Её беспокоила не столько царапина на ладони, сколько сильный ушиб лодыжки.

It is a very common Russian pattern meaning not so much X as Y.

So the structure:

не столько царапина на ладони, сколько сильный ушиб лодыжки

means that the first thing is less important, and the second thing is the real/main issue.

Here столько and сколько are not really about counting. In this expression, they function as part of a fixed comparison pattern.

Here её means her as a pronoun, not hers and not the possessive her.

In this sentence, её is the person affected by the verb беспокоила.

A useful way to see it:

• Её беспокоила царапина = The scratch was troubling her
• If it were possessive, it would normally modify a noun:
  • её ладонь = her palm
  • её лодыжка = her ankle

So here её is an object pronoun, not an adjective-like possessive.

Russian often expresses this idea with the pattern:

X беспокоит Y

literally: X worries/troubles Y

So in this sentence, the injuries are grammatically the things doing the troubling, and её is the person experiencing that concern.

English often prefers:

• She was worried about ...
• What troubled her was ...

Russian is happy with:

• Её беспокоила царапина
• Её беспокоил ушиб

So the sentence is built around that normal Russian pattern.

Because in the past tense, Russian verbs agree in gender and number with the grammatical subject.

The first noun after the verb is царапина, which is feminine singular, so the verb appears as беспокоила.

This can feel a little strange to English speakers because the sentence later adds ушиб, which is masculine. But in the pattern не столько X, сколько Y, the verb commonly agrees with the first noun in the pair.

So:

• царапина → feminine
• therefore беспокоила

If the order were changed so that the first noun were masculine, you would expect masculine agreement:

• Её беспокоил не столько ушиб ..., сколько ...

Беспокоила is imperfective because it describes an ongoing state or continuing concern.

The idea is not that one event suddenly made her worry at a single moment, but that this injury was what was troubling her.

Compare:

• беспокоила = was troubling, was bothering, was worrying
• обеспокоила = alarmed, caused concern, made someone worried

So the imperfective fits better when describing what was occupying her mind or causing continuing concern.

Here is the breakdown:

• царапина — nominative singular
• на ладони — prepositional singular after на
• ушиб — nominative singular
• лодыжки — genitive singular

Why?

• царапина and ушиб are the things that are grammatically doing the troubling, so they appear in the nominative.
• ладони is used after на to show location: on the palm
• лодыжки depends on ушиб and means of the ankle

So ушиб лодыжки is literally a bruise/contusion of the ankle.

Because these are two different relationships.

1. царапина на ладони

This describes the location of the scratch:

• на ладони = on the palm

2. ушиб лодыжки

This describes the body part affected by the injury:

• лодыжки = of the ankle

Russian very often uses this genitive pattern with injuries:

• перелом руки = fracture of the arm
• ушиб колена = bruise to the knee
• вывих плеча = dislocation of the shoulder

So ушиб лодыжки is a very normal medical/everyday way to say an ankle bruise/injury.

Not exactly.

Ушиб is an injury caused by a blow or impact — often translated as bruise, contusion, or sometimes just a bad knock/injury depending on context.

Синяк is more specifically the visible black-and-blue mark.

So:

• ушиб = the injury itself
• синяк = the discoloration/bruise mark

Also, ушиб is not the same as:

• растяжение = sprain/strain
• вывих = dislocation
• перелом = fracture

So сильный ушиб лодыжки suggests a fairly serious impact injury to the ankle, not just a small mark.

Yes, сильный often means strong, but with pain, symptoms, and injuries it very often means severe, bad, or serious.

Very common examples:

• сильная боль = severe pain
• сильный кашель = a bad cough
• сильный ушиб = a bad/severe bruise or contusion

So here сильный is completely natural and does not mean that the bruise is strong in a literal English sense.

Yes. Russian word order is flexible, and changing it changes emphasis more than basic meaning.

The given order:

Её беспокоила не столько царапина на ладони, сколько сильный ушиб лодыжки.

does a few things naturally:

• puts её first as the topic: as for her / what was troubling her
• introduces the verb early
• saves the strong contrast for the end

A different order like:

Не столько царапина на ладони, сколько сильный ушиб лодыжки беспокоил(а) её

would sound more contrast-heavy and stylistically different.

So the original word order is very natural because it leads smoothly into the не столько ..., сколько ... contrast.

Ладонь specifically means palm — the inner side of the hand.

Russian distinguishes clearly between:

• рука = arm/hand
• ладонь = palm

So царапина на ладони is more specific than царапина на руке.

Likewise, лодыжка specifically means ankle, not just leg or foot. So the sentence uses precise body-part vocabulary.