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Old 03-18-2009, 11:27 AM   #1
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Question Impingement of ATFL with Joint Effusion/Mild Synovitis question

has anyone else with impingement of the ankle at the ATFL and a Small ankle joint effusion with mild synovitis had problems walking without severe pain. I am due to see the surgeon next thursday but i am afraid its not soon enough. I have gone thru the pt, which started this whole mess again, and had a cortisone shot which i am allergic to apparently and didnt work and ice/ lidoderm patches/ ibu 800's havent worked either. I cant take Tramadol as prescribed because of a risk of stroke. i am 26 and post op almost 2 years with a bronstrom and 1 year post op of a ligament repair with tendon graft. What has been the couse of treatment for you if you have suffered from this? I am so ready to say replace the ankle.

alison

Last edited by Alycat4434; 03-18-2009 at 11:28 AM.

 
Old 03-18-2009, 01:42 PM   #2
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

I am not exactly sure that I have had impingement of the ATFL, but I have had mild synovitis and joint effusion. I too am s/p a brostrom repair, but not the tendon graft procedure. Since my brostrom, I have torn the retinaculum, broke the 5th metatarsal, torn the cartilage, and sprained it too many times to count. I've been told I need another operation to clean out the scar tissue and torn cartilage. I am like you where I have problems with pain when walking and at times, it's hard to control. I also have pain in my toes too so much that I'm about to have to go back to my surgeon for my ankle and for possible injury to my toes. Are you on crutches? I don't have much advice for you, sorry...I'm just about in your boat though. So I wanted you to know you aren't alone.

 
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Old 03-18-2009, 01:46 PM   #3
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

I had impingement and synovitis. It was awful. I needed a cane to walk more than a few steps, and if I tried to push too hard, I'd wake up the next morning unable to move my ankle due to swelling.

I had arthroscopic surgery, they found this ugly thing on my synovium, cut it off, and I got better.

Meanwhile, do you have a CAM walker? (boot)

 
Old 03-18-2009, 02:04 PM   #4
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

Quote:
Originally Posted by Hollywood48 View Post
I am not exactly sure that I have had impingement of the ATFL, but I have had mild synovitis and joint effusion. I too am s/p a brostrom repair, but not the tendon graft procedure. Since my brostrom, I have torn the retinaculum, broke the 5th metatarsal, torn the cartilage, and sprained it too many times to count. I've been told I need another operation to clean out the scar tissue and torn cartilage. I am like you where I have problems with pain when walking and at times, it's hard to control. I also have pain in my toes too so much that I'm about to have to go back to my surgeon for my ankle and for possible injury to my toes. Are you on crutches? I don't have much advice for you, sorry...I'm just about in your boat though. So I wanted you to know you aren't alone.
Thanks hollywood! I just took the crutches out in did a few steps walking with them and thats helping a little I also took a half a vicodin about 15 min ago so we shall see if it helps.I called my surgeons office again today to see what i could do but i really dont want to take crazy pain meds as I have a busy schedule the next few days and dont need to be sleepy. It is so odd to hear others that have had brostrom have had recurring sprains and injuries afterwards. I also had a possible chip on my anle where the tendons were grafted to after i sprained it in november in a monsoon lol... Jane, I do have a cam walker but it makes it so much wose since it forces it in the upward angle that is unbearable. I also started sleeping with it up to give the bone something soft since it also feels like my scar is ripping everytime i move it.

Last edited by Alycat4434; 03-18-2009 at 02:10 PM.

 
Old 03-18-2009, 05:33 PM   #5
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

I have and I'm getting a CT scan Friday again for it after 2 surgeries on my ankle. I've had Synovitis cleaned out twice. The impingement my dr. just told me could come from the surgery itself. I've had major surgery on my ankle in Sept. and he is afraid that the inpingement came from that. To me though it seems that with each surgery comes more scar tissue, more synovitis, etc. So, I'm scared to have anything cleaned out at this point. But, the impingement hurts a lot.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
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Old 03-18-2009, 05:53 PM   #6
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

I am putting myself on crutches till thursday when i see my surgeon. I have started a log of what ive taken done to show the dr i have been doing. I am wondering if he will order the ct as thats what i typically get as my sutures inside obstruct views. What did you do for the pain?

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Old 03-18-2009, 05:57 PM   #7
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

Well, Motrin because I can't take anything else. I think MRI is better but because I have plates and screws in my ankle my dr. said it would blur the MRI.

Good luck.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 03-18-2009, 06:08 PM   #8
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

you too. Keep me posted its nice to know im not alone in my symptoms

Last edited by Administrator; 04-12-2011 at 10:21 AM.

 
Old 03-20-2009, 05:54 AM   #9
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

Update:

they are sending me for a CT scan to look at the bone tunnels from last years surgery, they suspect a possible fracture. I tried taking vicodin Wednesday night and was up all night feeling very spaced but couldn't sleep.. Nothing seems to be working to alleviate the pain, not even crutches and ice and elevation. Sigh, is it next Thursday so i can know if i need surgery or not?

