Mr. Khan-Sprained Ankle This Case

Mr. Khan-Sprained Ankle

This case study presents the scenario of a middle aged man suffering from a sprained ankle. The ankle is one of the more intricately designed structures within the human body-from a skeletal perspective. There are a variety of bones, ligaments and tendons that coalesce into a working framework that provides the anatomical architecture to support balance and make the basic task of walking possible. This case study will focus on the anatomical structures that are at the heart of an ankle sprain. In order to establish this working framework, this case study will explain the three grades of Ankle sprains and indicate which grade Mr. Kahn, the patient, is experiencing. Furthermore, this case study will identify the key social and psychological that may influence the patient's experience regarding this problem. Lastly, this case study will discuss how consideration of these biopsychosocial factors might influence the management of this patient and the outcome of the case.

This case study will conclude with an overall review of the main principles both anatomical and psychological that can influence the patient's ability to cope with such an injury. Furthermore, this case study will serve as a representative example that injuries can impact more than just tissue and bone; they can have a deep psychological impact on an individual patient. Ultimately, this case study will seek to demonstrate how exigent-social factors-can influence a patient's ability to effectively manage an injury as well as influence medical staff's ability to treat the individual.

Discussion

At the outset of this case study, it is imperative to study in some level of comprehensive detail the anatomical structures that are in play when a patient breaks his or her ankle. The ankle is a joint which is formed by the tibia and fibula (bones above the ankle in the foreleg) and the talus (below the ankle joint) (LIGAMENT INJURY RECOVERY 2010). The ankle joint allows for the upwards (dorsiflexion) and downwards (plantarflexion) motion (LIGAMENT INJURY RECOVERY 2010). The end of the shin bone (tibia) forms the inner bony prominence of the ankle called the medial malleolus (LIGAMENT INJURY RECOVERY 2010). The outer bony prominence is called the lateral malleolus and is formed by the small outer bone in the foreleg called the fibula (LIGAMENT INJURY RECOVERY 2010). The stability of the joint comes from several factors. First, the structure formed by the anatomical architecture lends itself to stability (LIGAMENT INJURY RECOVERY 2010). Secondly, the ligaments that are incorporated into this anatomical structure further exacerbate the presence of stability and act as scaffolding, holding the essential components into place (LIGAMENT INJURY RECOVERY 2010).

Logically, any damage to this structure will result in joint stability and the inability of an individual to place a good deal of weight upon this ankle. On the lateral (outside) of the ankle is a complex of three ligaments (LIGAMENT INJURY RECOVERY 2010). These three ligaments provide stability by attaching the lateral malleolus to the bones below the ankle joint (talus and calcareous) (LIGAMENT INJURY RECOVERY 2010). These ligaments are the anterior-tato-fibular ligament, which goes from the talus to the fibula; the fibula-calcaneo-fibular ligament that goes from the calcaneous to the fibula and the posterior-talo-fibula, this ligament goes from the talus to the fibula (LIGAMENT INJURY RECOVERY 2010). Each of these ligaments is vital in maintaining the integrity of the ankle structure and ensuring there is continued stability within the overall architecture (LIGAMENT INJURY RECOVERY 2010).

There are three different gradients of Ankle injury. The first, Grade I is the least severe (LIGAMENT INJURY RECOVERY 2010). This type of ankle injury is the most common and requires the least amount of treatment and recovery. With this type of sprain, the ligaments are overstretched, damaged on the microbiological level; however they ligaments and tendons are not torn (LIGAMENT INJURY RECOVERY 2010). The second grade of ankle sprain is Grade II. This form of ankle sprain is more severe than Grade I (LIGAMENT INJURY RECOVERY 2010). There is more damage present within the ligaments; however there is still no instability present and the ligaments are remain in tact. The most severe form of ankle sprain is Grade III. This form of ankle sprain results in the tendons and ligaments being torn, causing significant amounts of instability (LIGAMENT INJURY RECOVERY 2010). The formulation of the injury prevalent in a Grade III injury involves the lateral side ligaments being damaged (ATKINSON 2005). The injury extends, in most cases, from the anterior portion to the posterior portion with the anterior portion of the ligament demonstrating the greatest amount of injury (LIGAMENT INJURY RECOVERY 2010). As a result of this injury geography, the most commonly damaged ligament in a Grade III ankle sprain is the anterior-talo-fibular ligament, extending from the talus to the fibula.

Given that the anatomical framework has been constructed that establishes the paradigm for further analysis of these types of injuries, this analysis can no turn to what researchers have referred to as "psychosocial" factors that impact these types of injuries. Injuries' impact does not just relegate itself to the physical realm but rather, these injuries can have significant psychological causes as well (WIESE-BJORNSTAL 2004). Furthermore, there is a level of social integration that can impact these injuries and affect how a patient experiences these injuries. The next portion of this analysis will focus on the various psychosocial aspects of these injuries, the specific psychosocial causes of such injuries and how these psychosocial factors can influence the treatment of such injuries.

The most common of these psychosocial injuries is stress (WIESE-BJORNSTAL 2004). Stress has been identified as one of the main antecedents of various types of physical injuries-ankle injuries being included in that dubious group (WIESE-BJORNSTAL 2004). There is a plethora of evidence demonstrating those athletes with greater amounts of stress in their lives experience a higher degree of injury. This concept is not only limited to athletes but also to non-athletes; stress does not discriminate. According to the facts of this case Mr. Kahn has recently been promoted to partner at a major law firm in town. This is a very stressful position and therefore, this stress could have played a role in the injury. However, it seems unlikely given the specific nature of this case in that Mr. Kahn stated that he was at a school function for his child and simply "rolled" over on his ankle, causing the injury. This does not rule out the idea that stress may have played a role.

