Saturday, September 3, 2011

CASE 3: Ankle Joint Examination (8 mins)




John Smith is a 41yo Carpenter who had an inversion injury to his Left Ankle yesterday after a game of bastketball at his club.  Please examination John's ankle and discussed your findings and management with the Examiner.


(Things to think about:  During your 3mins prior to going in and doing the case, how would you use your 3mins to prepare for this case?)

11 comments:

  1. 1. Ask examiner do I need to take further history?
    If yes, clarify with pt - what's happened? wt bearing afterwards? did he finish his game? injury to elsewhere? LOC? previous ankle injury history? sports insurance?

    If no need for further history, I would say I have washed my hands, ask pt permission for examination and ask pt to tell me if I hurt him.

    2. ankle examination
    ---first general appearance, comment whether see bruise/laceration to ealsewhere
    ---ask pt to have a walk, observe gait and posture, limp? crutches?
    ---look for swelling, bruise, scar, effusion, deformity (compare with right ankle)
    ----Feel tenderness, spasm and trigger points (compare with right side)
    ---Move (compare with right side): ROM (active, then passive and resisted if need), crepitus, pain



    3.management
    ---explain and pt education
    ---RICE
    ---xary if need to exclude #/dislocation
    ---physio 3 days after injury to strength ankle, ankle taping?
    --- certificate re off work
    ---sports insurance paper work?
    ---r/v in 3 days

    Tricia

    ReplyDelete
  2. One of the most important thing to ask yourself in the 3mins is "What is the problem list or "possible" problem list here?" The problem list will guide you during your case in assessment, examination or management...

    So, what is the "problem list" here?

    Dr Vinh Tran MBBS FRACGP

    ReplyDelete
  3. problem list - acute ankle injury
    possible sport insurance claim
    off work issue

    Tricia

    ReplyDelete
  4. Tricia,

    Can you clarify further with the problem list?

    ???type of ankle injury???

    Dr Vinh Tran
    www.fracgpexamsupport.blogspot.com
    www.doyouhavedepression.blogspot.com
    www.priorityhealthmedicalcentre.com.au

    ReplyDelete
  5. Ankle injury - most likely ankle sprain, but need to exclude fracture/dilocation

    Tricia

    ReplyDelete
  6. ankle instability from previous injury

    Tricia

    ReplyDelete
  7. When someone has an inversion injury of their ankle, there are 3 general DDX or problem list we need to consider....

    ??Is it a sprain (which you have mentioned)
    ??Is it a fracture (which you have also mentioned)
    and ?????Is it a ?????

    Dr Vinh Tran
    MBBS FRACGP Qld

    ReplyDelete
  8. Rupture of ligment?
    Sorry, I am not sure.

    Tricia

    ReplyDelete
  9. Good....

    What I was just wanting to highlight here is that when ever you have a patient with an injured ankle, you should consider the following in your differential diagnosis.

    1 Ligament sprain
    2 Ligament tear
    3 Fracture

    Dr Vinh Tran
    MBBS FRACGP

    ReplyDelete
  10. Sprain is actually tear of ligament - there are 3 grades - grade 3 being complete rupture.

    ReplyDelete