CASE STUDY 4 – ..

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.

What are the components of the lateral collateral ligament complex?

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

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

The anterior talofibular ligament is the most frequently injured.

What is a high ankle sprain?

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.

Name the individual ligaments of the deltoid ligament complex.

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

How are ligament sprains typically classified?

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

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

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

The physical examination revealed the following findings:

• 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.

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

This patient likely has a grade I ligament sprain.

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

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