Hi I am new to the site and was very happy when I saw that many were asking for help with their MRI reports so thought it would not hurt for me to ask for a little help. A month ago I twisted and sprained my ankle and then just recently I had done it again. So the attending physician thought it best to get MRI done. All I want to know is if there is anything I may need to be concerned about? I will be seeing an Ortho but I have no idea how soon. Here are the findings.
The most significant finding is involving the lateral stabilizing ligaments involving posterior talofibular and calcaneofibular ligaments. There is marked thinkening and edema involving the ligaments with severe tendinopathy and tendonitis. There are also some bone changes involving the fibula at the ligamentous attachment consistent with stress reaction, probably from a prior injury. The ligaments do not appear completely torn.
The medial deltoid ligament is intact. The ankle mortis is well maintained. There is no evidence of osteochondritis desiccans.
The medial peroneal tendons as well as the lateral posterior tibial flexor digitorum and flexor hallucis tendons are intact. There is some fluid in the retrocalcaneal bursa althought there is no fracture present.
There is no stress fracture involving the calcaneus. The Achilles tendon and plantar fascia are intact. No evidence of plantar fasciitis. No visible stress fractures or cortical fractures.
Impression: Marked edema and inflammation involving the lateral stabilizing ligaments involving the talofibular and calcaneofibular ligaments. There is marked inflammation and edema as well as stress reaction of the ligamentous attachments to the fibula. This is most likely from a prior injury with secondary partial ligamentous strain and consistent tendinopathy and tendonitis and incomplete healing.
Sorry but what ? lol any help would be greatly appreciated.
Last edited by akamommy2005; 06-07-2012 at 11:29 PM.
Hi and Welcome to the Boards! You definitely came to the right place! There's a wealth of information on here and it's been so helpful for me too. Sorry you have injured your ankle. I know much that stinks and hurts because I've been there unfortunately. On your MRI, looks like you have swelling and inflammation in your calcaneofibular ligament (CFL) and your posterior talofibular ligament (PTFL). So ligaments attach bone to bone and tendons attach muscle to bone. Your CFL is one of the lateral (outside of the ankle) stabilizing ligaments. It connects your calcaneus (heel bone) to your fibula (smaller lower leg bone) and your posterior (back or behind) talofibular (connects talus to fibula) ligament. Interesting it doesn't mention your ATFL (anterior talofibular ligament) because it is the most common and usually first lateral ligament injured in a sprain almost 100% of the time. Not exactly sure what the stress reaction is because it could mean theyre stretched out or fraying or could again be referring to the inflammation. As far as the tendinopathy tendinitis, again not sure because he is talking about ligaments and not tendons and says your tendons are intact. However, I've learned with my countless ankle sprains and 2 reconstructive surgeries because of them that what the radiologist says and puts on the report and what the foot/ankle OS reads and sees in surgery are two different things! My first doctor read the MRI and felt more was going on when I got in there and sure enough there were 2 torn ligaments and not just the one the MRI and radiologist suggested. Then this 2nd surgery had done in Feb, the radiologist read it as everything fine. My foot/ankle OS read it completely different showing me where all the damage was and confirmed it when he got in there during surgery. I had THEEE torn ligaments, a shredded tendon, my tendons were popping out of place so I had to have the bone drilled and broken to deepen the groove so they'd stay put! All of that to say, don't put much stock in the MRI report until your doctor reads it and goes over it with you. Make sure you go to a FOOT/ANKLE ORTHO! I made the mistake of seeing a general OS the first time and bad move! This time with foot/ankle OS is so much better. How did you sprain your ankle? I'm so,sorry! There are a ton of us on here very familiar with ankle sprains and a lot who've just gone through surgery for them. Good luck and let us know what the doctor says!!
