The guidelines for Ankle Sprain have been established by the New York State Workers Compensation Board to assist physicians, podiatrists, and other healthcare professionals in delivering suitable treatment.
These guidelines are designed to serve as a valuable resource for healthcare professionals, aiding them in making informed decisions about the appropriate level of care for patients with ankle and foot disorders.
It’s crucial to emphasize that these guidelines are not a replacement for clinical judgment or professional experience. The ultimate decision regarding care should be a collaborative one between the patient and their healthcare provider.
Ankle injuries are common and often necessitate urgent care. In an ankle sprain, one or more ligaments within any of the three ligament groups might be torn. The majority of ankle sprains involve only the lateral ligaments, while about 15% of injuries affect the medial ankle.
The natural course of recovery for a lateral ankle sprain is typically swift. However, between 10% and 20% of acute ankle sprain patients may develop persistent ankle instability.
To determine the severity of lateral ankle sprains based on physical examination results, classification methods are used to specify the level of ligament damage:
– Sprain: A ligament injury that isn’t always permanent.
– Grade I: Overstretching or slight tearing without instability.
– Grade II: Incomplete tearing.
– Grade III: Complete tear or rupture.
It’s crucial to consider red signs, including the possibility of a fracture, in the assessment of ankle injuries.
Diagnostic Studies for Ankle Sprain in workers compensation patients
Checking ligament rupture with routine stress X-rays in acute ankle sprains is not recommended, especially for severe tears.
Similarly, using regular stress X-rays for evaluating ligament rupture in chronic or subacute ankle sprains is not advised, particularly for assessing ongoing ankle pain.
Here’s why: X-rays are not needed to diagnose an acute ankle sprain because they aren’t effective in detecting soft tissue injuries. Instead, plain film X-rays are better suited to check for ankle or foot fractures, assessing factors like the direction of fracture planes and the extent of articular surface involvement. If there’s a strong suspicion of a foot or ankle fracture, X-rays are recommended.
For the evaluation of subacute or chronic ankle sprains, CT scans are recommended for specific cases. These include patients not improving after non-operative treatment, experiencing chronic discomfort with weight-bearing even after four to six weeks of therapy, or dealing with a persistent sense of instability. Signs such as crepitus, catching, ankle injuries, or locking may indicate a displaced chondral bone fragment and warrant a CT scan.
However, when it comes to acute ankle sprains, using CT for assessment is not recommended.
Magnetic Resonance Arthrography (MRA) is not suggested for evaluating subacute or chronic ankle sprains.
Similarly, MRA is not recommended for assessing acute ankle sprains.
However, Magnetic Resonance Imaging (MRI) is recommended for evaluating specific patients with acute or recurring ankle sprains. This includes individuals who don’t improve after non-operative treatment, experience chronic discomfort with weight-bearing even after four to six weeks of therapy, or have a persistent sense of instability. Signs like crepitus, catching, ankle injuries, or locking may suggest a displaced chondral bone fragment.
The reason for this recommendation is to assess ligament and osteochondral damage caused by fractures, ankle sprains, lesions of the talus, and other soft tissue injuries like impingement.
But, when it comes to assessing acute ankle sprains, MRI is not recommended.
Bone scans are recommended for assessing acute ankle sprains in specific cases where there is suspicion of a stress fracture, infection, or malignancy.
However, bone scans are not advised for patients with subacute or chronic ankle sprains.
Similarly, ultrasound is not recommended for diagnosing chronic or subacute ankle sprains.
On the other hand, electrodiagnostic studies of the peroneal nerve are recommended for select patients with recurrent or recalcitrant lateral sprains. This is especially crucial to rule out peroneal neuropathy in patients with clear inversion damage due to lateral sprains.