. HISTORY: A 29-year old Caucasian female presented at clinic with a new onset of bilateral ankle pain. Symptoms started after she began a running program consisting of 3 miles on Tuesday, Thursday and Sunday two weeks prior. Her pain level has progressed from mild to severe. She had not previously engaged in regular exercise. She described her pain as achy, an “7” on a 10-point pain scale, and mostly in the medial ankles. The pain was made worse with walking and minimized at rest. She denied radiating pain, numbness, tingling or weakness. She took ibuprofen without relief of her pain. She currently smokes 1 pack of cigarettes per day and has 3-4 drinks 2-3 times per week. Menstrual cycles are regular. She admitted to behavior consistent with bulimia nervosa from age 17 to 20. She was treated with oral contraceptives for endometriosis until 5 months prior to evaluation for this condition.
II. PHYSICAL EXAMINATION: Height: 5’7”; weight 150 lbs. There is warmth in the anterior ankles with no erythema. Mild ankle effusions were present. There was diffuse tenderness around both ankles including the posterior tibialis tendon, posterior joint line, and talar dome. Passive pronation, supination, inversion and eversion did not reproduce her pain. Strength, sensation, reflexes and pulses were intact. Anterior drawer tests were symmetric and without laxity. Her gait was antalgic with a shortened stance on the right.
1. Create a PRIORITIZED differential diagnosis list of the 5 most likely injuries and/or orthopedic conditions that this patient may be experiencing. Assign “#1” to the most likely and “#5” to the least likely injury or condition presented.
2. Evaluate the appropriateness of the orthopedic assessment techniques that were used in this case. Identify any additional special tests that you would have performed, and their purpose for being included in your physical exam.
3. Identify the diagnostic imaging technique(s) you believe to be most appropriatefor this case, and briefly explain why.
4. From your differential diagnosis list, choose one (1) injury/condition as your clinical diagnosisbased on the signs and symptoms that have been presented. Briefly summarize the clinical reasoning you used to make your clinical diagnosis.
5. In a paragraph or two, briefly describe the typical clinical course (“prognosis”) of the injury that you diagnosed, e.g., time loss from work or recreational activity, potential for complete recovery, level of long-term disability.
1. Prioritized differential diagnosis list:
#1. Bilateral ankle bursitis.
#2. Bilateral ankle synovitis.
#3. Bilateral ankle strain.
#4. Bilateral sprained ankle.
#5. Bilateral Achilles tendinitis.
2. Appropriateness of the orthopedic assessment techniques used:
3. MRI of bilateral ankle joints would be the most appropriate diagnostic imaging technique in this case. This can be used to find out bursitis, synovitis, overuse tendinitis etc. This is an advanced imaging technique, which uses a magnetic field and radio waves to create detailed 2D to 3D pictures of soft tissues. MRI provides images of inflammation in the affected bursae, tendons, etc., and may be used to reveal the depth of an injury.
4. Bilateral ankle bursitis can be chosen as the clinical diagnosis based on the signs and symptoms that the patient presented with.
. HISTORY: A 29-year old Caucasian female presented at clinic with a new onset of bilateral...
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