Thank you for your very informative reply The mention of tendinopathy and tendonitis struck me as odd as well because it mentioned that my tendons are fine but how can "severe" ever mean fine. lol And also tendinopathy usually refers to both terms so why the repetition? I know these are all things I should ask the ortho at my appt but alas I have to wait becuase of insurance issues. Meanwhile I am stuck with this pain in my ankle and fear of it twisting again. I slipped and fell at work (hence insurance problems) and ankle was first thing to go. after 3 weeks of wearing the boot (and I was released on full duty even though I worked in fast paced restaurant) and finally getting appt with ortho, I was released from the boot. Everything seemed to be fine except for my ankle hurting pretty badly after every shift. Then just recently, to my astonished embarrassment and frustration, I fell again thanks to ankle giving out. There are no foot and ankle specialists here in town, at least none that will accept workers comp.
One other thing I was curious about. Through the mri there is only one mention of ligaments torn. and they say "not completely torn" thats all. usually i wound assume that if there was no tear then no need to mention it right? lol
well you can pretty much read into my frustration. :/ Thank you again for being so thorough in ur post
Ugh, ugh, ugh! You have been through the ringer! I'm so sorry this has happened to you and while you are waiting on WC to do what they should, you have further injured the ankle. Was the MRI done after the first injury and before the 2nd? There is another girl on here, JOYFUL, who had the same surgery I did on the same day. She fell on the job too and it's WC and she had a time with them. Just what you need when you are injured and in pain and through no fault if your own! Argh!!! Yes I can see your frustrated and I think it's completely warranted! So a couple things on your comments regarding your MRI. Tendinitis, tendinosis, and tendinopathy aren't quite the same things. Tendinitis is an overuse injury where the tendon becomes inflamed. Tendinosis is a chronic degeneration of a tendon but usually without inflammation. It's where the tendon has been unable to heal. Tendinopathy means there is a tendon injury with nonspecific pathology so cause is unknown. On the ligament question, ligaments can be partially torn and cause significant pain, instability, and weakness. They don't have to be completely torn (ruptured) to cause issues. To help with the pain and instability, can you wear your boot until you see your doctor so you don't hurt it again? Are you elevating and icing? Did they give you anything for the inflammation and did they give you anything for pain? Do you have an appt set up or are you having to wait for that too?
No, the MRI was done after the second injury. When i went to first appt with Ortho (or the apprevaition is OS right so I will use that lol) I got dismissed pretty quickly. I told them the truth. It was feeling a lil better but this was due to the fact I was told i was a saftery issue and could not return to work until I was realeased from the boot. The boots are not slip resistant. So I was able to stay off of it for a lil while. However I also told them where I was having problems (exactly where the MRI shows I have problems) and so there was pain when I was on it for a lil while. They moved it a lil, determined I had good range of motion, poked at the ankle on inside (medial is the term I found out) and said there was no swelling. So I was realeased from my boot and told I could go back to work. Missing paychecks, I figured this was good news. Of course not to my ankle.
Regarding anti inflammatory.. they first told me to take ibprofren 600mg. I did. Started really giving my stomach problems and stopped taking them. Another doctor (cause the first said they would not see me.. I had to follow up with OS) prescribed me milder antiinflammatory and tramadol. Of course it worked for a lil then devolped tolerance to the tramadol and the antiinflammatory started messing with stomach as well. I have come to realize stomach is very sensitive. lol
The new NP (they were all NP xcept Dr who gave me new prescription: I even kinda believe the OS who I saw was not an OS but also office NP. i could be wrong.) Because this is WC case I have to go where they tell me to go and how to get there. She also told me about ice massage which has become a regime of mine. 3xs a day or more. Altho, when the effects wear off I can literally feel things inside my ankle swell up almost immediately. I was so surprised that I had gotten an MRI appt so quickly (only 2 days wait for phone call) but unfortunately no phone call about OS appt. I get the feeling that, because this WC case, no physicians do not really want to deal with me. Issues with getting paid. I mean why else would most physicians in town not want to work on a WC case when they previously had? I do believe before all this is said and done, I will have to make trips to Nashville instead of getting treatment here. I am not one to make a big deal about things... I hate too much attention drawn on me. But people close to me who know what I am dealing with have advised me to seek out lawyer. They say who knows how long I will be out of work this time. If my ankle was not healed first time after 6 weeks, i could be looking at that long (hopefully not longer) for recovery. No mentiong has been made on WC pay during my time out. I think my employers r just as clueless bout the whole process as I am. I can move my ankle but not without pain and restriction. The new NP stated that I can either wear my boot or use crutches. I am single with two young children, one who is 2 and persistent bout me holding her, so crutches are out. Boot helps a great deal so I wear that but even while out and about I cant be too long before my ankle starts. I feel for Joyful... I really wonder if she might have some advice. I do not think I need surgery. At least I hope not. All depends on what this OS says after he veiws my MRI pics and report. Interpertation is key after all.
