Differential Diagnosis for a 37-year-old Male with Ankle Injury
- Single most likely diagnosis:
- Ankle sprain: The patient's history of inverting his ankle while skateboarding, followed by immediate pain and a popping sensation, is highly suggestive of an ankle sprain. The fact that he has a history of a previous sprain to the same ankle also increases the likelihood of this diagnosis.
- Other Likely diagnoses:
- Ankle fracture: Although the patient denies any previous fracture, the mechanism of injury and the presence of immediate pain and a popping sensation could also be indicative of a fracture. It is essential to consider this diagnosis, especially if the patient has significant pain, swelling, or difficulty bearing weight.
- Achilles tendon rupture: The patient's report of a popping sensation at the time of injury could also suggest an Achilles tendon rupture, especially if the pain is localized to the posterior aspect of the ankle.
- Peroneal tendon injury: The peroneal tendons are located on the lateral aspect of the ankle and can be injured with inversion mechanisms. This diagnosis should be considered if the patient has pain or swelling on the outside of the ankle.
- Do Not Miss diagnoses:
- Compartment syndrome: Although less likely, compartment syndrome is a potentially devastating condition that can occur after an ankle injury. It is essential to consider this diagnosis if the patient has severe pain, pallor, poikilothermia, paresthesia, or paralysis.
- Neurovascular injury: Injury to the nerves or blood vessels around the ankle can occur with severe trauma. It is crucial to assess the patient's neurovascular status and consider this diagnosis if there are any abnormalities.
- Rare diagnoses:
- Osteochondral lesion: An osteochondral lesion is a rare condition where a piece of cartilage and bone becomes damaged or detached. This diagnosis should be considered if the patient has persistent pain or swelling after an ankle injury.
- Syndesmotic injury: A syndesmotic injury occurs when the ligaments that connect the tibia and fibula are damaged. This diagnosis is less common but should be considered if the patient has pain or instability in the ankle, especially with external rotation mechanisms.