Ultrasound signs of ankle injury

Torn ligaments of the ankle joint.

Damage to the ligaments of the ankle joint is found mainly among athletes. A typical mechanism of injury is the pivoting of the foot to the inside or outside at the time of loading on the limb (running, jumping off the projectile, jumping). Another mechanism of damage is possible, which is caused by the rotation of the foot relative to the longitudinal axis of the shank. Such injuries are most often encountered in skiers when, when descending from the mountains, the ski touches for some obstacle, and the skier himself continues to move forward by inertia. At this point, the foot, fixed by the shoe, remains in place, and the shin continues to move forward, resulting in a violent foot eccentricity (rotation of the foot in the ankle around the longitudinal axis of the shin from the outside). Proceeding from the above described mechanisms of development of trauma, various ligamentous components of the ankle joint are damaged. For example, the outer lateral ligaments are damaged during supination and inversion of the foot, while the deltoid and intercellular ligaments may suffer from pronation and eversion.

The severity of damage should distinguish between tears (sprain) and ligament ruptures. With partial rupture, patients complain of local pain at the places of attachment of damaged ligaments to the bone, which are amplified by palpation. In the area of damage, swelling and bruising due to hemarthrosis is visualized. A characteristic clinical sign of damage to the front portions of the lateral ligaments is the intensification of pain in checking the symptom of the "drawer". In cases of injuries of the intercostal ligaments, in most patients, it is possible to note an increase in local pain when the foot is unbent in the ankle. With tearing and tearing of the outer lateral ligaments, the pain is intensified when the foot is placed in the supination and inversion position, and in the case of injuries of the deltoid and intercostal ligaments, pronations and eversions.

When the deltoid ligament ruptured, a diastasis between the inner ankle and the inner lateral surface of the talus bone was a characteristic feature. The talus bone is shifted to the inside. In the ultrasound study, the breaking and disruption of the typical course of the ligament fibers is noted. In this case, the ligament thickens, its echogenicity decreases. Against the background of echogenic fatty tissue, hypoechoic fibers of the torn ligament are well identified.

With a partial rupture of the anterior talon-peroneal ligament in the rupture zone, a site of reduced echogenicity is determined-hematoma and edema of surrounding soft tissues.

Rupture of the tendon of the ankle joint.

A common problem for a group of lateral or peronial tendons (the tendon of the long fibular muscle and the tendon of the short fibular muscle) is the subluxation and dislocation. The ruptures of these tendons are extremely rare. Usually they are observed with injuries of the calcaneus and lateral ankle, which are accompanied by the dislocation of the peronic tendons. Sometimes there are signs of tendinitis and tenosynovitis. The clinical picture is characterized by a recurring course, pain along the tendon, which is enhanced by palpation. The tendon is thickened in volume, its structure is not uniform due to edema.

As for the group of medial tendons (the tendon of the posterior saphenous muscle, the tendon of the long flexor of the fingers and the tendon of the long flexor of the thumb), the presence of inflammatory changes and the presence of tendinitis, tendinosis and tenosynovitis are more characteristic for them. Tendons of the tendon of the posterior saphenous muscle can be observed in the projection of the medial malleolus, and the presence of a chronic rupture is most typical.

With ultrasound (ultrasound) at the rupture, a hypoechoic region in the tendon and fluid in its vagina are visible. Torn tendons of the front group are very rare. They meet at a ballet trauma, at football players. Ultrasonic manifestations are the same as in the rupture of tendons of the medial and lateral groups. Also observed is the discontinuity of the fibers, the effusion in the synovial vagina of the tendon.

Tendonitis of the tendon of the ankle.

In the presence of tendinitis, fluid will also be observed in the vagina surrounding the tendon, but the tendon itself will look normal. The diagnosis in this case will already be formulated as tenosynovitis. Tenosynovitis is usually a consequence of mechanical action on the tendon or as a result of a disease - rheumatoid arthritis. Rheumatoid lesion is characterized by a decrease in the diameter of the tendon, whereas for ordinary inflammation the thickening of the tendon is typical. It is necessary to differentiate the effusion in the synovial vagina of the tendon and hygroma. Hygromes have a limited length and rounded edges.

Rupture of the Achilles tendon.

The ruptures of the Achilles tendon occur solely as a result of trauma. They can occur not only among athletes who are exposed to excessive stress loads, but also for ordinary people after an awkward movement and an inadequate load on the tendon. Sometimes, in cases of incomplete rupture, the diagnosis can be viewed by a clinician.

These ultrasound findings play an important role in the diagnosis. With complete ruptures of the Achilles tendon, a violation of the integrity of the fibers, the appearance of a hypoechoic zone of various lengths, the diastase of the fibers, is detected at the site of the rupture. The zone of rupture, as a rule, is located 2-6 cm above the attachment point of the tendon. Sometimes, with a complete rupture, the tendon is not found in a typical place. The hematoma around the rupture is usually small, due to the weak vascularization of the tendon.