I am sorry for my long winded reply. It just actually feels good to get out some of the frustrationg I have been feeling to people who do not cut me off short by saying "get a lawyer". lol Thank you for reading this
Well absolutely get your frustration out here! That's what we're here for! A lot of doctors don't take WC because of how long it takes to get treatment approved and them reimbursed by them. You're right. It's unfortunate too because the person who suffers in these cases are the patients. WC is put in place toprotect the employee and it turns out to be a nightmare for the employee. I know you don't want to hear this but you may need to get a lawyer. JOYFUL did and she is SO glad! Without the lawyer, not sure where she'd be right now, but it wouldn't be where she is now. You really do need to talk to her! I will see if I can find her because she would be happy to talk to you! I can see why you chose boot over crutches with your situation. I'd choose boot over crutches ANY day! Ive spent 4-5 months of my life on them total and I hate them!! You say you may have to go to Nashville. Where do you live? I live in Bham and we have GREAT foot and ankle OS here!!
I live in a lil big town in between nash and knox. As much as they try to become advanced I have noticed they are lacking a lil. All I want is to be better. From what I understand I should of been off work and off my feet after first injury. Even if for just a lil bit. But the NP put me on full duty release even when I told her what is required of me to perform my job and the slick floors. I thought it was odd but because they put me in a boot I thought they knew what they were talking about. And they even said they will have to leave it up to my employer whether or not they want me to work with the boot. Things have been getting hairy, and so I was forced to get into contact with a lawyer. I didnt want to go that route but after recent happenings they gave me no other choice. I am not going to delve into too much but I will say I do not appreciate being lied to by someone who works for the system that was put into place to protect me and others in my situation. Yay me. No doubt I will lose my job now.
I'm so sorry! Why do you think you will lose your job now? They can't fire you over a workers comp case that involved lying to you which has made you have to lawyer up! They fire you and then they are REALLY going to have a case on their hands. I'm so sorry. I hat you are having to go through this!!
I totally understand what your dealing with. Since it took WC five months to authorize and mri for my ankle, during that period of five months and lack of proper treatment, i have major issues that need surgery now...very frustrating in deed.
Went to OS appt and WC nurse accompanied me because of lack of proper communication (believed to be on my part but proven later that I was telling claims adjuster everything) between me and Claims person. Yet again, I was dismissed very quickly. WC Nurse briefed me on what OS will most likely do before the appt: prescribe me a steroid pack for inflammation, pain meds for pain, and would want me to go to PT. He did nothing. He read radiologist report on MRI, did not look at disc, said looks like I have some swelling and some tendonitis and eeverything looked fine. He said take tylenol, do abcs with my foot 3xs a day, and continue wearing boot for 4 more weeks. The most poignant thing he said, let nature take its course.. and have a good day. He didnt even poke my ankle again. My jaw dropped. I asked him about tendinopathy. he said that is tendonitis. I asked him then why severe and the repetition. He said "I dont know... radiologists". I almost cried while being checked out. WC nurse saw my frustration. She was just as frustrated. Told her this was exactly what it was like last time. She said, "say to me u want a second opinion". Of course!
