The use of anti-inflammatories is widespread in the treatment of musculoskeletal injuries and pain (Paoloni et al. 2009). This has in part led to the common misconception that inflammation is an inherently negative occurrence which needs to be stopped or at least limited rather than the essential healing process that it is (Garnham, 2009). In this case study the use of anti-inflammatories for a common musculoskeletal complaint will be discussed with the impact on the prescribing clinician’s clinical reasoning highlighted.
Presentation & Initial Management
The case in question is one of a 29yr old man (Patient B) who suffered an inversion injury to his right ankle whilst playing football. He attended the Emergency Department (ED) where he was diagnosed as an ankle sprain following a negative x-ray and given elbow crutches to facilitate early weight bearing, tubigrip for additional support and paracetamol 500mg for pain relief. He was given a physiotherapy appointment for five days later.
At the physiotherapy appointment the patient continued to complain of significant discomfort, worse with weight bearing and continued swelling which also worsened with weight bearing and towards evening. On examination Patient B had significant swelling spreading from the forefoot to the distal lower leg. Bruising was significant being present into both the forefoot and the medial ankle but being most significant over the lateral aspect. Range of motion was limited with swelling, stiffness and pain, most notably into inversion and dorsiflexion. The patient had widespread tenderness as would be expected but was most tender over the lateral ligamentous complex, especially the anterior tibiofibular ligament (ATFL) and calcaneofibular ligament (CFL) with notable point tenderness at the distal fibula, approximately at the origin of CFL. Diagnosis was one of a high grade ankle sprain.
Management & Case Progression
The primary barriers to progress