A collegiate volleyball player lands awkwardly after a jump serve and reports sharp lateral ankle pain with immediate swelling. She denies numbness or tingling, but has significant pain limiting her range of motion. On examination, there is tenderness over the lateral aspect of the ankle, no deformity, and the skin is intact. What is the next best step in managing this patient's injury?
Immobilize the ankle and schedule the patient for an outpatient MRI to assess for ligamentous damage.
Refer the patient to an orthopedic specialist for an evaluation before initiating any treatment.
Order an X-ray to exclude a fracture before taking any further actions.
Implement the RICE protocol immediately and reassess the injury after initial swelling has been managed.
The mechanism of injury and the symptoms described are highly suggestive of an ankle sprain, which may include a rupture of the lateral ligaments. Considering the acute event and the absence of neurovascular compromise, immediate application of the RICE protocol would be the next step, as this modality will help minimize swelling and pain, which are the immediate concerns. Assessing for distal pulses should be included in the physical assessment, but not prioritized over the RICE protocol in the absence of neurovascular symptoms. While immobilization and an X-ray are important for definitive management, they are steps that follow initial injury care principles like RICE. A specialist referral may be warranted but only after the initial management and assessment are completed.
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BCEN CEN
Musculoskeletal and Wound Emergencies
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