for returning athletes to their preinjury function.

Main Methods:

  • Physical examination tests: external rotation test, proximal squeeze test, fibular shuck test.
  • Advanced imaging: MRI and weight-bearing CT scans for prognostic insights.
  • Diagnostic benchmark: arthroscopic stress evaluation.

Main Results:

  • Physical exams can aid in diagnosing syndesmotic injuries.
  • Advanced imaging offers prognostic information for treatment planning.
  • Arthroscopic evaluation is the definitive diagnostic method.

Conclusions:

  • Subtle syndesmotic injuries require specific diagnostic approaches beyond static radiography.
  • A combination of clinical examination and advanced imaging aids diagnosis and management.
  • Effective treatment strategies, surgical or non-surgical, can restore function.