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Deltoid Ligament Injury

deltoid ligament injury 3

While most of us have heard of an outside ankle sprain, can you
also have problems with the inside ankle ligaments? That’s called
deltoid ligament injury and let’s dive into what happens and how
to treat that problem without surgery.

What Is The Deltoid Ligament?

deltoid ligament injury 2

Your ankle has ligaments on the outside and the inside. The ones
on the inside are called the deltoid ligament. Think of these as
the duct tape that holds your inside ankle bones together. To the
left here, the ligament is shown as highlighted yellow. It has
three parts, the back, middle, and front. This ligament along with
others provides stability to the ankle joint including the main
articulation (tibiotalar) and the joint below that (called
subtalar).

What Is a Sprain of the Deltoid Ligament?

A sprain is when a ligament gets stretched and injured. There
are different grade sprains from lest severe (grade 1) to most
severe (grade 3). This means that parts of the ligament have
microtears.

The next type of deltoid ligament injury up from a sprain would
be an incomplete tear. That’s where a part of the ligament is
torn, but the other part remains intact. Then there’s a complete
non-retracted tear, which is where the ligament is damaged all the
way through, but there are fibers are still left connected.
Finally, there’s a complete retracted tear where fibers are torn
in half and the two parts are snapped back like a rubber band.

How Do You Check the Deltoid Ligament?

ankle deltoid ligament injuryOn a physical examination,
a deltoid ligament injury can be checked by everting the ankle as
shown here. That means taking the ankle by the heel and pulling it
outward and thus stretching the inside ankle ligaments. For a
patient at home, this should cause pain on the inside of the ankle.
An experienced physician can also see if there’s too much
motion.

There are also many different imaging options to see the extent
of the deltoid ligament injury damage. These include MRI that can
visualize the ligament (more on that below) or movement-based
imaging techniques using ultrasound or x-ray. MRI is a type of
imaging using magnetic fields that can see soft tissues like
ligaments. One downside is that this is a static test, meaning if a
ligament is loose, a movement-based image can show more problems
than an MRI which doesn’t include movement.

Movement images of the deltoid ligament use the eversion
movement as shown above plus either ultrasound or x-ray. The
advantage of ultrasound is that you can directly see the ligament
and how it responds (i.e. if it’s too stretchy). X-ray only looks
at the bones and if they move too much, but can’t see the
ligament. Both of these types of imaging can determine if the ankle
is unstable. This means that the ligament is no longer protecting
the joints, making them susceptible to arthritis.

Treatment Types

Sprains are usually treated with rest and/or immobilization (for
example bracing). They should heal in a few weeks. If pain or an
unstable feeling continues, then the next level up for treatment of
deltoid ligament injury would be injections to promote healing.
Let’s review those procedures.

If the deltoid ligament is partially torn or had a complete
non-retracted tear, then these injections can usually heal it:

  • Please avoid steroid injections (the most commonly offered
    option), which may help the pain, but will inhibit healing.
  • Prolotherapy is a solution that can prompt another inflammatory
    healing reaction giving your body another bite at the proverbial
    healing apple.
  • Platelet-rich plasma is using your body’s concentrated
    platelets that have healing growth factors that they release over
    time.
  • Bone marrow concentrate is isolating and concentrating the stem
    cell fraction in your bone marrow and using that to help heal the
    area. Stem cells act as a general contractor for the repair
    response.

If the tear is a complete retracted (snapped back like a rubber
band which is more unusual), then a surgical repair may be needed.
This frequently involves removing the existing ligament and
sacrificing a tendon to replace it by drilling holes and feeding
the tendon through. Regrettably, since this is not the original
equipment as Nature has designed, it will never function like a
completely normal ligament.

Now let’s review actual deltoid ligament injury results.

An Example of a Deltoid Ligament Injury and Non-surgical Treatment

Julie is a middle-aged avid runner who was playing the surf on a
vacation and injured the inside of her ankle. Her initial MRI
images are below (far left) which shows that the deltoid ligament,
which is in the yellow dashed lines, is a whitish color. A normal
ligament is dark in this type of MRI image, so this indicates a
full-thickness non-retracted tear. That means that the ligament
looks different on the MRI all the way through, indicating damage,
but it hasn’t snapped back like a rubber band. [Note, it’s
critical that you have an experienced non-surgical physician take a
look at the MRI films and not rely on the MRI report, as the
reading radiologist may not make this distinction.]

deltoid ligament injury

In the images above, the middle one was taken about 2 months
after a PRP injection using ultrasound guidance. Regrettably, while
the patient reported some mild results, she was still having
issues. In addition, the ligament is still light-colored, meaning
it’s still mostly torn up. Hence, at that time, she underwent a
bone marrow concentrate (BMC)injection to use her own healing stem
cells. Again, in that procedure, the BMC was precisely placed into
the damaged ligament using ultrasound guidance. After that
procedure, she began to feel much better and 10 months later, her
new MRI to the right (3rd image) now shows a mostly normal dark
appearing ligament. Her function is almost normal, but she wants to
return to higher-level running, so she was back in for a second BMC
treatment which she would have had earlier if not for the
pandemic.

The upshot? A deltoid ligament injury may heal on its own, but
if it doesn’t, there are a number of non-surgical techniques that
can promote healing of the natural ligament without surgery.
Julie’s deltoid ligament injury is a great example of how she was
able to avoid surgery and keep her own ligament.

