Author: Daniel Chen, MD
Co Author #1: Drew Duerson, MD, RMSK
Senior Editor: Justin Mark Young, MD
Editor: James Robinson, MD

Patient Presentation:
Patient is a 15 year old male football player who presents with ongoing pain after a left ankle injury.

History:
The initial injury occurred 3.5 weeks ago during practice. He describes an inversion mechanism. Afterwards he could bear weight, but could not keep playing. He had pain and swelling over his medial ankle. He was seen at an urgent care that same day, and described to have a "fluctuant cyst" on his ankle. Ankle X-rays were obtained and read as normal. He was given a stirrup brace, and told to follow up in 1 week. After wearing the stirrup brace for 4 days, symptoms improved and he resumed full participation in football, with only occasional pain. He has not had any re-injury of the ankle, but his pain did worsen the day prior, prompting presentation to clinic. He has not done any physical therapy. Of note, he continues to report a swollen "bump" on his medial ankle that has not resolved.

Physical Exam:
He is well-appearing in no obvious distress. He walks with a normal gait. Inspection of the ankle reveals a 2-3 cm round, fluctuant area of swelling over the anterior medial ankle. There is no ecchymosis. There is tenderness to palpation over the medial malleolus and deltoid ligament with no lateral ankle tenderness.
He has full range of motion in all direction, but pain with inversion and eversion.
He has 4/5 strength with eversion with pain and 5/5 in all other directions. There is mild laxity with anterior drawer. Talar tilt and Syndesmotic squeeze are negative. He has pain with toe raise and one leg hop. The ankle is neurovascular intact.

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