意大利整骨Pathophysiology 3.3.pptVIP

Pathophysiology through clinical cases- Leg and Foot -CLINICAL CASE 3 TakeCare Osteopathic Academy Milano - Italy Patient Presentation A 17-year-old female high school volleyball player presents in the emergency department with severe ankle pain and swelling History During a volleyball match, she jumped to block an opponent’s hit and landed on the opponent’s foot, “rolling” her ankle In the 2 hours since the injury, her ankle has become progressively swollen and dark Physical Examination Considerable edema of the entire ankle region Large hematoma on the lateral aspect of the ankle Severe ankle pain, regardless of foot position Pain exacerbated with pressure over lateral malleolus Positive anterior drawer test of ankle Clinical Reasoning This patient presents with signs and symptoms indicating a clinical condition of severe ankle pain following forced inversion Clinical Problems to Consider Ankle sprain Avulsion fracture of the lateral malleolus Rupture of calcaneal tendon Imaging Studies Anterior and lateral radiographs reveal an ankle joint fracture Relevant Anatomy Talocrural joint is a synovial uniaxial joint where dorsiflexion and plantar flexion are the two movement possible. Inversion and eversion do not involve ankle joint, but occur in the inter tarsal joints, mostly in the subtalar one. The trochlea has its greatest transverse dimension anteriorly, thus the ankle is more stable in dorsiflexion, when the broadest part of the trochlea is between the malleoli. Situation in which the ligaments of the ankle have been overstretched but not completely ruptured With severe sprains, the pain may be so intense that walking is not possible and the ankle shows signs of instability Signs and Symptoms Sensory Deficit Ankle pain Other Deficits Swelling Bruising, ecchymosis Ankle instability in severe cases, with positive anterior drawer test Predisposing Factors Participant in activities that require jumping, because at the end of the jump the ankle is plantar flexed