20.03.19 Clinical Hours (Second Clinic session)

19-year-old male climber and surfer came into the clinic due to a climbing accident. Before this session I went through objective ankle assessment to prepare for the clinic session. He fell off the climbing wall and landed on his left ankle in a hyper-inverted position. Was initially severely swollen and could not weight bear. Now can walk without pain but can’t jog or run. Left ankle is still moderately swollen on palpation but no pop on the ATFL, CFL and deltoid ligaments. ROM of ankle is normal, and no pain is felt except for passive plantarflexion (4/10). Functional tests such as double leg stance and lunges where fine. Single leg stance showed decreased balance in when standing on left ankle. Covered special tests such as talar tilt (inversion & eversion) and anterior and posterior draw test for ankles but all were negative. Diagnosis was grade 2 lateral ankle sprain due to lack of weight bearing at beginning and moderate swelling. Treatment was strength exercises with resistance band for ankle strength for inversion, eversion, dorsiflexion and plantarflexion and proprioception exercises such as single leg stance on unstable surfaces to work ankle stability.

This session was difficult for me as this one of the first times I had gone through a full initial assessment. I need to go through the different ankle sprain grade classifications as I was not sure if the patient had a grade 1 or 2 sprain. I then also refreshed my memory on ankle special tests by using an Orthopedic special tests book by Konin, Lebsack, Valier & Isear (2016). I based my treatment of an ankle sprain off a study by Mattacola & Dwyer (2002) which suggested a rehabilitation plan for acute ankle sprains (grade 1 and 2). For the next session I will do more reading on ankle sprains and their rehab stages.

References:

Konin, J., Lebsack, D., Valier, A., & Isear, J. (2016). Special tests for orthopedic examination (4th ed., pp. 364-390). SLACK incorparated.

Mattacola, C. G., & Dwyer, M. K. (2002). Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. Journal of athletic training37(4), 413-429.

Leave a Reply

Your email address will not be published. Required fields are marked *