Hi again Henry
Sorry, missed the bit about the pt being 20yo.
After re-reading the problem, it seems more rheumatoid, or maybe the
flairing of an old ankle injury. I have seen young patients who sprain the
deltoid or atfl, and have irregular recurrent ankle swelling for years
afterwards.
Re rheumatoid conditions, although rare in a 20yo, gout commonly attacks one
joint at a time (monoarticular arthritis), though when severe can spill over
into nearby jts. And sometimes the swelling is worse than the pain. You
might question him about his drinking habits i.e. a heavy binge combined
with getting dehydrated and missing sleep can unmask at this age, a genetic
predisposition to gout.
Cheers
Bruce
|