Stress is not the only psychosocial factor that can influence the prevalence of injuries (DICK 2007). Another, much more common, psychosocial factor is that of depression. Those individuals who are suffering from various forms of depression are more prone to engage in more risky behaviors. This type of increased risk taking raises the probability of those individuals experiencing certain types of injuries (DICK 2007). Depression has been demonstrated to increase the prevalence; however depression is not singular in its contribution as a psychosocial factor. There are other psychosocial factors that can increase injury and extend the occurrences of discomfort associated with injuries.

Those patients who tend to exhibit higher degrees of anger and frustration as a result of their condition are more likely than others to have increased amounts of pain associated with their injury. A study of patients with Severe Chronic Pain can reveal the nature that attitude and personality can have in pain management and injury incidents. Chronic pain is a problem among patients with spinal cord injuries, but the psychosocial factors associated with spinal cord injury (SCI) pain are not well understood. To understand SCI pain further, 54 patients (19 with quadriplegia and 35 with paraplegia) completed the Beck Depression Inventory, State-Trait Anxiety Inventory, Profile of Mood States, Acceptance of Disability Scale and SCI Interference Scale (DICK 2007). Forty-two patients stated they had SCI pain and completed the Multidimensional Pain Inventory and the Pain Experience Scale. Results revealed that anger and negative cognitions were associated with greater pain severity (DICK 2007). Patients who reported pain in response to a general prompt experienced more severe pain than patients who reported pain only when directly questioned about the presence of pain, but these different reporting groups did not differ on emotional variables.

These psychosocial variables are important qualities to the identification of risk factors for certain types of injuries. The presence of certain psychosocial risk factors will invariable have an impact on the nature of treatment pursuant to the degree of injury a patient presents to the medical staff. Therefore, it is critical that medical staff have recognition of the implications these factors can have on treatment outcome and furthermore how these variables can impact the outcome of this specific case (VAN RIJN 2007).

Goal-setting is a critical aspect of psychosocial factors post-injury (VAN RIJN 2007). Those individuals that are more positive and goal oriented tend to exhibit higher degrees of accomplishment, rapid advancement in healing time and generally are more prone to reduced post-operative rehabilitation, physical therapy and extended, invasive post-operative treatments and evaluations (VAN RIJN 2007). Emotional reactions to the onset of injuries as well as a patient's attitude toward the injury itself and the proposed treatment have great impacts on the length of time it will take for the patient to recover (VAN RIJN 2007). Therefore, it is in the medical staff's best interest to maintain the patient in a positive, reinforcing paradigm in order to create an atmosphere of positive goal-orientation so the patient may experience significantly reduced levels of anxiety during post-operative procedures as well as reduced rehabilitation time.

Annotated Bibliography

N.A.. (2010). Ligament Injury Recovery. Available: http://www.sportsinjurybulletin.com/archive/ligament-injury.html. Last accessed 17th Nov 2010.

Researchers at the University of Wisconsin, the University of Houston and NASA severed the medically collateral ligaments in the knees of lab rates. Three to seven weeks after the incision mechanical and morphological properties were measured in ligaments, bones and muscles. Ligament testing revealed that there were significant reductions in maximal force, stress tolerance and elastic property in the ligaments. The researchers concluded that "stress level from ambulation" are necessary to form structurally competent, continuous, collagen fibers in ligaments which are engaged in healing following an injury. The final conclusion was that leg unloading following an injury impaired the healing of connective tissue. Judicious weight bearing activity appears to be beneficial for ever fairly traumatic injuries to ligaments such exercise stimulates a process by which the collagen in ligaments forms structurally competent fibers.

Atkinson, K (2005). Physiotherapy in orthopedics: a problem-solving approach. New York: Elseiver Health Sciences. 7-311.

This book covers a variety of topics including changes in the musculoskeletal system, decision making and clinical reasoning, management of fractures, soft tissue repair, Rheumatic conditions, total joint replacement, bone diseases, gait assessment and hydrotherapy in orthopedics. The others attempt to explain the basic premises concepts and principles of Orthopedics. Good knowledge of the principles of Orthopedics is essential to fundamental practice. This work seeks to draw on the years of experience of clinical work in various orthopedic settings and of teaching of both the undergraduate and graduate levels of each of these surgeons. The authors express the view that Orthopedics should learn to examine the patient in front of them and make a decision based on that information. Also these orthopedics assert that a variety of injuries may exist; however the symptoms are the same. Finally this work attempts to explain the process of treating more complex orthopedic injuries.

Wiese-Bjornstal, D.M.. (2004). Psychological responses to injury and illness. In G.S. Kolt and M.B. Anderson Psychology in the Physical and Manual Therapies . London: Livingston Publishing. 34-56.

This comprehensive text addresses a number of important issues. It features extensive coverage of psychological principles as they relate to illness, injury, and rehabilitation. It covers key concepts relevant to psychological care in physical therapies, with special focus on approaches to client care. This unique text also includes material on specific client populations. This chapter describes the philosophical influences in professional perceptions of health and illness. Furthermore this chapter identifies the role played by personal health beliefs on an individual's perception of illness and injury. Also, this chapter identifies the various coping styles that may be adopted by those recovering from illness and injury and during recovery and rehabilitation. Additionally this chapter describes the process of psychological adaptation following illness and injury. The essential components of effective psychological are also identified. The main concept of this chapter is that there is not one and only one response to the experience of illness, injury or recovery. To this end, this chapter dictates that the responses and process of treating illness cannot be readily ascertained or predicted. Therefore, it is imperative to determine and analyze the various types of emotional, behavioral, psychological and interpersonal ramifications each patient is going through with regard to their various injury. According to this chapter, these concepts could play a pivotal role in determining the appropriate level of treatment.