Ankle Capsulitis

Ankle capsulitis can involve a disabling lack of ability to fully move the ankle instead of normal healing of the ankle. It can happen, for example, after a motor vehicle accident in which the ankle was severely affected by trauma. There can be osteochondral fractures with loos bodies in the joints and severe degeneration, which causes a “capsule” to form around the joint surface, effectively freezing the joint.

What is Ankle Capsulitis?

Adhesive capsulitis is a joint disease that mostly affects the shoulder after an injury prevents the shoulder from moving and the joint capsule freezes the joint, resulting in “frozen shoulder”. It can also occur in the wrist, hip and ankle. In the ankle, it is called having a “frozen ankle”. It is complex to diagnose and difficult to treat.

When capsulitis is in the ankle, it causes pain and there are restrictions in the range of motion, both passive and active. Eversion difficulty usually starts first, followed by internal rotation and inversion. Eventually, the loss of motion is global. It is usually secondary to trauma such as chronic ankle sprains, ankle fractures, or pilon fractures.

Some cases of ankle capsulitis are idiopathic or are believed to be related to having one of the following medical conditions:

  • Diabetes
  • Connective tissue disease
  • Inflammatory arthropathies
  • Infection
  • Heart disease
  • Autoimmune disease

When capsulitis occurs, it not only affects the site of the injury but eventually the entire joint capsule is affected with capsulitis, so that there is a complete loss of motion.

There is initially an outbreak of inflammatory cells in the synovium of the joint. After about 3-4 weeks, the capsular layer (fibrous layer) becomes thicker. It destroys the integrity of the posterior and anterior joint recesses and the presence of new collagen destroys the availability of the range of motion of the joint.

The growth of inflammatory infiltrates and the secondary ankle joint contractures are believed to be because of the presence of cytokines, which bring on the fibrous thickening of the joint capsule. Many patients will say they feel a sharp, stretching sensation associated with popping sounds or cracking sounds in the joint with any motion.

Causes of Ankle Capsulitis

Ankle capsulitis is less common than “frozen shoulder syndrome” and is more likely to be related to trauma than the shoulder is. Causes of ankle capsulitis include:

  • Idiopathic
  • Severe ankle fracture
  • Multiple ankle sprains
Symptoms of Ankle Capsulitis

Ankle capsulitis is so difficult because it is so hard to treat. Most patients have these symptoms for many years without significant relief. The major symptoms of adhesive ankle capsulitis are:

  • Frozen ankle
  • Swelling of the ankle
  • Pain with attempts to move the ankle
  • Difficulty ambulating on the affected ankle
  • Withered musculature around the ankle
Diagnosis of Ankle Capsulitis

Ankle capsulitis can be diagnosed through a careful history and physical examination, which will show a previous injury to the ankle that may have been weeks prior to symptoms of capsulitis. Sometimes the symptoms come on after the patient has “recovered” and attempts to resume weight bearing after having the ankle in a brace, splint or Ace wrap for a prolonged period of time.

The doctor will look for obvious deficits of ankle range of motion associated with pain and swelling of the ankle joints. During the examination, the doctor will attempt ankle dorsiflexion and ankle plantar flexion. With regard to dorsiflexion, its range was only about 1 percent and with plantar flexion, the range was only about 16 percent. In addition, there was atrophy of the calf muscle on the affected side.

Patients can have arthrography to diagnose ankle capsulitis. There are several criteria which make up a positive diagnosis of ankle capsulitis using arthrography. They include:

  • Obliterated anterior and posterior ankle reflexes
  • Decreased joint space volume from 10-25 ml to about 3-5 ml
  • Resistance with injection of contrast media
  • Backflow of contrast medium

Because it is a painful and invasive procedure, arthroscopy is not often used by doctors to diagnose capsulitis of the ankle. In addition, plain film x-rays are too nonspecific to show capsulitis.

MRI is increasingly coming into use in the diagnosis of ankle capsulitis. It often shows a lack of enough joint fluid and a thickening of the capsule of the joint. As this procedure is relatively new when it comes to diagnosing capsulitis, more research needs to be done to see if it is an accurate test.

Treatment of Ankle Capsulitis

Most people get better from ankle capsulitis following a course of physical therapy, which focuses on getting back an adequate active and passive range of motion. Joint mobilization techniques are used to increase motion while decreasing pain. People who have had 8 weeks of immobilization after an ankle fracture can undergo 10 weeks of physical therapy and can have the strength, range of motion and function of the ankle joint restored.

If physical therapy fails, doctors can do arthroscopic debridement of the fibrous capsule. One researcher found that the range of motion with dorsiflexion improved by 18 degrees and with plantar flexion by 23 degrees after undergoing arthroscopic debridement. Corticosteroid injections can also be used but this doesn’t seem to help by itself.

If you or a loved one has suffered Ankle Capsulitis as a result of someone else's negligence and would like to discuss your legal options with an experienced Sacramento Personal Injury Attorney, contact us online or call us at 916-921-6400 or toll-free at 800-404-5400 to set up a FREE consultation.

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