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Young Man With Ankle Pain and Stiffness

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BACKGROUND
A 39-year-old man presents with a 6-month history of pain in his right ankle. The pain has been insidious and is accompanied by stiffness and swelling of the ankle joint. The patient cannot move his ankle well. He cannot perform his daily activities despite using a crutch.

The patient has no history of trauma. He does not have fever, other joint involvement, or back pain. He has no history of sexually transmitted diseases, and his family history is negative for arthritis.

On physical examination, the patient has normal vital signs, including temperature. Cardiac findings are negative for murmurs or rubs. No rash or penile discharge is observed. Examination of the right ankle elicits discomfort and reveals physical limitation with inversion and eversion and especially with flexion and extension. On palpation, the patient has mild tenderness, and the swelling feels firm. No warmth or redness is found over the joint. The remainder of the physical examination yields unremarkable results.

A plain radiograph of the ankle is obtained. What is the diagnosis?
Hint
Monoarticular large-joint disease with a male preponderance
Author: Gautam Dehadrai, MD, Staff Physician, Department of Radiology, Veterans Affairs Medical Center, Albuquerque, NM
eMedicine Editor:

Rick G. Kulkarni, MD, Assistant Professor, Yale School of Medicine, Section of Emergency Medicine, Department of Surgery, Attending Physician, Medical Director, Department of Emergency Services, Yale-New Haven Hospital


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