One of the most common workplace injuries is an ankle sprain. Often the mechanism involves an inversion injury which tends to stretch the structures on the lateral side of the ankle and compress the structures on the medial side of the ankle. In general terms, most people who sprain their ankle will get better within six weeks. The remainder tends to get better in another six weeks. The overall timeframe, therefore, is three months or so before we even consider surgery.

In terms of initial treatment, GPs, physiotherapists, other therapists and workplaces are in tune with the RICE principles. Further management really should at least involve x-rays and more commonly than not, an early MRI is being obtained within the first week or so following the injury. Whilst it is not strictly needed for every ankle sprain, MRIs are now becoming an imaging modality more easily obtained and more readily obtained as well.

The problem then becomes how do we treat the patient following an MRI scan! In terms of initial treatment, the best response would be early physiotherapy involving boot and crutches, weight-bearing as tolerated and appropriate analgesia involving paracetamol and anti-inflammatories. This is definitely true for all inversion type injuries. In the setting where an early MRI has been obtained, quite commonly the features discovered are ATFL or CFL tear. This is in fact a normal sprain and these are the ligaments that are torn when an ankle is sprained.

What to look out for on early MRI is any reference to the syndesmosis, ie. the tib fib ligaments. In fact, if an early MRI is obtained, the specific parameter that should be asked for is to check for any syndesmosis injury. This is often unlikely with a normal inversion injury but can be quite common in injuries where the leg or ankle is fixed and the body twists around the ankle. If a syndesmosis injury is found an early referral to an orthopaedic surgeon or foot and ankle specialist is warranted.

Other findings on an early MRI that should warrant early referral to an orthopaedic surgeon include fractures. Whilst not all fractures represent major injuries, in the setting of an injured worker, therapists who wish to get on with therapy and often a GP or occupational physician unfamiliar with all the pathology associated with an MRI, I believe is entirely appropriate for an early referral to be sought. Certainly, if a patient who is sent to me has had an MRI indicating the AFTL and CFL tears plus some other pathology, I think it is warranted that I get that patient in to see me within 1-2 weeks. Further management can then be delineated after review with the friendly orthopaedic surgeon.

Finally, MRI is a great modality for defining an ankle sprain. If an early MRI is obtained, then features of syndesmotic injury and fractures should alert the treating therapists to seek earlier Ortho opinion.