Do You Really Need That Scan?

Earlier this week I saw a patient who rolled his ankle 3 weeks ago. He came in with an xray of his ankle which was negative (nil fractures). He had been limping around for 3 weeks, managing his injury with RICE & medications, and was wondering why he wasn’t getting any better. He then went back to the GP and was referred on for an ankle xray.

WHY??

My issues with this are:

1# There are a tonne of unnecessary scans (xrays, MRIs, ultrasounds etc) being done out there

2# It is often a waste of time and money

3# Most importantly, if an injury hasn’t been diagnosed & managed properly at the start, a negative xray or MRI isn’t going to change the outcome!

I’m not trying to put down GPs. They have an incredibly broad base of knowledge and are experts in many scopes of practice. However for musculoskeletal injuries, physiotherapists are actually more qualified to diagnose the initial injury and decide whether a scan and/or referral to a specialist are indeed necessary.

In the case of this patient who came to see me, my physiotherapy assessment clearly showed that it was a Grade 3 lateral ankle sprain, without the need for xray or any other scan. This should have been managed from the start with bracing/taping and even perhaps a short non-weight bearing phase. If this was done, the patient would have most likely regained relatively normal walking gait by the start of Week 4. Instead, now he begins Week 1 of rehab at Week 4…

Coming up next… when should you actually get an ankle xray or a spine scan.