Health Assessment and Diagnostic Reasoning
Case 2: Ankle Pain at the Boehler’s angle
A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a \”pop.\” She is able to bear weight, but it is uncomfortable.
In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved?
- What other symptoms need to be explored?
- What are your differential diagnoses for ankle pain?
- What physical examination will you perform?
- What special maneuvers will you perform?
- Should you apply the Ottawa ankle rules to determine if you need additional testing?
With regard to the case study you were assigned:
- Review this week\’s Learning Resources and consider the insights they provide about the case study.
- Consider what history would be necessary to collect from the patient in the case study you were assigned.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient\’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis (DD) for the patient. I am giving you 7 to choose from they must have 2 current ( last 5 years ) references for each DD
She is able to walk and it means she didn’t break her ankles. It can be a sprain or a minor fracture. A popping sound in the angle indicates it is an ankle sprain, not an ankle fracture. A sprain occurs when ligaments stretch beyond their possibility. Depending on the damage pain can vary from mild to the severe form. An ankle sprain is a common injury while playing sports. Excessive twisting or turning of the ankle may injure the ligaments. An unstable ankle can make a popping sound. Sprains can happen due to inversion or inward rolling. Popping sound indicates that a ligament has torn or ruptured. The most common type of ankle sprain is a lateral ankle sprain. The foot rolls inward and can damage ligaments of the outer ankle the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament.
- The symptoms of an ankle sprain are pain,bruising, tenderness when you touch the ankle, instability in the ankle, and swelling.
Differential Diagnosis of Ankle sprain: here are 7 need to choose any 5
- Achilles tendon injury
- Fracture of the base of the fifth metatarsal
- Lateral collateral ligament injury
- Medial collateral ligament injury
- Tendon injury
- Talar neck fracture
- Syndesmosis ligament injury.
Physical Examination; Observe the ankle and look for swelling, ecchymosis or any deformities. Identify the site of pain . Check the areas where bony and ligamentous injury can occur like lateral and medial malleoli, deltoid ligament, talofibular ligaments and Achilles tendon .Check base of fifth metatarsal ,entire tibia for any injuries .Range of motions can be assessed like plantarflexion ,dorsiflexion ,inversion and eversion. Assess patients ability to bear weight.
In Ankle sprain following tests are used:
- Anterior drawer test is used to assess ankle instability
- Prone anterior drawing test is used to assess ligamentous instability
- Talat tilt test is used to assess integrity of calcaneofibular ligament.
Yes will apply Ottawa Ankle Rules if additional testing is needed. Ottawa ankle rules are set of guidelines for physicians to decide whether patient with ankle pain need x-rays to diagnose a possible bone fracture. A ankle x-ray is needed if there is bony tenderness at the tip of lateral malleolus or bone tenderness at tip of medial malleolus or inability to bear weight.
v Please use references that have been published in the past 5 years Please use primary research and references rather than patient webpages.
v Please also review APA for your title page and use of the first person. Please do not write in the first person for your papers
v Please remember to include an introduction and conclusion in your papers.
v Please also be sure to include a purpose statement for the paper (i.e. \”The purpose of this paper is to…\”).
v Please do not include the assignment instructions in your paper or discussion boards. You can use headings per APA, but headings should not be the assignment instructions. Please review use of headings in your APA book.
v Please make sure to include primary sources that have been published in the past 5 years to support your assertions in the paper. Remember, websites like the Mayo Clinic are not primary sources. Please also make sure to review the rubric for the assignment and use it to guide your
paper.
Please use Peer-Reviewed scholarly articles and websites designed for health professionals (not designed for patients) for your references. We should also use these scholarly works as a basis for our patient education and recommendations to patients in the clinical setting. Even some resources written for professionals, such as Up to Date, these are not admissible as a scholarly reference. Students should be using the original citation.
The following are examples (not all inclusive) of resources/websites deemed inadmissible for scholarly reference
Up to Date (must use original articles from Up to Date as a resource)
Wikipedia
Cdc.gov- non healthcare professional’s section
Webmd.com
Mayoclinic.com