With the help of ultrasound it is possible to reliably determine the level and dimensions of the rupture, and also to distinguish the partial rupture from the full one. Thus, with a partial rupture of the tendon, the tissue defect is localized in the thickness of the tendon and only one contour is interrupted.

It should be remembered that when the Baker cyst ruptures, the fluid can go down to the level of the Achilles tendon and simulate its defeat. The ruptures of the median gastrocnemius muscle can also cause pain in the projection of the muscle-tendon junction.

With the help of ultrasound it is possible to easily exclude pathological changes of the Achilles tendon. In the case of old Achilles tendon ruptures, up to 6 weeks old, a permanent tissue defect is usually seen at the site of the rupture, which is combined with fibrosis areas and small calcifications. The tendon, as a rule, is thickened, and its echogenicity is reduced. Ultrasound can monitor the treatment of damage to the Achilles tendon.

When surgically restoring the torn ends of the tendon, hyperechoic ligatures are visualized in the tendon structure. Using ultrasound angiography techniques, it is possible to accurately assess the vascular reaction in the area of the operation and in surrounding tissues, and, therefore, in a timely manner to identify possible inflammation.

Functional tests performed under ultrasound control help to identify diastasis, evaluate the nature of recovery of tendon activity.

Tendonitis of the Achilles tendon.

In acute inflammatory process in the Achilles tendon on the echogram the tendon is sharply thickened, its echogenicity is reduced. In the inflammatory process, a backbone bursa may be involved. With the development of inflammatory changes, its dimensions increase more than 3 mm. In this case, behind the Achilles tendon, a hypoechoic stretched bag is visualized. Inflammatory blood flow can be recorded in the bursal walls.

The transition of inflammation to the chronic process is accompanied by the appearance of heterogeneity in the structure and the presence of calcifications in the Achilles tendon. Calcifications are also formed at the site of the former rupture of the tendon and are more often localized at the point of attachment of the tendon to the calcaneus. In this zone, there are often repeated breaks.

Achilles tendon tendonosis.

With age, due to the development of degenerative changes in the Achilles tendon, its structure changes. The tendon becomes uneven, thickened, calcifications appear. With an inadequate load on the tendon, a partial or complete rupture is possible.

Heel spur.

Bony growths in the form of a spine or wedge in the area of the plantar surface of the calcaneus calcaneus or at the attachment point of the calcaneal tendon are called heel spurs.

Most often, heel spurs are a consequence of involuntary changes in the human body. The clinical picture is characterized by burning pains while resting on the heel, defined by patients as a feeling of "nail in the heel."

Clinical symptoms are caused primarily by changes in soft tissues: inflammation of deep mucous bags (subclavian bursitis, achillobursitis) and phenomena of periostitis. Echographically in the heel of the calcaneus, hyperechoic inclusions are defined around which inflammatory infiltration occurs due to permanent traumatization.

Morton's neuroma.

This relatively rare disease is one of the causes of metatarsalgia. One of the causes of the appearance of the Morton's neuroma is the compression of the branches of the common plantar finger nerves with the heads of metatarsal bones.

Trauma, the pressure of tight shoes, overloads also affect the development of the disease.

The clinical picture is characterized by severe burning pains in the area of the third interdigital gap on the foot, arising when standing and walking in tight shoes and weakening after unloading the foot or removing tight shoes. Echographically characterized by the appearance of thickening of honey 3 and 4 interdigital intervals.

Osteoarthritis.

When osteoarthritis is primarily affected articular cartilage. As is known, with various movements the cartilage acts as a shock absorber, reducing pressure on the articulating bone surfaces and ensuring their smooth sliding relative to each other. The main causes of dystrophic changes in articular cartilage of the lower leg are overload, healthy articular cartilage or its damage. Due to the constant load, aging and destruction of a part of the fibers takes place.

Chronic inflammatory processes in the joint, systemic metabolic changes, such as gout, endocrine disorders (hypothyroidism) lead to a change in the structure of the articular cartilage. The layer of cartilage becomes thinner, down to its complete destruction. Together with the cartilage, the bone tissue under it also changes. Bony outgrowths - osteophytes - form along the edges of the joint.

Most often there is arthrosis of the metatarsophalangeal joint of one toe, which is characterized by pain arising from physical exertion. Constant pain and their connection with physical activity distinguish this disease from gout. Gradually develops limitations of flexion of the thumb in the joint, it deforms.

Rheumatoid arthritis.

The chronic stage of the disease is characterized by perivascular infiltration of the synovial membrane. The proliferation of the synovial membrane leads to the formation of nodules, to deformation of the joint and ankylosis, since eventually these nodules undergo fibrosis and calcification. Inflammation of periarticular soft tissues, which develops in parallel with changes in the joint, leads to the development of edema and is accompanied by pain during movement.

Restricting the mobility of the joint and fixing it in the bending position leads to a gradual development of deformation of the joint itself, contractures of muscles and tendons, development of joint instability.