Joined: January 31, 2005
Steve- Funny you should ask about CBT, I was just about to set him up for my psychoanalysis group. :)
I have found in patients with complaints of "rolling" the ankle frequently, who fail a proprioceptive program, and who have what seems to me Negative drawer/tilt exams, that stress views can be helpful. I consider 2-3 mos of good disciplined therapy to be a fair trial. If still feeling unstable, then I consider stress views.
I would also like to know if Alex ordered the films or if they were done by someone else, and echo Jon's questions.
Joined: March 1, 2004
Hi there Jon. This was a young female soldier truck driver with complaints of lateral ankle pain and frequent episodes of lateral ankle sprains. She found her way to our clinic after about her 3rd bad ankle sprain of the year. She had never seeked care before for her ankles. After her acute swelling and pain were under control I was able to better examine her. At this time on physical exam she had decreased proprioception and demonstrated Grade II anterior drawer and talar tilts. Tenderness to palpation over the ATFL lateral malleoli. No evidence of syndesmotic injury. Plain film ankle series were normal (ordered by primary care). I treated her for about about two months working on proprioception, ankle stability exercises. Not much improvment. We have an Airforce orthopaedic surgeon who comes once a month from an Airforce Base in Northern Italy who evaluated her and ordered the talar tilt stress views above. She is scheduled for Modified Brostrum repair in two weeks.
Joined: April 25, 2004
From: Amherst, WI
One of my automatic associations reared its ugly head (the patient was a guy assumption). Oh well, we all have them whether we successfully hide them or not.
I'm guessing the films were justified on the history of numerous bad ankle sprains and grade II anterior drawer and talar tilts tests versus the presence of chronic pain itself. I say this because I'm assuming those views would be less likely to have been taken if this was a first time sprain and no abnormal special testing. Although I would also guess that it would be unlikely that these views would have been taken with that presentation in the absence of pain.