Differential diagnosis for Ankle sprain.

Differential diagnosis for Ankle sprain.

What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.

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Differential Diagnosis for Ankle Sprain:Possible diagnosis for Ankle Sprain include:

 Fracture:

 Plan for Diagnostics: Request Lateral view X-ray of the ankle to rule out bone fracture. However, a negative first set of radiographs should not deter the clinician especially if there is a high clinical suspicion of a fracture as a CT or MRI scan should be requested.

 Plan for Treatment and Management: In case of a fracture, the patient may require to be put in a cast or splint, the affected limb should not be used, the limb should be elevated and in severe cases surgery depending on the type of fracture. The results of imaging should be confirmed by repeated examination in the case of rehabilitation.

 Tendinitis:

 Plan for Diagnostics: A routine physical examination should be done and special emphasis should be paid to the tendons around the ankle most especially the Achilles tendon. Inflammation, or tears in the tendon are well captured by an ultrasound or a Magnetic Resonance Imaging (MRI).

 Plan for Treatment and Management: It also entails the R. I. C. E protocol; which include the use of rest on the affected area, application of ice on it, administration of non steroidal anti inflammatory drugs to reduce pain and inflammation and physical exercise in form of stretching and building up the muscles. Among the other forms of treatment that may be employed are the ultrasound therapy or the shock wave therapy. The doctor examines the patient and enquires on the symptoms in order to assess the condition of the patient.

 Ligament Tear (e.  g.  , Anterior Talofibular Ligament Tear):Tear of a Ligament (e. g. , Anterior Talofibular Ligament Tear):

 Plan for Diagnostics: The examination may also reveal instability or paradoxical motion that is, the joint may appear to be loose or shift abnormally. Besides this, an MRI can be done or at times plain X-ray with stress views will be done to assess for ligament ruptures.

 Plan for Treatment and Management: The first treatment comprises of R. I. C. E which is an acronym for rest, ice, compression as well as elevation and NSAIDs. It is imperative to do physical therapy for the range of motion and for the strengthening of muscles. At the extreme, it may be necessary to operate. The follow up entails assessment of the stability of ligaments with regard to their ability to function.

 Plan for Ankle Sprain Diagnosis and Management:Proposal for the Diagnosis and Management of Ankle Sprain:

 Diagnostics:

 Initial Assessment: Conduct a complete history and physical examination to determine the degree and nature of the damage.

 Imaging: X-ray, as a minimum, to rule out bone injuries and if soft tissue injury is suspected then MRI or sonography can be utilized.

 Primary Diagnosis:

 Ankle Sprain: If there is no evidence of fractures on the imaging and there is a suspicion of the ligament problem on the clinical examination then.

 Treatment and Management:

 Pharmacologic Treatments:

 NSAIDs: For pain and inflammation, for instance, there are ibuprofen and naproxen.

 Acetaminophen: For analgesia in patients in whom NSAIDs are contraindicated or not suitable to be given.

 Nonpharmacologic Treatments:

 R.  I.  C.  E.  : RICE technique; in order to cure the swelling and the pain one needs to avoid the use of the affected part, use an ice pack, use a bandage or a compression wrap and try to keep the affected part raised.

 Physical Therapy: To improve and reconstruct or strengthen the muscles of the ankle joint.

 Supportive Devices: An orthopedic shoe or an ankle brace or splint to support the joint that is involved in the case.

 Alternative Therapies:

 Heat Therapy: Heat is also a known mediatory of inflammation; after the inflammation has been reduced heat is applied for the muscle relaxation.

 Acupuncture: May have an effect on pain and the process of recovery.

 Follow-Up Parameters:

 Re-evaluation: To assess the patient’s condition and to recommend subsequent course of action and treatment in case there are no improvements or deterioration of the patient’s condition, as well as to check for side effects or occurrence of other diseases.

 Functional Assessment: Evaluation: Perform ROM and check the patient’s muscle strength, and mark their preparedness for the next round of activities.

 Rationale:

 Diagnostics: It assist in the right management to be made and or to avoid or reduce on complications that may arise in the course of the disease. It is a means of differentiating the three from other related conditions.

 Treatment and Management: Pharmacological and Non pharmacological measures: Pain, inflammation and recovery of the function is the aim of both drug and non drug therapies. There is a possibility of the two forms of treatment to be regarded as additional to the conventional treatment. It is used in establishing whether there is any improvement and if there is the need to make adjustments in the plan of treatment.