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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 game
yesterday, when he ‘dunked’ a ball and coming down
he twisted his ankle. His foot turned inwards
underneath him and because of quite severe pain he
stopped playing. Marked swelling appeared on the
lateral side of the ankle but with ice treatment by the
trainer and resting the foot , the swelling has gone
down although it is still sore to walk on the foot.
Your task is to:
 Perform an examination (tell the patient what
you are doing!)
 Explain your findings and the most likely
diagnosis to the examiner
 Explain your management plan to the patient

eversion. FEEL !!!!): Or inspection . extension (dorsiflexion). gait for possible limping John has a slight limp because of pain on lateral side of ankle! MOVEMENT (ACTIVE AND PASSIVE!): Flexion. old scars. deformity.palpation! INSPECTION: Swelling. Ligaments: MEDIAL: “deltoid ligament” LATERAL: anterior talofibular ligament calcaneofibular ligament posterior talofibular ligament Tibiofibular ligament! “Anterior draw sign!” John is tender over the anterolateral area (anterior talofibular ligament area!) “OTTAWA ANKLE RULES”: X-ray if pain near the malleoli and any of the following:  Inability to weight bear ( immediately following the injury and during examination!)  Bone tenderness over distal 6 cm of tibia or fibula or over the inferior tip of malleolus. John complains about pain on plantar flexion and inversion PALPATION (start on non tender side!): Tenderness. circular movement. effusion. inversion. bruising. Special attention to bony prominences like medial and lateral malleolus and base of fifth metatarsal (Ottawa rules!).EXAMINATION: (LOOK.movement testing . LISTEN. CLASSIFICATION OF SPRAINS: .

then twist and turn. usually of anterior talofibular ligament. when able to weightbear comfortably then walk. little swelling. I: cold therapy with covered ice packs (not directly on skin!) for about 20 minutes every 3-4 hours (vasoconstriction and reduces inflammation) C: compression bandage E: elevation R: review in 48 hours. tenderness next to the tip of the malleolus. physiotherapy referral. . for the first two days and perhaps even longer depending on extent of the injury. then 7 days S: special strapping. immediate swelling. pain on movement. ankle reconstruction recommended! MANAGEMENT: R: rest for 48 hours with early mobilisation with short term use of crutches depending on extent of injury. moderately severe localised pain and swelling. when able to walk comfortably then run. when able to run.GRADE I : GRADE II : GRADE III: partial tear. calcaneofibular ligament usually involved. mild to moderate instability complete tear of two or more ligaments. limited weight bearing. pain at rest. to allow rest and healing! ?Do I need crutches? Yes. especially if early return to sport required QUESTIONS: ?When can I go back to playing basketball again? : on extent of injury. tenderness directly inferior to malleolus. 3-6 weeks with support. severe pain. joint movement with AP stressing (anterior draw test). consider ‘wobble board’. depending ?Can I drive my car?: Not for about a week. normal ROM.