Pop! A Young Tennis Player's Unlikely Ankle Injury

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Pop! A Young Tennis Player's Unlikely Ankle Injury - Page #1

Author: Logan Garfield, BS, MD Senior Editor: Drew Duerson, MD Editor: Andrew Grozenski, MD Patient Presentation: A 15-year-old female with no past medical history presented with left calf pain. History: She reported that several days prior to presentation, while playing tennis, she moved laterally and felt a pop in her left calf. Her foot subsequently felt heavy, and she had difficulty moving it. The patient developed progressively worsening pain in the calf and an inability to bear weight. This was followed by swelling and bruising of the posterior left lower leg. The day following injury, she was able to limp on the left leg with continued pain. She tried ibuprofen with minimal pain relief. The patient had initially presented to an emergency department where radiographs were obtained of the left ankle which demonstrated soft tissue swelling without evidence of a fracture or dislocation and closed physis. Physical Exam: CARDIOVASCULAR: well-perfused, 2+ symmetric tibialis posterior/dorsalis pedis pulses. MUSCULOSKELETAL: Left ankle demonstrated swelling and deformity at the distal Achilles tendon, no bruising or discoloration. No rash was present. There was not a distinct palpable Achilles tendon. Tenderness to palpation of the distal Achilles was present. The left ankle demonstrated decreased range of motion with plantarflexion, dorsiflexion, inversion, and eversion due to pain and guarding. Strength testing of the left ankle was 1/5 with plantarflexion, 4/5 with dorsiflexion, 3/5 with eversion, and 3/5 with inversion. A positive Thompson squeeze test was present. Sensation within the left lower extremity remained intact. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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