Lower Extremity Strains and Sprains

Chapter 167 Lower Extremity Strains and Sprains




Clinical Case Problem 1 A 21-Year-Old Woman with a Swollen Ankle


A 21-year-old woman comes to the emergency department after “twisting” her ankle while playing lacrosse. She tells you her ankle “rolled in” at the time of injury, and she says she has pain at her right ankle. She is able to walk without any assistance.


On examination, there is minimal ecchymosis and swelling on the lateral side of her right ankle. There is pain with inversion of the right ankle. Ankle tenderness is maximal just anterior to the tip of the lateral malleolus. There is no actual bone tenderness. There is no ligamentous laxity.



Select the best answer to the following questions




1. The injury in this patient is most likely which of the following?


a. a grade I sprain of the ligament complex on the medial side of the right ankle

b. a grade III sprain of the ligament complex on the lateral side of the right ankle

c. a grade I sprain of the ligament complex on the lateral side of the right ankle

d. a strain of the peroneus brevis tendon

e. a fracture of the distal fibula

2. What ligament is most likely involved in this injury?


a. anterior inferior tibiofibular ligament

b. calcaneofibular ligament

c. anterior talofibular ligament

d. dorsal calcaneocuboid ligament

e. interosseous talocalcaneal ligament

3. What is the treatment of choice in this patient?


a. fiberglass cast

b. weight bearing as tolerated with active range of motion exercises

c. non–weight bearing and a posterior splint

d. corticosteroid injection

e. surgical repair of the ligament


Clinical Case Problem 2 A 26-Year-Old Football Player Hit on the Lateral Side of the Knee


A 26-year-old professional football player is brought to the emergency department after being hit on the lateral side of the left knee. His knee buckled, and he is now in severe pain.


On examination, there is swelling over the medial aspect of the left knee. There is laxity when a valgus stress test is performed on the knee. The results of the Lachman and McMurray tests are negative.




4. What is the most likely injury in this patient?


a. lateral meniscus tear

b. medial meniscus tear

c. lateral collateral ligament sprain

d. medial collateral ligament sprain

e. tibial plateau fracture

5. Based on your diagnosis in question 4, what is the initial treatment of choice?


a. corticosteroid injection

b. knee brace

c. fiberglass cast

d. complete bed rest

e. surgical repair


Clinical Case Problem 3 A 22-Year-Old Man Who Twisted His Right Knee


A 22-year-old man is brought to the emergency department 8 hours after twisting his right knee while playing in a soccer match. At the time of injury, he felt a sharp pain on the “inner” part of his right knee. He has been unable to straighten his knee fully and had to be carried off the field by his teammates.


On examination, there is a moderate joint effusion, tenderness at the medial joint line, and limitation of the last 20 degrees of extension by a springy resistance. There is sharp anteromedial knee pain when passive extension is forced.



6. What is the most likely diagnosis in this patient?


a. medial meniscus tear

b. lateral meniscus tear

c. medial collateral ligament sprain

d. anterior cruciate ligament sprain

e. fractured patella

7. The radiologic procedure of choice to confirm the diagnosis in this patient is which of the following?


a. plain radiography of the right knee in the anterior-posterior and lateral views

b. cone view radiography of the right knee

c. arthrography

d. computed tomography scan

e. magnetic resonance imaging (MRI) scan

8. What is the treatment of choice for the injury to this patient?


a. non–weight bearing and a knee immobilizer

b. non–weight bearing and a full cast

c. ice, elevation, and an elastic bandage

d. arthroscopic surgery

e. physical therapy


Clinical Case Problem 4 A 23-Year-Old Woman with Right Posterior Thigh Pain


A 23-year-old woman comes to your office with right posterior thigh pain. She was running in a 100-meter race when she felt a “pop” in her thigh.


On examination, there is tenderness over the midportion of the right hamstring muscles and pain with resisted stress testing. There is mild swelling and discoloration. There is no bone tenderness and no palpable defect.



9. What is the most likely diagnosis in this patient?


a. right hamstring strain

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Lower Extremity Strains and Sprains

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