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Brendan 17 year old soccer player (lateral ankle sprain) (PROFESSIONAL…
Brendan 17 year old soccer player (lateral ankle sprain)
HYPO-THETICO-DEDUCTIVE-REASONING (initial assessment)
MOI: slipped off a step and twisted ankle inward
typical lateral ankle sprain mechanism
hypermobile joints and has sprained it before
swelling, pain on weight bearing and palpation over ligaments (ATFL)
scan shows no fracture
degree of swelling and pain intensity are consistent with ligament sprain
ankle is unstable and lax compared with other side
DX: lateral ankle sprain
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EVIDENCE-BASED PRACTICE
ankles sprains should weight bear as soon as pain allows
ligaments respond to light controlled loading
ice reduces swelling and pain
unstable ankles should be rehabbed with stability and strength work
immobilising sprained ankle should only be temporary
compression bandage can help odema
NARRATIVE BASED REASONING
"i stepped awkwardly off the balcony and twisted my ankle"
'since then i havent been able to walk properly'
'ice has helped the swelling'
sprained both ankles a few times
'cruise trip with family coming up in 3 weeks, need to get better'
'pain is okay now just can't walk'
DX: likely a lateral ankle sprain
PROFESSIONAL SOCIALISATION ethics, values and prof identity
discuss goals with PJ
discuss exercises with Caitlyn
liaise with his soccer coach
consult his parents
best practice: ensure best healing to prevent future sprains
DIALOGUISM
teenage boy, talk about sports, music and school
relaxed casual manner
liase with parents
relate RX to his goals eg soccer
be upbeat and motivating
PATTERN RECOGNITION
MOI is typical for lateral anklw sprain
hypermobile patients are predisposed to sprains
pts who sprain ankles are likely to sprain again
type of swelling and location of tenderness is consistent with ATFL sprain
