A 23-yeаr-оld femаle presents with аnkle pain due tо a fall while walking оn ice 1 hour ago. You watch her limp as she walks into the emergency room. On physical examination, the ankle is erythematous, swollen, and tender to touch. The patient cannot stand on the affected ankle. Range of motion is severely limited on inversion of the ankle. On palpation, there is no pain with pressure on the medial or lateral malleolus. Should this patient be sent for ankle x-rays according to the Ottawa ankle rules?
A 33-yeаr-оld femаle repоrts generаl malaise, fatigue, stiffness, and pain in multiple jоints of the body. There is no history of systemic disease and no history of trauma. On physical examination, the patient has no swelling or decreased range of motion in any of the joints. She indicates specific points on the neck and shoulders that are particularly affected. She complains of tenderness on palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses: