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When Love Makes You Limp: An Unusual Case Of Ankle Pain In A High School Athlete - Page #1
 

Author: Grace Danby, MD
Co Author #1: Nicole Prendergast MD
Senior Editor: Drew Duerson, MD
Editor: Sandra de Mel, MD

Patient Presentation:
An 18-year-old male high school football player presented to the emergency department with progressive left ankle pain and swelling.

History:
The patient reported symptoms started upon waking 16 hours ago, progressed throughout the day, and that he was unable to bear weight on the left lower extremity. He noted painless clicking and popping at football practice yesterday, but otherwise recalled nothing out of the ordinary prior to symptom onset. He denied fever, paresthesia, weakness, recent antibiotic use or illness, or preceding trauma. He denied sexual activity and urinary symptoms. He had no medical or surgical history and was not on any medication.

Physical Exam:
The patient was afebrile and normotensive with a temperature and blood pressure of 37.2 C and 121/59, respectively. His heart rate and respiratory rate were within normal limits and he was tolerating room air. He appeared non-toxic and in no acute distress, resting quietly in bed. His left ankle was diffusely swollen and tender without erythema, warmth, or signs of trauma. His active and passive range of motion were limited by pain. He was unable to ambulate for gait assessment. Dorsalis pedis pulse was 2+ and sensation was normal in the left lower extremity and foot. Strength testing of isolated muscle groups was +5/5. His neurologic exam was normal.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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