Best Practice Case Studies-Case 112 Asset 5 Lateral Ankle Injury

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Video Summary

The AMSSM Sports Ultrasound case series features Doug Hoffman presenting a protocol-based approach to lateral ankle pain in a 17-year-old male soccer player injured by a slide tackle. Initial radiographs were normal except for mild lateral soft-tissue swelling. Hoffman emphasizes reviewing X-rays first and using a comprehensive ultrasound protocol that extends beyond “lateral” structures.<br /><br />His protocol begins with joint-focused anterior and medial views: talocrural joint (including plantarflexion to assess for talar dome osteochondral defects), a short-axis anterior ankle/tarsal tunnel view, dorsal talonavicular/naviculocuneiform joints, and a coronal medial tibiotalar/subtalar view to screen for synovitis, loose fragments, deltoid issues, and talocalcaneal coalition. Ultrasound revealed hypoechoic thickening of the dorsal talonavicular ligament (a commonly missed injury), without hyperemia.<br /><br />Lateral protocol elements included a lateral subtalar joint view and sinus tarsi evaluation. Dynamic scanning demonstrated fragmentation at the anterior process of the calcaneus, prompting an “expanded” assessment of the bifurcate ligament, showing an avulsion-type fracture at its calcaneonavicular component and thickening of the calcaneocuboid fibers.<br /><br />The ATFL and AITFL were normal, but the calcaneofibular ligament showed a complete tear from its calcaneal attachment. Peroneal tendons and superior peroneal retinaculum were normal; technical tips included heavy gel and using a hockey-stick probe. Q&A covered limited reliability of posterior syndesmotic ligament imaging and strategies for following the peroneus longus to the cuboid sulcus.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 2

Topic Ankle

Keywords

4th Edition

4th Edition, Case 2

Ankle

lateral ankle pain ultrasound protocol

AMSSM Sports Ultrasound case series

dorsal talonavicular ligament injury

anterior process of calcaneus fracture fragmentation

bifurcate ligament avulsion calcaneonavicular component

calcaneofibular ligament complete tear

soccer slide tackle ankle injury