Patient Encounter 1 Part 1

A 32-year-old man presents with left ankle pain. He was playing football with friends earlier today and twisted his ankle. The pain occurs at rest and is worsened by movement and weight-bearing activities. There is moderate swelling and mild bruising of the left ankle. He states "I don't like to take pills" and asks for a recommendation to cool the affected area.

What information is suggestive of a musculoskeletal disorder?

What is your assessment of the patient's ankle pain?

What additional information do you need to formulate a treatment plan?

In many cases, musculoskeletal disorders are self-treated with over-the-counter (OTC) oral or topical agents. However, further evaluation may be warranted if acute pain persists longer than 7 to 10 days, symptoms worsen or subside and then return, or there are signs of a more serious condition.11,24 26 Warning signs of more serious conditions include joint deformity, dislocation, or lack of movement in a joint. Low back pain accompanied by burning, radiating pain, or difficulty urinating requires further evaluation.

In children and adolescents, treatment practices are similar to the approach in adults with a focus on nonpharmacologic therapy and oral analgesics. Children younger than 2 years of age, elderly persons, and pregnant women also may need special care. Elderly patients may be more prone to systemic effects because of thinning of the skin and increased absorption of topical agents and drug interactions from poly-pharmacy.

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