The post Deltoid
Ligament Injury
appeared first on Regenexx.

deltoid ligament injury

deltoid ligament injury 3

While most of us have heard of an outside ankle sprain, can you
also have problems with the inside ankle ligaments? That’s called
deltoid ligament injury and let’s dive into what happens and how
to treat that problem without surgery.

What Is The Deltoid Ligament?

deltoid ligament injury 2

Your ankle has ligaments on the outside and the inside. The ones
on the inside are called the deltoid ligament. Think of these as
the duct tape that holds your inside ankle bones together. To the
left here, the ligament is shown as highlighted yellow. It has
three parts, the back, middle, and front. This ligament along with
others provides stability to the ankle joint including the main
articulation (tibiotalar) and the joint below that (called
subtalar).

What Is a Sprain of the Deltoid Ligament?

A sprain is when a ligament gets stretched and injured. There
are different grade sprains from lest severe (grade 1) to most
severe (grade 3). This means that parts of the ligament have
microtears.

The next type of deltoid ligament injury up from a sprain would
be an incomplete tear. That’s where a part of the ligament is
torn, but the other part remains intact. Then there’s a complete
non-retracted tear, which is where the ligament is damaged all the
way through, but there are fibers are still left connected.
Finally, there’s a complete retracted tear where fibers are torn
in half and the two parts are snapped back like a rubber band.

How Do You Check the Deltoid Ligament?

ankle deltoid ligament injuryOn a physical examination,
a deltoid ligament injury can be checked by everting the ankle as
shown here. That means taking the ankle by the heel and pulling it
outward and thus stretching the inside ankle ligaments. For a
patient at home, this should cause pain on the inside of the ankle.
An experienced physician can also see if there’s too much
motion.

There are also many different imaging options to see the extent
of the deltoid ligament injury damage. These include MRI that can
visualize the ligament (more on that below) or movement-based
imaging techniques using ultrasound or x-ray. MRI is a type of
imaging using magnetic fields that can see soft tissues like
ligaments. One downside is that this is a static test, meaning if a
ligament is loose, a movement-based image can show more problems
than an MRI which doesn’t include movement.

Movement images of the deltoid ligament use the eversion
movement as shown above plus either ultrasound or x-ray. The
advantage of ultrasound is that you can directly see the ligament
and how it responds (i.e. if it’s too stretchy). X-ray only looks
at the bones and if they move too much, but can’t see the
ligament. Both of these types of imaging can determine if the ankle
is unstable. This means that the ligament is no longer protecting
the joints, making them susceptible to arthritis.

Treatment Types

Sprains are usually treated with rest and/or immobilization (for
example bracing). They should heal in a few weeks. If pain or an
unstable feeling continues, then the next level up for treatment of
deltoid ligament injury would be injections to promote healing.
Let’s review those procedures.

If the deltoid ligament is partially torn or had a complete
non-retracted tear, then these injections can usually heal it:

  • Please avoid steroid injections (the most commonly offered
    option), which may help the pain, but will inhibit healing.
  • Prolotherapy is a solution that can prompt another inflammatory
    healing reaction giving your body another bite at the proverbial
    healing apple.
  • Platelet-rich plasma is using your body’s concentrated
    platelets that have healing growth factors that they release over
    time.
  • Bone marrow concentrate is isolating and concentrating the stem
    cell fraction in your bone marrow and using that to help heal the
    area. Stem cells act as a general contractor for the repair
    response.

If the tear is a complete retracted (snapped back like a rubber
band which is more unusual), then a surgical repair may be needed.
This frequently involves removing the existing ligament and
sacrificing a tendon to replace it by drilling holes and feeding
the tendon through. Regrettably, since this is not the original
equipment as Nature has designed, it will never function like a
completely normal ligament.

Now let’s review actual deltoid ligament injury results.

An Example of a Deltoid Ligament Injury and Non-surgical Treatment

Julie is a middle-aged avid runner who was playing the surf on a
vacation and injured the inside of her ankle. Her initial MRI
images are below (far left) which shows that the deltoid ligament,
which is in the yellow dashed lines, is a whitish color. A normal
ligament is dark in this type of MRI image, so this indicates a
full-thickness non-retracted tear. That means that the ligament
looks different on the MRI all the way through, indicating damage,
but it hasn’t snapped back like a rubber band. [Note, it’s
critical that you have an experienced non-surgical physician take a
look at the MRI films and not rely on the MRI report, as the
reading radiologist may not make this distinction.]

deltoid ligament injury

In the images above, the middle one was taken about 2 months
after a PRP injection using ultrasound guidance. Regrettably, while
the patient reported some mild results, she was still having
issues. In addition, the ligament is still light-colored, meaning
it’s still mostly torn up. Hence, at that time, she underwent a
bone marrow concentrate (BMC)injection to use her own healing stem
cells. Again, in that procedure, the BMC was precisely placed into
the damaged ligament using ultrasound guidance. After that
procedure, she began to feel much better and 10 months later, her
new MRI to the right (3rd image) now shows a mostly normal dark
appearing ligament. Her function is almost normal, but she wants to
return to higher-level running, so she was back in for a second BMC
treatment which she would have had earlier if not for the
pandemic.

The upshot? A deltoid ligament injury may heal on its own, but
if it doesn’t, there are a number of non-surgical techniques that
can promote healing of the natural ligament without surgery.
Julie’s deltoid ligament injury is a great example of how she was
able to avoid surgery and keep her own ligament.

The post Deltoid
Ligament Injury
appeared first on Regenexx.

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