A 28-year-old soccer player presents to the ED with ankle pain after an injury during a game. On examination, there is moderate swelling, point tenderness, and the anterior drawer test is positive but with a firm endpoint. What is the most likely diagnosis?
The correct answer is a grade II ankle sprain. This diagnosis is based on the following key points:
Moderate swelling and point tenderness are consistent with a significant ligament injury.
A positive anterior drawer test indicates damage to the anterior talofibular ligament (ATFL), the most commonly injured ligament in ankle sprains.
The presence of a firm endpoint during the anterior drawer test suggests that the ligament is partially torn but not completely ruptured.
Grade II sprains involve partial tearing of the ligament fibers, resulting in moderate instability. This is in contrast to:
Grade I sprains: Minimal swelling, negative anterior drawer test, and no significant instability.
Grade III sprains: Severe swelling, positive anterior drawer test without a firm endpoint, and significant instability.
Ankle fracture: While possible, the described symptoms are more consistent with a ligament injury than a fracture.
Understanding these distinctions is crucial for proper management and treatment planning in emergency settings.
Ask Bash
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What is the anterior drawer test, and how does it help diagnose ankle sprains?
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What is the function of the anterior talofibular ligament (ATFL) in the ankle?
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How can you differentiate between a Grade I, II, and III ankle sprain based on symptoms?
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Musculoskeletal and Wound Emergencies
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