Post by jmfkmd on Oct 24, 2014 12:17:41 GMT -5
Hey guys, working another wonderful shift at TTH on this beautiful day when I'd rather be logging in another Century on my bike. Glad I'm here now though because I came across this cool x-ray to post on this forum!
68 yo woman with hx of foot drop in the right foot from a MVA back in March. Has seen vasular and neurosurgery for her right foot issues... the whole battery of exams and tests... even was plugged in with St. V's Pain Clinic and now is on our pain protocol here. 2 days ago she was walking from her bed to her wheelchair, her dropped foot caught on the floor and she fell. Presents to the ER with pain in her right ankle.
Being a chronic pain patient and on our pain protocol, you can imagine the pre-entry sign out i got from the nurse... "Dr. K - we got another one (cue: eyes rolling). Just so you know she's on the pain protocol, has all these pain issues with her foot, already has been seen and d/c'd from a pain management practice at St. V's. She's such a handful, she's crying and screaming and she's not very nice. Oh and yeah, she fell or something 2 days ago and now her ankle (cue: the miming quotation marks) 'hurts'."
So, I nod my head and acknowledge the nurse, go in and examine the patient. Palpation of her ankle has TTP over bilateral malleoli (M>L). I palpate her knee, fibular head, patella, radial head... no pain whatsoever. Thompson's test negative. And she nearly kicks me in the face when i squeeze her calf.
Here's her X-Ray
What do you guys see? What's your Diagnosis? And What's your Management?
Love,
JMFK
68 yo woman with hx of foot drop in the right foot from a MVA back in March. Has seen vasular and neurosurgery for her right foot issues... the whole battery of exams and tests... even was plugged in with St. V's Pain Clinic and now is on our pain protocol here. 2 days ago she was walking from her bed to her wheelchair, her dropped foot caught on the floor and she fell. Presents to the ER with pain in her right ankle.
Being a chronic pain patient and on our pain protocol, you can imagine the pre-entry sign out i got from the nurse... "Dr. K - we got another one (cue: eyes rolling). Just so you know she's on the pain protocol, has all these pain issues with her foot, already has been seen and d/c'd from a pain management practice at St. V's. She's such a handful, she's crying and screaming and she's not very nice. Oh and yeah, she fell or something 2 days ago and now her ankle (cue: the miming quotation marks) 'hurts'."
So, I nod my head and acknowledge the nurse, go in and examine the patient. Palpation of her ankle has TTP over bilateral malleoli (M>L). I palpate her knee, fibular head, patella, radial head... no pain whatsoever. Thompson's test negative. And she nearly kicks me in the face when i squeeze her calf.
Here's her X-Ray
What do you guys see? What's your Diagnosis? And What's your Management?
Love,
JMFK
