Clinical Case Slide Presentation Ankle Ankle Injury - Rock Climbing. Poster presentation

Medicine & Science in Sports & Exercise: May 2002 - Volume 34 - Issue 5 - p S243 F33g Clinical Case Slide Presentation Ankle Ankle Injury - Rock Climbing Christensen, G A.

HISTORY:
- A 25 year-old female experienced rock climber from England sustained a left ankle injury while outdoor climbing in Australia. During a high leg rock-over maneuver, she was bearing all her weight on the medial edge of her left forefoot/great toe with the ankle/foot in an externally rotated, everted, and dorsiflexed position, while then attempting to stand and reach for handholds. Without slipping, her ankle suddenly gave way with severe pain as she felt something move in her ankle. She did not strike her ankle/foot or suffer other appreciable injury during the resulting 20 foot fall. After being unable to bear weight initially, she could do so without pain within 2 hours; but she did not trust her ankle. Recurrent sensations with minimal pain of the tendon flicking over the bone and then back on the ankle's lateral aspect followed several times daily for weeks to follow. She saw myself as a visiting physician and fellow climber at the site on days 1 & 2 after the injury, and she was referred to and ultimately seen at a major Australian sports medicine center.

PHYSICAL EXAMINATION:
- Exam at the climbing site and later at the sports med center revealed a 5′8″, 58 kg athletic female with only mild swelling and tenderness limited to the soft tissues posterior to the lateral malleolus. Mild tenderness without swelling of the anterior distal aspect of syndesmotic ligament, pain with forced external rotation of the foot/ankle, FROM of the ankle joint, equal Grade I anterior drawer sign of both ankles, decreased power of peroneals, and patient apprehension or examiner ability to sublux peroneal tendons on forceful resisted eversion in the dorsiflexed position were other significant findings. There was no neurovascular compromise.

DIFFERENTIAL DIAGNOSIS-:
1. Subluxation peroneal tendons with or without tear.
2. Syndesmotic ankle sprain
3. Fracture of lateral malleolus
4. Lateral ligament ankle sprain
5. Cuboid subluxation

TESTS AND RESULTS-:
Radiograph left ankle: no fracture, bony avulsion, or abnormality. Ultrasound left ankle (with right ankle control): peroneal tendons intact without tear, equal contical irregularity of distal fibula just proximal to left and control ankle joint, equal excess soft tisue adjacent to peroneal tendons (possible normal variant of peroneus tertius) of left and control ankle.

FINAL/WORKING DIAGNOSIS-:
Recurrent subluxation peroneal tendon left ankle without tear

TREATMENT AND OUTCOME-:
1. Initial: taping, elastic bandage, ice, rest
2. 2 weeks post injury, at sports med center: posterior splint of ankle in
neutral position, crutches, NWB
3. 3 weeks post injury, at foot and ankle surgical referral: Camm Walker,
6-8 weeks conservative management without physiotherapy or exercise,
recheck in England with foot and ankle surgeon
4. 9 weeks post injury to present: extensive physical therapy and patient
doing quite well.