WEEK 1 - ACUTE LIGAMENTOUS INJURY - ANKLE

Question 1

Describe the components of a purposeful clinical interview - Overview

Answer 1

Clinical examination
- Subjective examination
- PE planning (diagnostic hypotheses generated
- Physical examination

Clinical reasoning

Definitive diagnosis, stage, classification and key contributing factors

Reason - is Physiotherapy indicated / or is referral required

Question 2

Clinical reasoning and determining best care - definition and components

Answer 2

Clinical Reasoning

Definition: Clinical reasoning is the complex process whereby the thinking and decision-making associated with clinical practice is used to make decisions, based on sound judgement, to ensure the
well-being of the patient (Higgs & Jones 2008)

For health professionals, clinical reasoning is the process by which practitioners ‘get it right’ for their
patients.

• Two linked components:
  
  • Diagnostic reasoning
  • Care related reasoning

Determine the ‘best’ care

• Informed by high quality research evidence
• shared decision making with patient
• based on patient presentation, values and preferences
• potentially influenced by clinical experience
• knowing when to refer onward

Question 3

What does a diagnosis consist of

Answer 3

• Structure + Pathology
  
  • e.g Grade 1 Biceps Femoris tear
• What do patients what?
• They want to be validated and heard
  
  • patient centred care features, thorough examination and communication of findings, empathy and communal understanding of the issue.
• Whats wrong with me? (diagnosis and contributing factors)
• How long will it take to get better? (prognosis)
• options on how to get back to full function
• clear plan for recovery
  
  • shared decision making is critical

Question 4

Describe the roles and responsibilities of the primary practitioner

Answer 4

• Data gathering
  
  • Hear the story + other information
• Hypothesis generation
  
  • What could this be?
• screening for potential serious injury
• Hypothesis testing
  
  • Physical assessment to confirm/negate
  • Response to care
• Reflection/Re-assessment and refinement
  
  • How did that go?
  • What else could this be?

Question 5

Importance of screening for potential serious injury (2)

Answer 5

• early intervention to serious pathologies can greatly improve the rehabilitation process, preventing further damage and improving potential for recover
• relevant referrals are an important part of being the primary practitioner, as we must work within our scope of profession.

Question 6

screening for relevant red flag conditions related to acute, high-energy ankle injuries - FEATURES OF CONCERNING (5)

Answer 6

• Clear history of trauma with clear mechanism of injury
  
  • moment in time injury
• high energy trauma with severe pain
• Inability to WB due to pain
• Rapid, severe effusion?
• Low-energy/minor trauma with disproportionate pain

Question 7

Ottawa ankle rules

Answer 7

An ankle XR series is required only if any of the following are evident…

• TOP midline distal 6cm of fibula OR tip of lateral malleolus and/or
• TOP midline distal 6cm of tibia OR tip of medial malleolus and/or
• Unable to WB at time of the injury and unable to walk 4 steps in the clinic or ED

A foot XR series is required if…

• TOP base of 5th metatarsal and/or
• TOP at the navicular and/or
• Unable to WB at time of the injury and unable to walk 4 steps in the clinic or ED