Syndesmosis and deltoid ligament injuries in the athlete.
Deltoid ligament injury is often associated with lateral malleolar and fibular fractures. This article describes the deltoid injury without a fracture. The deltoid ligament could be divided into a superficial vertical layer and a deep horizontal orientated layer. The deltoid ligament limits talar abduction, pronation and external rotation.
After injury, pain, swelling and hematoma formation over the medial malleolus may be present. The lateral talar tilt test, anterior drawer test in external rotation and the gravity stress test can be used to identify deltoid injury. Examination should always include the syndesmosis, lateral ankle and the entire fibula (to exclude a high fibula fracture). Ultrasound has a great diagnostic value (high sensitivity / high specificity) in identifying deltoid injury.
Superficial deltoid injury could be treated conservatively with a short period of immobilization (5-7 days) followed by a rehabilitation program. Time to return to light training is expected between 6-8 weeks. Surgical stabilization could be indicated in injuries of both the superficial and deep ligaments. > From: McCollum et al., Knee Surg Sports Traumatol Arthrosc. 21 (2013) 1328-37. All rights reserved to Springer-Verlag.
The Pubmed summary of the article can be found here.
Below you'll find a few Youtube clips for testing the syndesmosis
Ultrasound of part of the deltoid ligament: the tibiotalar ligament:
The osteology and arthrology of the ankle can be viewed in the YouTube clip below.