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Diagnosed with serious ligament damage. MRI radiology done. What does the report signify?

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Orthopaedic Surgeon
Practicing since : 1994
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I am 10 weeks post a non-displaced fracture of the distal tip of the right fibula. The ER physician that treated me indicated that I may have some pretty serious ligament damage - but, that the Orthopedic i was referred to would review & discuss it all with me. When i initially saw my Orthopedic, he indicated that it should all heal just fine on it's own. I've been MOBILE & in an air cast for 10 weeks except for it being removed per Dr order @ 8 weeks. I began using for 8 days. Ankle pain & swelling increased each day - worsening each day. I was put back into the air cast & sent for an MRI. The orthopedic told me that I have had previous severe sprains & have now arthritis in my ankle. PRIOR to this injury, I haven't recognized any problem in my ankle, pain or swelling. Today, I returned to hear the results of my MRI. I informed my dr that the last few days the pain had begun circling around from the anterior to the back & inside of my ankle. It is NOT what I would describe as "joint" pain - but, burns - I can describe it as how it burns when a blood vessel breaks & bleeds under the skin - only burns worse & all the way around. Well, I was told that I have arthritis (again) & should go for physical therapy - also received a lidocaine & steroid injection. NOTHING @ any time ever has a tear in a ligament been mentioned. I asked for & received a copy of my MRI Radiology Consultation Report. After leaving the Dr office, I read the report. Here is what it says:
1) marked diffuse circumferential subcutaneous edema throughout the right lower leg & ankle;
2) small non displaced of the distal tip of the right fibula with mild edema in the small fracture fragment;
3) FULL THICKNESS TEAR of the anterior talofibular ligament & a small contusion of the adjacent corner of the talus.
4) mild tenosynovitis of the tibial is posterior & flexor hallucis long us tendons;
5) there is no osteochondral lesion.
I called the dr's nurse & asked her to ask him about the tear in the ligament that had NOT been mentioned to me be cause it concerned me. She said that she SHOWED him the report & told him my concern. She said he said the "sprain" is the same as what is referred to in the report as a "tear" & that he wants me to go ahead & begin physical therapy.
My concern is that it is worsening each day - the burning & spreading over a wider area. Could it be synovial fluid? And, that beginning physical therapy, if there is actually a tear may be detrimental - especially 10 weeks post-injury. I am a 53 year old female that wants full use of my ankle. I've followed my dr instructions, although it has not shown any real improvement, however the bone has healed.
HELP! I need direction.
Posted Mon, 6 Aug 2012 in Bones, Muscles and Joints
Answered by Dr. Praveen Tayal 1 hour later
Thanks for posting your query.
There is a tear of anterior talo fibular ligament as mentioned in the MRI report.
The burning sensation and pain with swelling is likely to be due to post traumatic stiffness which is usually seen after the removal of the cast. The swelling is not due to synovial fluid leakage.
Now that the injury is 10 weeks old and you have an almost full range of movement around your ankle joint, there is no need to worry.
The ligament tear will heal on a conservative treatment with pain killers, anti inflammatory medicines, hot fomentation and physical therapy.
You will be able to use your ankle completely over next 4-6 weeks. Your orthopedician is guiding you in the right direction.
To reduce the swelling you can use two pillows under your leg while resting.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
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