 
Old 03-21-2009, 11:25 AM   #10
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

Have you been taking anti-inflammatories? Have you considered a topical like Aspercreme? It works really well on pain in the smaller joints like ankles.

Hang in there.

Last edited by janewhite1; 03-21-2009 at 11:26 AM.

 
Old 03-23-2009, 06:57 AM   #11
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

Quote:
Originally Posted by janewhite1 View Post
Have you been taking anti-inflammatories? Have you considered a topical like Aspercreme? It works really well on pain in the smaller joints like ankles.

Hang in there.

I have and neither have worked and i know why now. I have minor spurring at the anterior distal tibia as well as at the insertion of the Achilles tendon on the posterior aspect of the calcaneus. I also have a non displaced fracture at the lateral aspect of the tunnel within the distal fibula from where he drilled in previous surgeries. I also have the synovitis and thickening of the ATFL. The one thing i dont understand is jmoderate joint space narrowing at the talonavicular joint,

 
Old 03-23-2009, 08:53 AM   #12
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

Alycat, did you get your CT films? Is your appt. this Thurs?
I had my CT and they didn't place my ankle at 90 degrees so I'm pointing my toes in my CT. I don't think that helps to show anterior impingement. I'm a bit worried my CT was useless for that issue.
Keep us updated with news form your appt.
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Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
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Old 03-23-2009, 09:03 AM   #13
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

yes i got my ct films back but my appt isnt until thursday but it didnt say anything about impingment. my ankle was held at 90 degrees put i dont know if the angles matter on a ct, could be wrong tho. i will keep you posted. when is your appointment? when was your ct?

Last edited by Alycat4434; 03-23-2009 at 09:05 AM.

 
Old 03-23-2009, 10:54 AM   #14
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

here are my ct results

HISTORY: Pain and tenderness lateral ankle; previous history of a
Brostrom repair as well as ligament repair with tendon graft in
05/2008 with increasing ankle pain since December. The patient also
states that felt a snap in her ankle.

TECHNIQUE: Multiple axial noncontrast images of the left ankle are
performed with sagittal and coronal reconstructions per Departmental
protocol. Comparison is made to previous MRI scan performed on
03/13/09 as well as plain radiographs 2/3/09 and prior CT scan from
04/25/08.

FINDINGS: The bones are well mineralized. There is no dislocation.
A small ankle joint effusion is identified. The patient is status
post Brostrom repair of the anterior talofibular ligament as well as
graft repair of the anterior talofibular ligament. There is a tunnel
within the distal fibula as well as within the lateral talus with
interference screw within the lateral aspect of the talus. The graft
is moderately thickened. There are mild inflammatory changes
surrounding the graft. Subcutaneous soft tissue edema overlying the
lateral malleolus is noted, which may in part be related to the
patient's prior surgery or recent traumatic injury. There are no
drainable fluid collections. A small ankle joint effusion is noted.
A tunnel within the upper lateral calcaneus is also noted with
interference screw. There is no discontinuity or gap within the graft
to suggest a complete tear. There is, however, a subtle linear
lucency within the lateral aspect of the tunnel within the distal
fibula concerning for a subtle nondisplaced fracture. There is minor
spurring at the anterior distal tibia. There is no CT evidence for
osteomyelitis. Minor spurring at the insertion of the Achilles tendon
on the posterior aspect of the calcaneus is noted. There is moderate
joint space narrowing at the talonavicular joint, minor joint space
narrowing at the navicular cuneiform articulation and tarsometatarsal
joints. There is mild joint space narrowing at the first
metatarsophalangeal joint. Sinus tarsi is unremarkable. The extensor
tendons and flexor tendons are unremarkable. Peroneal tendons are
grossly intact; however, there appears to be minor tenosynovitis.
There is no osteochondral defect of the talus identified.

IMPRESSION:

1. The patient is status post lateral ankle ligament repair with
Brostrom procedure as well as tendon graft procedure with no
discontinuity within the graft or gap to suggest graft disruption;
however, there is at least mild tendinopathy of the anterior
talofibular ligament graft associated with inflammatory changes as
well as tendon thickening.

2. No drainable fluid collection identified.

3. Subcutaneous soft tissue edema within the lateral soft tissues as
noted above.

4. Subtle linear lucency within the lateral tunnel of the distal
fibula concerning for a nondisplaced fracture.

5. No dislocation.

6. Small ankle joint effusion.

7. Apparent mild tenosynovitis involving the peroneal tendon sheath.

 
Old 03-23-2009, 12:56 PM   #15
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Re: Impingement of ATFL with Joint Effusion/Mild Synovitis question

CT scan can't see some types of impingement. It does say you have swelling, though.

 
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