Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Anterior Impingement Syndrome

SYMPTOMS

There is a gradually increasing stiffness of the ankle and exercise-induced pain around the anterior part of the ankle joint, often after previous sprain.

AETIOLOGY

Impingement syndrome is not a diagnosis but a symptom and may be caused by repetitive trauma to the anterior ankle joint, for example from striking footballs, recurrent sprains causing fibrosis or chondral damage, or be secondary to a chondral injury to the talus dome or caused by loose bodies. Several underlying pathoanatomical factors can cause impingement, including loose bodies, fibrosis, chondral flap tears, synovitis and impinging
soft tissue flaps.

CLINICAL FINDINGS

There is effusion and localised tenderness on palpation over the anterior talus dome during forced dorsi-flexion while compressing the extensor tendons and capsule. This is the ‘anterior impingement test’.

INVESTIGATIONS

X-ray can show intra-articular loose bodies or osteophytes. MRI may show sub-chondral oedema of the talus and effusion. Clinical findings and patient history are more important for clinical decisions. MRI often misses superficial cartilage injuries.

TREATMENT

NSAID can give short-term relief, as can intra-articular cortisone injections. If there are persistent or severe symptoms, arthroscopy with debriding and excision of impinged structures is recommended and curative.

REFERRALS

Refer to orthopaedic ankle surgeon Dr Kevin Yip for consideration of arthroscopy.

EXERCISE PRESCRIPTION

Rest will not help so allow all kinds of sporting activities using well-fitting shoes. If there is pain on impact suggest low-impact activities such as cycling and swimming.

EVALUATION OF TREATMENT OUTCOMES

Monitor decrease of clinical symptoms and signs. The anterior impingement test should be negative.

DIFFERENTIAL DIAGNOSES

As mentioned above, several underlying problems can cause impingement, including loose bodies, fibrosis, chondral flap tears, synovitis or impinging soft tissue flaps.

PROGNOSIS

Excellent if treated properly.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>