Patient Presentation

C.C. was a healthy 17 year-old female, who visited the ER after her left ankle twisted and inverted during a basketball game. Her vitals were stable, but pain was 7/10 with complaints of a burning, stinging sensation. The ankle and foot had 3+ swelling and bruising despite the injury occurring 2.5 hours prior. The patient could not bear any weight on the effected ankle.

Differential diagnosis:

Ankle sprain, fractured ankle

Testing:

The patient’s ankle was inspected and range of motion examined. Anterior drawer test, cross leg test, squeeze test, and inversion stress testing were used with the patient experiencing severe pain with these movements.

An XRAY did not show any left lower extremity fractures. An MRI revealed complete tears of syndesmotic ligament as well as tears of the 3 lateral ligaments of the ankle (ATFL, CFL, and TFL).

No blood tests were necessary.

Treatment:

The patient was given Percocet; RICE treatment was used while awaiting radiology reports.

Outcome:

C.C. was diagnosed with a Grade 2/3 high ankle sprain. A split was applied; the patient was given crutches, and instructed to avoid weight bearing. Pain medications were also given at discharge. She was instructed to follow up with an orthopedic doctor.

It was expected that the orthopedic doctor would prescribe an immobilizer boot to be worn, as well as non-weight bearing for several weeks. Physical therapy would then be necessary for the patient to regain strength and movement. Recovery could take several months because of the extent of the damage and severity of the sprain.  Usually surgery is not necessary.

Case created by Crystal Chappell, 2011.