Case 3 TB Arthritis Ankle

Case 3

TB Arthritis Ankle 

Introduction , Permission to ask questions and examine. Tell patient to remind him if the patient is not comfortable during the examination.

Two Relevant Questions

What happened ?                                            Pain and swelling  elsewhere on body ?

Shoe Wears – Worn outerside of sole

Gait – Limping

Alignment of Ankle /foot and toes – Normal

Attitude of Ankle  - no any particular 

No LLD

Look ankle / foot / leg  from Front , Side and Back on standing position

Skin erythematous and oedematous around ankle ,

Skin on dorsum of foot normal , normal medial arch from side and no too many toes from back

Calf muscle – wasted

          Ask patient to lie with feet out of bed – see the sole of feet

Feel  - Always first superficially then deep for bony palpation .

                                                Feel Temperature at Contralateral Ankle / Affected Ankle

Superficial then Deep Palpation

Tibia , Medial Malleolus , First metatrasal ,phalanges, other metatarsal bones, heel , lateral mallolus and along fibula

Ankle joint at last

Fluctuation at ankle joint

Palpate Popliteal and inguinal lymph nodes

Movement –                            Dorsiflexion , Plantarflexion of ankle , toes , and knee if possible

LLD – not there

Ligamentous Instability –

                                                Anterior and Posterior Drawer test

                                                Inversion/ Eversion stress test

Neurovascular Assessment

                                                Senstation – Dorsum of foot , first toe web space , sole

                                                Power of muscles – TA ,TP , Extensor of toes , Gastrosoleus

                                                Reflexes if time allows 

                                               

D/D

Arthritis of Ankle

Inflammatory Arthrtits

Infective Arthrits

Post traumatic Arthritis

Charcot Neuroapthy if there is DM

         Tensosynovitis of Flexor Tendons / TP

Investigations

Blood

CBC , ESR ,

Additionally to diagnose systemic illness

                        RBS, RA Factor

                        Urine R/E

Xray- Ankle – AP , Lateral

MRI

           

Treatment

            General ATT

            Splint in a neutral position

            Non weight bearing in a caliper