Post on 07-Jul-2018
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Information Sheet for Candidates
Your next patient in a suburban emergency
department is a 20 year old basketball player, John.
He injured his right ankle during a basketball gameyesterday, when he ‘dunked a ball and coming down
he twisted his ankle. His !oot turned inwards
underneath him and because o! "uite se#ere pain he
stopped playing. $arked swelling appeared on the
lateral side o! the ankle but with ice treatment by the
trainer and resting the !oot , the swelling has gone
down although it is still sore to walk on the !oot.
Your task is to:
• %er!orm an examination &tell the patient what
you are doing'(
• )xplain your !indings and the most likely
diagnosis to the examiner • )xplain your management plan to the patient
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EXAMINATION: (LOOK, LISTEN, EEL !!!!":
*r inspection + mo#ement testing + palpation'-%)/*-1
welling, de!ormity, bruising, old scars, gait !or possible limping
John has a slight limp because o! pain on lateral side o! ankle'
$*)$)- &3/) 3-4 %3)'(15lexion, extension &dorsi!lexion(, in#ersion, e#ersion, circular mo#ement.
John complains about pain on plantar !lexion and in#ersion
%36%3*- &start on non tender side'(1
enderness, e!!usion. pecial attention to bony prominences like medial and lateral
malleolus and base o! !i!th metatarsal &*ttawa rules'(.
6igaments1$)4361 7deltoid ligament8
63)9361 anterior talo!ibular ligamentcalcaneo!ibular ligament
posterior talo!ibular ligament
ibio!ibular ligament'73nterior draw sign'8
John is tender o#er the anterolateral area &anterior talo!ibular ligament area'(
7*3:3 3-;6) 9
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@934) 1 partial tear, usually o! anterior talo!ibular ligament, little swelling, pain on
mo#ement, normal 9*$, tenderness next to the tip o! the malleolus.
@934) 1 pain at rest, limited weight bearing, moderately se#ere localised pain andswelling, calcaneo!ibular ligament usually in#ol#ed, tenderness directly
in!erior to malleolus, mild to moderate instability
@934) 1 complete tear o! two or more ligaments, se#ere pain, immediate swelling, joint mo#ement with 3% stressing &anterior draw test(, ankle
reconstruction recommended'
$3-3@)$)-1#: rest !or AB hours with early mobilisation with short term use o! crutches
depending on extent o! injury, when able to weightbear com!ortably then walk,
when able to walk com!ortably then run, when able to run, then twist and turn, physiotherapy re!erral, consider ‘wobble board.I: cold therapy with co#ered ice packs ¬ directly on skin'( !or about 20 minutes e#ery C+A hours asoconstriction and reduces in!lammation(
C: compression bandage
E: ele#ation
#: re#iew in AB hours, then D days
S: special strapping, especially i! early return to sport re"uired
$%ESTIONS:
E:hen can go back to playing basketball againE 1 C+? weeks with support, depending
on extent o! injury.
E/an dri#e my carE1 -ot !or about a week, to allow rest and healing'
E4o need crutchesE Yes, !or the !irst two days and perhaps e#en longer depending onextent o! the injury.