Evidence-Based Medicine for Student Health Services
Robert J. Flaherty, MD
Swingle Student Health Service
Montana State University
Bozeman, MT 59717
Sprains
 
Etiology Monitoring
Epidemiology Prognosis
Diagnosis Prevention
Treatment Patient Education
 
General Information
   
EBM for Student 
Health Home Page  
   
About EBM  
  
EBM Resources 
 
Specific Conditions/Diseases
  
    		  
Etiology 
No evidence is cited. 
 
  
Epidemiology 
No evidence is cited. 
 
  
Diagnosis    
Clinical Diagnosis
Ankle/Foot Sprain
An ankle radiographic series is only required if there is any pain in malleolar zone and any of these findings: 
  • Bone tenderness at A (see diagram), or,
  • Bone tenderness at B, or,
  • Inability to bear weight both immediately and in the emergency department (4 steps; unable to transfer weight twice onto each lower limb regardless of limping) 
A foot radiographic series in only required if there is any pain in midfoot zone and any of these findings: 
  • Bone tenderness at C (see diagram), or,
  • Bone tenderness at D, or,
  • Inability to bear weight both immediately and in the emergency department (4 steps; unable to transfer weight twice onto each lower limb regardless of limping)   
 
100% of fractures were identified when the Ottawa Ankle Rules were applied. Time in the ER was decreased by 36 minutes and cost of care decreased by 60% ($111). Knee Sprain 
A knee X-ray series is only required for knee injury patients with any of these findings:
  • Age 55 or older, or, 
  • Isolated tenderness of the patella (that is, no bone tenderness of the knee other than the patella), or, 
  • Tenderness at the head of the fibula, or, 
  • Inability to flex to 90 degrees, or, 
  • Inability to bear weight both immediately and in the emergency department (4 steps; unable to transfer weight twice onto each lower limb regardless of limping) 
100% of fractures were identified when the Ottawa Knee Rules were applied.  Wrist Sprain 
No evidence is cited. 
  
Laboratory/X-ray Diagnosis
Ankle Sprain
No evidence is cited. 

Knee Sprain 
Accuracy, sensitivity and specificity of MRI for meniscal and cruciate lesions are consistently high and support the use of MRI for these common problems.  

Because of the high accuracy, sensitivity and specificity of knee MRI, MRI examinations of the knee should be performed before arthroscopy is performed. 
  • Caveats
    • Age group studied: Unknown
    • Type/size: Meta-analysis (53 studies = 7524 patients)
    • Population characteristics: Patients with suspected cruciate, meniscal and cartilage injuries of the knee
    • Outcome measure: Sensitivity and specificity, positive and negative predictive value (PPV, NPV) and accuracy of MR investigation were calculated for each study with arthroscopy as the gold standard
  • Citations
Wrist Sprain 
No evidence is cited. 
 
   
Treatment  
Ankle Sprain 
Ankle injuries have a good prognosis, which is altered little by treatment. However, acute symptoms, pain and disability could 
be reduced by: 
  • Early mobilization aided by the use of bandages or strapping
  • Nonsteroidal anti-inflammatory drugs early on in treatment and for short periods, which allows early recovery but limited change in outcome
  • Cryotherapy (cold, heat, contrast bath, and cryotherapy), which allows early recovery but limited change in outcome
  • Diapulse diathermy, which improves recovery time and symptom relief
Surgery did not significantly improve outcome Ultrasound does not have an important beneficial effect on the treatment of soft tissue injuries of the ankle.    
Knee Sprain 
No evidence is cited. 

Wrist Sprain 
No evidence is cited. 
 
   
Monitoring
No evidence is cited.
 
 
 
Prognosis  
No evidence is cited.  
 
  
Prevention 
Ankle Sprain
There good evidence for the beneficial effect of ankle supports in the form of semi-rigid orthoses or air-cast braces to prevent ankle ligament injury during high-risk sporting activities (e.g. soccer, basketball, etc.). The benefit was greater for those with a previous history of ankle sprain, but still possible for those without prior sprain. There was no apparent difference in the degree of severity of the ankle sprain prevented nor any change to the incidence of other leg injuries. The protective effect of  'high-top' shoes remains to be established. There was limited evidence for reduction in ankle sprain for those with previous ankle sprains who did ankle disc training exercises.

 
 
Patient Education
The following patient education materials are consistent with the available evidence.
Rev. 4/5/00

This Web site developed and maintained by Robert J. Flaherty, MD.
Comments, additions and corrections are encouraged.