Episodic/Focused Note

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

CASE STUDY–
A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Sample Answer

Episodic/Focused Note:

Subjective: A 46-year-old female presents with complaints of pain in both of her ankles, with the right ankle being of particular concern. She reports experiencing the pain after playing soccer over the weekend when she heard a “pop” sound. The patient mentions that she can bear weight on her ankles but finds it uncomfortable. She seeks medical attention to determine the cause of her ankle pain.

Objective:

Inspection: Observe both ankles for any swelling, bruising, or deformities. Note any signs of inflammation or discoloration.
Palpation: Assess tenderness, warmth, and crepitus over the affected area. Check for any bony abnormalities or joint instability.
Range of motion (ROM): Evaluate the patient’s ability to move her ankles in all directions, noting any restrictions or pain during movement.
Specific tests: Perform the Ottawa ankle rules to determine if additional testing is necessary.
Assessment: Based on the patient’s reported history and physical examination, several foot structures are likely involved in her ankle pain. Possible structures include:

Ligaments: Given the mechanism of injury and the audible “pop” sound, a ligament sprain or tear is a potential cause of the pain.
Tendons: The patient’s symptoms and history suggest the involvement of the Achilles tendon or other ankle tendons.
Cartilage: There may be damage to the articular cartilage within the ankle joint, leading to pain and discomfort.
Bones: Fractures or stress fractures in the ankle bones are also possible, considering the mechanism of injury during sports activity.
Muscles: Strained or injured muscles in the lower leg may be contributing to the patient’s ankle pain.
Differential Diagnosis:

Ankle ligament sprain or tear
Ligamentous injuries are common during sports activities and can cause pain, swelling, and instability.
Achilles tendonitis or rupture
A history of hearing a “pop” sound and continued discomfort suggests a potential Achilles tendon injury.
Osteochondral lesion
Damage to the articular cartilage within the ankle joint can cause localized pain and limited range of motion.
Ankle fracture or stress fracture
The mechanism of injury and the patient’s symptoms raise suspicion for a possible bone fracture.
Lower leg muscle strain
Injuries to the muscles in the lower leg can refer pain to the ankles and cause discomfort during weight-bearing activities.
Diagnostic Tests:

X-ray: To evaluate for fractures, dislocations, or bony abnormalities in the ankle.
MRI (Magnetic Resonance Imaging): To assess soft tissue injuries such as ligament tears or tendon ruptures.
Ultrasound: To visualize and assess the integrity of tendons and ligaments.
References:

Fong DT, Hong Y, Chan LK, Yung PS, Chan KM. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37(1):73-94. doi: 10.2165/00007256-200737010-00006
McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part II: Is balance training clinically effective? J Athl Train. 2008;43(3):305-315. doi: 10.4085/1062-6050-43.3.305
Bahr R, Pena F, Shine J, Lew WD, Tyrdal S, Engebretsen L. Biomechanics of ankle ligament reconstruction: An in vitro comparison of tendon grafts. Am J Sports Med. 1997;25(6):835-843. doi: 10.1177/036354659702500618

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