Discharge Instructions - Ankle Sprain

As discussed in the Emergency Department prior to discharge, you have been diagnosed with an ankle sprain.  An ankle sprain is a very common injury.  An ankle sprain means there is damage to one of the ligaments in the ankle.  The most common type of ankle sprain occurs on the lateral or outside part of the ankle.  In this area, there are three main ligaments, all of which attach to the bone on the outside of your ankle: the anterior talofibular ligament (in the front), the posterior talofibular ligament (in the back), and the calcaneofibular ligament (underneath).

In most ankle sprains, the anterior talofibular ligament is partly torn, usually when the foot rolled inwards during activity.

Unfortunately, ligaments do not have a good blood supply (unlike tendons) and as a result, they can take 4-6 weeks to heal, and up to six months for full strength to return.

There are several ways to reduce swelling and to help the healing process:

-Elevate the injured ankle.  This can be done by putting your leg up on a chair when sitting down (watching TV, reading, eating dinner, etc.).  Elevating the ankle uses gravity to drain the swelling away from the ankle.

-If the ankle is swollen or painful, apply ice wrapped in a towel (or a bag of frozen peas wrapped in a thin towel) on the ankle for about 10 minutes at a time.  Then remove the ice pack and allow the skin to return to normal temperature before re-applying the ice pack (to avoid frostbite).  Continue this while the ankle is still swollen; do not apply heat while the ankle is swollen.

-A tensor bandage can be wrapped around the ankle to provide more support over the lengthy healing period.  This bandage can be removed when applying ice to the ankle.

-If the sprain was severe, you may have been provided with a splint during your visit to the Emergency Department.  Use the splint as directed by the emergency physician.

You can take Acetaminophen (also known as Tylenol), Ibuprofen (also known as Advil or Motrin), or Naproxen (also known as Aleve) for the pain.

When can you walk on your ankle?  The answer to this question is to “listen to your ankle.”  If you feel pain when you try to put any weight on the injured ankle, then listen to your ankle and use crutches or a cane for a few days instead.  After a few days, try to put some weight on your ankle again, starting with a small amount of weight and gradually increasing this amount as you feel comfortable.

If your ankle is not healing in 4-6 weeks, see your primary care doctor.

https://orthoinfo.aaos.org/globalassets/pdfs/2017-rehab_foot-and-ankle.pdf

https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/

Physical Exam - Orthopedic Knee Exam

[No/Minimal/Moderate] isolated tenderness to palpation over the patella of the [right/left] knee.  [No/Minimal/Moderate] tenderness to palpation at the head of the [right/left] fibula.  [Limited/full] active range of motion of the [right/left] knee to [90/##]°.  [Limited/full] passive range of motion of the [right/left] knee to [90/##]°.  Patient [not able/able] to ambulate 4 steps in the ED [despite pain/due to pain]. 

[No/Mild/Moderate] instability on valgus (medial) stress of the [right/left] knee.  [No/Mild/Moderate] instability on varus (lateral) stress of the [right/left] knee.  [Negative/Positive] Lachman's test (instability with anterior stress on the knee in 15-30° flexion).  [Negative/Positive] anterior drawer test (instability with anterior stress on the knee in 90° flexion).  [Negative/Positive] posterior drawer test (instability with posterior stress on the knee in 90° flexion).  [Negative/Positive] McMurray's test of lateral meniscus (pain when knee is brought from full to 90° flexion while leg is externally rotated with compression over the medial joint line).  [Negative/Positive] McMurray's test of medial meniscus (pain when knee is brought from full to 90° flexion while leg is internally rotated with compression over the lateral joint line). 

[Remainder of extremity exam unremarkable.]

https://www.orthobullets.com/recon/12755/knee-physical-exam--adult

MDM - Ankle Sprain

[##]-year-old [male/female] with history and exam consistent with ankle sprain.

Initial consideration in this patient included ankle fracture or sprain, and foot or leg fracture or sprain among others.

Patient noted to [not] meet all of the Ottawa ankle rules upon presentation to the ED, [so plain films of the ankle/foot were obtained/imaging was not obtained due to low risk for significant injury/but plain films of the ankle/foot were obtained in triage].  Patient noted to have [minimal/no evidence of significant] laxity of the ankle on exam.  [Plain films of the ankle/ankle and foot showed no evidence of fracture or dislocation.]  Ankle [placed in splint/wrapped] in the ED, and patient provided with crutches and training prior to discharge.

We discussed RICE measures (rest, ice, compression, and elevation) and use of crutches with early weight bearing as tolerated with the patient.  We discussed return precautions, symptomatic treatment, and follow up with primary care doctor within 1 week as needed for further evaluation, and the patient demonstrated understanding and agreement with this plan.

https://orthoinfo.aaos.org/globalassets/pdfs/2017-rehab_foot-and-ankle.pdf
https://orthoinfo.aaos.org/en/diseases--conditions/sprained-ankle/