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INITIAL EVALUATION

Upon initial evalution, the athletic trainer could see the ankle starting to swell significantly. No ecchymosis was present at the time of injury, and no obvious deformity was visible. The patient's point tenderness was limited to over the anteriolateral portion of the ankle, over the anterior talofibular ligament. Palpation over the area revaled no deformation, and palpation over the fibular head revealed no symptoms. The patient's pain increased with weight-bearing (7/10, sharp) and decreased with rest (3/10, achy).  A range of motion evaluation revealed that the patient was limited by pain in active inversion, eversion, plantar flexion and dorsiflexion to 50% of what her healthy ankle could do. With resistive range of motion, the patient could only dorsiflex and evert her ankle to 25% compared to her healthy ankle. Passively, the athletic trainer could move the athlete into almost full range of motion with eversion and dorsiflexion, but could only go to 75% of inversion and plantar flexion compared to her healthy ankle before pain was too overwhelming for the patient.  The athletic trainer performed several special tests:

  • Anterior Drawer: positive for pain and slight laxity in comparison with right ankle

  • Posterior Drawer: negative

  • Talar Tilt: positive for pain with the ankle in plantar flexion

  • Kleiger's: negative

  • Bump Test: negative

 

Manual muscle testing revealed a 3+/5 in all directions, however, it is thought that the athlete wasn't exerting herself fully due to pain. 

 

Based on the results, the AT diagnosed the athlete with a Grade II sprain to the anterior talofibular ligament. After wrapping the ankle in a compression wrap, she put ice on the ankle and gave the athlete crutches. The athlete returned to the gym to watch the rest of practice, and was given instructions to return for a follow up evaluation the next afternoon. 

FOLLOW-UP EVALUATION

When the athlete returned the next day, the athletic trainer noticed a significant amount of swelling, as well as ecchymosis over the lateral aspect of the ankle. The special tests were repeated with the same results. The functional testing and range of motion evaluation came up with the same results as the day prior. The AT decided to continue with rest, ice, compression, and elevation for the next two days, with plans to start a rehabilitation program on day four, post injury. 

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​INITIAL INJURY

During her third game of the season, the patient was shuffling over to get a ball when she stepped on a teammate's foot and inverted her left ankle. The patient was able to walk off the court on her own power, but walked with an antalgic gait favoring her left ankle. The patient reports feeling a small "pop" over the lateral aspect on her left ankle, and said her pain was a "6/10" at the moment of injury. The athletic trainer helped her to the athletic training room for a full examination. 

PATIENT

Patient is an 18 year-old female high school volleyball player who has participated in varsity volleyball for four seasons. She plays both back row as a defensive player and front row as an outside hitter, and will often play entire games. The patient also participates in varsity swimming and diving and is a distance runner in track and field. She has no previous injury to her lower body, but had dislocated her left elbow during a game in her sophomore year. The patient was diagnosed with sports-induced asthma her freshman year of high school, but has an unremarkable medical history besides that. 

Photographer: Carley Maanika, 2011

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