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An 18-year-old male basketball player presents with a right ankle injury sustained when landing awkwardly after attempting a layup three days previously. The patient was not using any assistive device for ambulation. Upon questioning, it was determined that the patient's ankle was in a position of plantar flexion and internal rotation when injured. The patient reported that the ankle had swelled on the outside of the ankle and that weight-bearing was difficult due to pain. The patient also reported a history of previous right ankle sprains.

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What are the components of the lateral collateral ligament complex?

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The lateral collateral ligament complex consists of the anterior talofibular ligament, calcaneofibular ligament, and the posterior talofibular ligament.

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Which ligament of the lateral collateral ligament complex is most frequently injured?

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The anterior talofibular ligament is the most frequently injured.

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What is a high ankle sprain?

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The high ankle sprain, or syndesmotic sprain, involves disruption of the ligamentous structures between the distal fibula and tibia, just proximal to the ankle joint.

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Name the individual ligaments of the deltoid ligament complex.

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The deltoid ligament complex consists of superficial fibers (the tibionavicular, posterior talotibial, calcaneotibial) and deep fibers (anterior talotibial).

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How are ligament sprains typically classified?

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Ligament sprains are graded from I (stretched), II (partial tear), and III (complete).

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Based on this presentation, which great ligament sprain do you think this patient has?

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This patient likely has a grade I or II ligament sprain.

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The physical examination revealed the following findings:

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  • Antalgic gait with increased stance time on the left.
  • Mild to moderate swelling on the lateral aspect of the patient's right ankle.
  • Palpation yields acute pain and tenderness over the anterolateral ankle at the tip of the fibula, lateral calcaneus, and sinus tarsi.
  • Patient demonstrates difficulty in heel and toe walking on the right side.
  • Passive range of motion of the right ankle is limited in plantar flexion, inversion, and dorsiflexion.
  • Strength testing of the lower extremities revealed no deficits.
  • The patient had a negative anterior drawer test, negative talar tilt sign, and negative tibiofibular squeeze test.
  • The neurologic examination for this patient was normal.

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Following the findings of the tests and measures, which grade of ligament sprain does this patient have?

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This patient likely has a grade I ligament sprain.

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The patient asks whether he should use heat or ice for his ankle. What should you tell him?

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