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Hey all,
I have attached the patient case below ahead of the journal club meeting this Thursday. See you then!(IE 4/8/22)
Subjective:
Pt is a psychiatrist that is on her feet for multiple hours a day making rounds around UVA hospital. Endorses an insidious onset of R lateral ankle pain in January of 2022 when she was doing yard work. Denies any ankle sprain or MOI. States that she was pulling on a tarp that had logs on it trying to side step at the same time with her R foot closest to the tarp. She believes she might have been over working some of the muscles in the lateral ankle because she states that she had pain, swelling and bruising over the anterolateral aspect of the ankle and inferior to the lateral malleolus. States that she initially wore an ankle boot for a month and still would feel ankle pain when engaging in yard work. Currently is still experiencing pain in the same areas of the ankle and is now wearing an ankle brace to reduce pain. States that sometimes plantarflexion of the ankle can produce discomfort in the achilles area but states that this isn’t as painful as the other aspects of her ankle.Aggs: General end of day discomfort, WBing activities such as yard work and ambulation around the hospital, plantar flexor activation activities such as driving and descending stairs
Eases: boot use, rest, NSAIDs, arnica creamObjective:
Mild swelling and tenderness around posterior aspect of the lateral malleolus R side and ATFL
Pain in the posterior aspect of lateral malleolus and plantar aspect of the R foot in the region of the peroneus longus with hopping (pushing off of the ground), descending stairs, and Bil heel raises.
Weakness and pain provocation with resisted testing of the peroneals
Increased mobility in all planes of the ankle (most notably DF and INV) with end range INV with OP being very painful
Increased postural sway and stepping strategies with SLS on RLE with mild pain
Hypermobile talocrural and midfoot
(+) Anterior drawer and syndesmosis squeeze test
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