Wk 5, Case 2 - Review

Patient History
14-year-old girl, with previous history of fibular fracture 4-5 months prior, complaining of continued right ankle pain, swelling, and locking symptoms.

Findings
SKELETAL/BONES:
Pattern of patchy, mostly peripheral/subcortical (window frame type) osteoedema throughout the midfoot and hindfoot. Osteoedema more pronounced than typical pattern of stress/overuse related osteoedema.
No micro- or macro-trabecular fracture. No stress fracture. No aggressive osseous abnormality.

ARTICULATIONS:
Tibiotalar joint/talar dome: Mild to moderate capsulitis with a small posterior tibiotalar effusion.
Ankle mortise/syndesmosis: The ankle mortise is in anatomic alignment. No syndesmosis widening.
Chopart joint: Unremarkable.
Midfoot/hindfoot: No fracture or injury of the anterior calcaneal process. No prominent midfoot or hindfoot arthrosis.
Lisfranc joint: The Lisfranc joint is intact, without fracture or joint space widening.

LIGAMENTS:
High ankle: Intact.
Low ankle: Evidence for a remote 2-part low ankle sprain with a markedly thickened, fibrotic ATFL and calcaneofibular ligament. Posterior talofibular ligament swollen but intact. Deltoid ligament complex intact.
Subtalar/Chopart: Intact.

TENDONS:
Intact.

GENERAL:
Sinus tarsi: Unremarkable.
Muscles: No traumatic muscle injury. No volumetric muscle atrophy.
Soft tissue: Unremarkable.
Plantar fascia: Intact.
Neurovascular complex/tarsal tunnel: Unremarkable. No evidence of entrapment neuropathy.
Intra-articular/loose bodies: None.

Impressions
1. Findings highly suspicious for complex regional pain syndrome type 1 (CRPS type 1, previously known as RSD). Recommend assessment for allodynia, pilomotor and proprioception hypersensitivity. If clinical syndrome matches MRI diagnosis, strongly consider movement therapy and/or lumbar block.
2. Evidence for a remote/chronic 2-part low ankle sprain.