Is the Ankle Sprained Broken or Dislocated

Musculoskeletal Examination Is the ankle swollen? Does it hurt when you do not put pressure on it? How did you hurt your ankle in the past? Was it a tear or a sprain or a break? Does your ankle look twisted? Is there any numbness in your ankle? Are you able to put any weight at it all, or is it impossible to put any weight on it? Is there any bruising? You did not hear a cracking sound, it was distinctly a popping sound? Can you describe the pain when you put pressure on it from 1-10: 1 being hardly any pain and 10 being intolerable? Can you roll your foot around from side to side? Can you move your foot at all if you hold your leg out from where you are seated? Differential Diagnoses: The differential diagnosis consists of a likely high ankle sprain.

The popping sound would indicate a sprain. However, if there is bruising and/or swelling or any lumps in the localized area of the ankle, this could indicate a fracture, perhaps in the lateral, medial or posterior malleolus as well as in the anterior calcaneus. So a high ankle sprain or a fracture would be two possible diagnoses, including stress fracture. A third diagnosis would possibly be peroneal tendon dislocation. This dislocation is usually evidenced by swelling behind the ankle, and this can be the result of a severe sprain.

It too is accompanied by a loud pop when it happens. However, if this is a common injury (chronic) and as with this patient, she has presented in the past with ankle injuries, so there may not be any swelling. Further assessment is necessary in order to determine the exact extent and nature of the injury. The patient needs an x-ray performed so that the view of the musculoskeletal system can be seen. 3.

Body Systems and Positive/Negative Tests The body systems that need to be checked include the nervous system for pain, the endocrine system, which releases adrenaline to ease the pain, the circulatory system, which allows the body to send nutrients to the site of injury that help to repair the site, and the musculoskeletal system, which is involved in tissue repair. Positives and negatives for each of these systems include: dorsiflex of the ankle (up to 20 degrees) as well as plantar-flex (45 degrees).

Inverting the ankle should also be done (30 degrees) as well as evert of the ankle (20 degrees). Any pain produced is a positive sign of tear, sprain or fracture. Swelling and/or discolorization is a positive sign of fracture. No pain and ample movement is a negative sign of injury (Walker, Hall, Hurst, 2015).

Likewise, as Lynch (2012) indicates, the anterior drawer test can be performed to assess the extent of displacement in the sagittal plane, by having the examiner take the heel in hand pull gently forward while keeping the anterior side of the distal tibia in place. There should be 10 degree motion but "increased anterior translation of the talus with respect to the tibia is a positive sign and indicates a tear" of the anterior talofibular ligament (p. 410).

As far as diagnostic tests are concerned, an x-ray is first and foremost, after the ankle movement exercises and the observation of ankle for swelling, lumps, crookedness or discolorization. Radiographic analysis should asses the talar-tilt stress test as well as the anterior-drawer stress test. 4. HIPPA Violation? Because Elizabeth is a teenager, consideration should be given to avoiding any HIPPA violations when disclosing information.

Is it permissible to share healthcare information with her parents if she is not present? It is absolutely permissible so long as the health care provider has determined that the family member is involved in the care of the patient. Thus, the U.S.

Department of Health and Human Services (2015) states that "where a patient is not present or is incapacitated, a health care provider may share the patient's information with family, friends, or others involved in the patient's care or payment for care, as long as the health care provider determines, based on professional.