Question

You are casually watching a pick-up game of basketball at a local park when a 24-year old male player appears to sprain his right ankle. You decide to offer your assistance. He tells you that he came down from getting a rebound and landed on another player’s foot, rolling his ankle. The right ankle is swollen and tender, and he has difficulty bearing weight on his affected leg.

1. Create a differential diagnosis list for 3 possible injuries that could logically be associated with her history and set of symptoms.

2. For each condition/disease listed in your differential diagnosis list, briefly list the orthopedic examination and/or diagnostic imaging techniques that would be used to rule out (R/O) the existence of this condition.

Answer 1

a)Differential diagnosis of ankle injuries that could logically be associated with her history and set if symptoms are:-

1)Archilles tendinitis :--It is a partial or complete disruption of the tendon just above the heel resulting in inability to raise the foot.

2)Talar process fracture :- Fracture of lateral and posterior processes of the talus.

3)Peroneal tendon subluxation:- It is the dislocation of peroneal tendon involving an elongation,a test or an avulsion of superior peroneal reticulum.

b)Orthopaedic examination and diagnostic imaging techniques for various differential diagnosis mentioned above:-

1) Orthopaedic examination in case of Achilles tendinitis:-

-Doctor will inspect lower leg for tenderness and swelliy .

--He might be able to feel a gap in tendon if it has ruptured completely.

-Doctor might ask patient to kneel on chair or lie on stomach with feet handling over the end of examination table .He or she might then squeeze calf muscle to see patient foot will automatically flex.If it doesn't their have been ruptured of Achilles tendon.

- ULTRASOUND or MRI may create image of tissue of the foot.

2) Talar process fracture :-

Physical examination:-Pain aggravated by flexon or extension may be found with posterolateral tubercle fracture.

- Plain X -- Ray of ankle in anteroposterior ,lateral and mortise views should be performed.

- CT is indicated when suspision is high.

3)Peroneal tendon subluxative:-

Physical examination:-

- Swelling posterior to the lateral malleolus.

--Tenderness over the tendon

--Apprehension test:--The sensation of apprehensive or subluxative eversions against resistance cause subluxative.

-Compression test:- Pain with passive dorsiflexion and eversion.

- MRI can demonstrate peroneus quartus muscle ,Low lying peroneus brevis muscle belly