Everyone watching the game in Chicago about had a heart attack when they saw Derrick Rose sprain his right ankle when he came down on a Cleveland Cavalier player’s foot. Luckily for Bulls fans, the xrays were negative. After the game, Rose was asked if he was going to get an MRI. This brings me to a discussion about the appropriate use of imaging to assess the ankle sprain.
The Ottawa Ankle Rules: History
In 1992, doctors at the Ottawa Civic Hospital in Ottawa, Canada Emergency Department came up with a list of rules to determine if a patient with a foot or ankle pain or a history of ankle sprain would need an x-ray. Before this time, most ankle injuries, were almost always imaged with an x-ray. It was realized that too many x-rays were being taken for lateral ankle sprains with very little yield. Too much money, and too much time, while also increasing radiation exposure. (2)
Ottawa Ankle Rules: What are they?
The following image explains the rules that determine if an x-ray is required or not. Simply stated, if there is bone tenderness in the highlighted areas, an x-ray is warranted. The rules are good at ruling out fracture, meaning if there is no bone tenderness, there is no fracture. Yet, it isn’t as good at predicting when there is a fracture. With bone tenderness, it isn’t guarantee there is a fracture, but x-rays should be taken, just in case. In the case of Derrick Rose and other high profile athletes, an x-ray will be taken every time.
Should he get an MRI?
After the game, one reporter asked Derrick Rose if he was going to get an MRI for his ankle sprain. This is a good question. Should you get an MRI after an ankle sprain? An MRI is used to determine if there is a complete rupture or just a small tear of one of the ligaments that make up the lateral ankle complex. In this scenario, the all-star player didn’t have any swelling, maybe had some tenderness, and was able to play on the sprained ankle for a few minutes after the injury and could walk on it after the game. Only when money isn’t an issue would this much imaging be ordered. You and I would never get an MRI for an ankle sprain that you could walk on an hour or two after the injury. The bigger question at hand for any of us is this: will the MRI or any imaging modality for that matter, direct or change the course of treatment? If you get an x-ray, will it change how you treat a possible fracture? Yes. Surgery could be necessary or simply tracking the healing process is warranted. Will an MRI change the course of treatment for Derrick Rose, in this case? No, not at all. He will receive physical therapy and rehabilitate the ankle quickly.
1. Screen shot from video on http://espn.go.com/chicago/nba/story/_/id/11799505/derrick-rose-chicago-bulls-sprains-left-ankle-vs-cavaliers. Accessed 11/1/2014
4. Screen shot from video on http://hangtime.blogs.nba.com/2014/10/31/derrick-rose-down-but-not-out/ Accessed 11/1/2014.