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Synovial impingement in the ankle

A NEW PHYSICAL SIGN

Department of Orthopaedics, Princess Royal Hospital, Lewes Road, Haywards Heath, Sussex RH16 4EX, UK.

Correspondence should be sent to Mr S. Molloy at 38 Burleigh Park, Cobham, Surrey KT11 2DU, UK.

Inversion injuries of the ankle are common and most are managed adequately by functional treatment. A significant number will, however, remain symptomatic.

Synovial impingement is one cause of continuing pain. This condition is often difficult to diagnose because the physical signs and investigations are non-specific. If the diagnosis is made, treatment by arthroscopic debridement has been shown to be highly effective. Our aim was to describe a new physical sign to help in the diagnosis of anterolateral synovial impingement in the ankle.

A cadaver dissection demonstrated the anatomical basis for the physical sign and a prospective clinical study involving 73 patients showed that the lateral synovial impingement test had a sensitivity of 94.8% and a specificity of 88%.

We describe the test and conclude that this physical sign will be of use to practitioners treating patients with chronic pain in the ankle after injury.