4.4 of 84 Ratings
A 21-year-old recreational athlete lands awkwardly after a basketball rebound. He presents with lateral ankle pain and swelling, and reports that he feels as if his ankle is unstable. Plain radiographs were obtained initially as he was unable to bear weight and are depicted in Figures A and B. An MRI is obtained by his primary care physician and depicted in Figure C. Which of the following is the most appropriate next step in management?
Sinus tarsi corticosteroid injection with ankle taping during basketball
Lateral ankle ligament repair with suture tape augmentation
Lateral ankle reconstruction with a peroneal tendon autograft
Early weightbearing, functional bracing and peroneal muscle strengthening
Immobilization in walking boot for 4-6 weeks with delayed proprioception exercises
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A 17-year-old basketball player went up for a rebound and inverted his left foot upon landing. He experienced immediate pain and swelling to the ankle. He was taken to the local urgent care where radiographs were taken (Figures A and B). The patient is given crutches and referred to you for further evaluation. On exam, you notice significant swelling and ecchymosis of the left ankle. With the ankle in 10 degrees of plantar flexion, the talus is noted to translate 10mm anterior to the tibia. Which of the following structures in Figure C is most likely injured in this patient?
A 30-year-old high level athlete sustained a low ankle sprain 1 week ago. The treatment options of immobilization and functional management are discussed. Which of the following statements is FALSE?
Functional management is associated with higher rate of return to sports than immobilization.
Functional management is associated with greater range of motion than immobilization.
Functional management is associated with less persistent swelling than immobilization.
Functional management is associated with a greater risk of increased ankle joint laxity than immobilization.
Functional management is associated with higher rate of satisfaction than immobilization.
An 18-year-old male college student presents with a right ankle injury two weeks after slipping on a soccer ball. The skin is grossly intact and there is no evidence of neurovascular compromise. The provocative test demonstrated in Figure A is positive. Which of the following nonoperative treatment modalities have been shown to minimize recurrence of his injury?
Immobilization in a non weight-bearing cast
Immobilization in a weight-bearing boot
Immobilization in a splint
Functional bracing with early proprioceptive training
Neuromuscular training alone
A 36-year-old male recreational runner presents for evaluation of right lateral forefoot pain. He notes that these symptoms have persisted for many years, and that he has had multiple ankle sprains which caused him to take time off from running. He is currently training for a marathon and would like to address his pain. Examination reveals a stable ankle with talar tilt and anterior drawer testing. He has a supple subtalar joint and his peroneal tendons are non-tender and do not subluxate with circumduction. Weightbearing foot radiographs demonstrate no fracture. A clinical photograph is shown in Figure A. Which intervention would most likely allow him to continue his marathon training and reduce his symptoms?
A UCBL brace
A lace-up ankle brace
An orthotic with medial hindfoot posting
An orthotic with medial hindfoot posting and a rigid arch support
An orthotic with lateral hindfoot posting and first metatarsal head recess
A 25-year-old soccer player reports a history of multiple ankle sprains and a feeling of instability when he plays soccer. Physical examination is notable for laxity in his ankle and radiographs are unremarkable for fracture. After failing conservative management, he is scheduled to undergo a lateral ankle ligament reconstruction. Which of the following factors would make the reconstruction prone to failure?
First ray plantarflexion
Answers 1 and 3
All of the above
A 25-year-old military service member presents four weeks after sustaining an inversion ankle injury with continued severe pain despite conservative treatment. Anterior drawer testing and MRI obtained at initial presentation demonstrated a tear of the anterior talofibular ligament (ATFL). Exam reveals improved swelling but significant pain with light touch about the dorsal foot and anterolateral distal leg. Management should include prescription of a medication that acts by which of the following mechanisms?
Interferes with nerve conduction through binding of intracellular sodium channels
Reduces hyper-excitability of voltage dependent presynaptic calcium channels
Binds and activates the mu receptor
Directly activates the gamma-amino-butyric acid (GABA) receptor
Selectively binds and inhibits cyclooxygenase type 1 (COX-1) enzymes
A 20-year-old male sustains a right ankle injury after landing awkwardly catching a rebound in a basketball game. The next day he has swelling and ecchymosis present about the lateral ankle. There is no effusion in the knee. His area of maximal tenderness is represented by the area at the white arrow in Figure A. The examination demonstrated in Figure B reveals 2mm of ankle translation. The examination demonstrated in Figure C is not provocative for pain. A 3-view radiograph of the ankle is normal. What is the next most appropriate step in management?
Short leg cast for 4 weeks followed by physical therapy
Magnetic resonance imaging (MRI) of the ankle
Brostrom reconstruction with Gould modification
Functional bracing as needed and physical therapy
Magnetic resonance imaging (MRI) of the ankle with intra-articular contrast
The anterior drawer test with the ankle in 20 degrees of plantarflexion most effectively tests for injury or laxity or which of the following ligaments shown in Figure A?
A 21-year-old collegiate basketball player comes down with a rebound and rolls his ankle. He is able to finish the game, but complains of ankle pain and swelling afterwards. Physical exam is notable for moderate inversion laxity with the ankle held in dorsiflexion. With placement of the ankle in plantarflexion, no inversion laxity is appreciated. Which of the following ligaments has been attenuated?
Anterior talofibular ligament
Anterior tibiofibular ligament
Posterior tibiofibular ligament
A 38-year-old postal carrier complains of recurrent right ankle sprains and lateral ankle pain. A clinical photograph and radiograph are provided in Figures A and B. Coleman block testing demonstrates correction of the deformity. Custom orthotics, bracing, and NSAIDS have failed to provide pain relief or prevent recurrent sprains. Which of the following treatments should be pursued?
Steroid injection of the sinus tarsi and taping of the ankles before activity
Lateral ligament repair and augmentation with inferior extensor retinaculum
Lateral ligament reconstruction with peroneus brevis tendon grafting
First metatarsal osteotomy and lateral ligament reconstruction with peroneus brevis tendon grafting
Triple arthrodesis and split peroneus brevis tendon graft reconstruction of the lateral ligaments
An 18-year-old presents with complaints of ankle pain after a fall 10 days ago. He has kept his ankle wrapped and elevated as recommended by his primary care doctor. He is neurovascularly intact on physical exam. The provocative maneuver shown in Figure A is positive. What neuromuscular pathway needs to be rehabilitated to reduce recurrence of the injury?
A 20-year-old female collegiate basketball player has had recurrent ankle sprains of her right ankle. Trials of immobilization and physical therapy have not prevented further injuries. Physical exam reveals significant laxity of the right ankle compared to the left ankle, but otherwise is normal. Radiographs are unremarkable. What is the best surgical treatment for this patient?
Evans tenodesis (peroneus brevis tenodesis)
Modified Broström procedure
Allograft reconstruction with a tendon graft from the fibula to the 5th metatarsal base
Primary ligament repair with lateralizing calcaneal osteotomy
Primary ligament repair with a dorsiflexion osteotomy of the 1st metatarsal
In dancers, peroneal muscle weakness has been shown to be the cause of which of the following?
Acute cuboid subluxation