Wow. Just wow. Yes you want a 2nd opinion! Is the WC nurse going to help facilitate that? Is that why she asked that question the way she did??? I can't believe he didn't even read the disc or examine your ankle. That is complete, no doubt about it, dismissal! He did not do his job. I'm so sorry!! I can't imagine your frustration and being in pan on top of it! Will you be able to go see someone else? What about getting a lawyer? Like I said JOYFUL had to do that and is SO glad she did because she needed him! Or if you can't do that, cn you break WC and be seen on your own insurance and go see who you want?
Unfortunately I cant break WC because too much is reliant on it. Even though I am not recieving pay for my time off (yet: according to WC nurse i will be paid for time off) I have no income coming in due to my time off. I have state insurance and even if they would cover drs for me, there is a chance they wont. Besides, I only like to use the insurance for my children unless it is an emergency for me. I dont want to take advantage of the system. WC should and will pay for my medical expenses regarding my ankle.
Yes, she asked me that way so that she could facilitate it. She even told me about a specialist that works with workers comp here in town that she has confidence in. I beleive she said that so it would not be just her idea. Like she influenced me. But of course, as u can see, it is the current OS that influenced me thru the first visit with him. I was quickly dismissed then as well but because it was so early on and I truly thought it was getting better. I did not make big stink about it.
I truly wonder how in the heck a professional would say that, "let nature take its course"? Thru numerous family and friends, I have seen first hand what happens when nature takes its course. Crippled fingers because they broke them but never put them in splints to straighten them, bones and muscle overcompensating at the site of injury and growing where they shouldnt, atrophy and arthritis. There are numerous risks involved when u let nature take its course. Nature is a beautiful thing but it doesnt work to well when dealing the complexities of the human body, especially in areas that are delicate like the ankle or back or knee or hands.
I know my injury is just a sprain, but obviously when it has not gotten better and pain increased tenfold after second injury, nature takes a strange course.
Yes. I swallowed whatever loyalties I have to my job and signed contract with lawyer. As far as I know I still have a job. But business being business, they do not ever fire anyone. Even if their performance is poor. They just put them on suspension for long length of time, hoping that they will quit. They do not want unemployment benefit claims put against their insurance.
Wow is exactly what goes thru my mind everytime I think about the care I have recieved. Wow. Thank you for being understanding and an ear, Hollywood48. Also thank u too Loki for putting ur voice in there. Makes me not feel too crazy for feeling this way.
Well you're certainly welcome and I hope I can continue to help in any way possible. You're right about the nature taking its course thing in medicine. I mean, there are sometimes it does but it's like "get lots of rest as the body heals itself while you're sleeping"....not "oh you injured your ankle so badly that you can hardly walk and are in a ton of pain and it's been going on for a while? Oh just let nature take its course and the nature fairy will heal it with one flip of her wand!" Oh please! I've never heard that being said in my whole career! I'm just so sorry for all the frustration you are going through while in pain. I figured you couldn't leave WC, but was just covering my based and thought I'd ask on the slight chance you could! How is your ankle feeling today? How I it with putting weight on it? OH! And it isn't "JUST" a sprain!! That is the common way they are viewed and they are a much more serious injury than people give it credit for because they can lead to further issues down the road if not taken care of properly the first time. Most people would do better with breaking the bone than spraining the joint!! Hang in there!
Regarding about the pain... while I admit the pain seems to lessen a lil bit with more time, I dont know if it is because I am getting used to it or what? I have been told that I have a high pain tolerance by my father, and this is a man who would tell ya u r being a big baby lol. He says he is just judging by the past. After all, I have had some car accidents, bicycle accidents, falling down stairs, falling out of a moving vehicle all when I was a child just to name a few. He also says that I have to have a high pain tolerance considering how much of a clutz i am. Lol (its fun to make jokes at my expense ) ).
But when I am on it for any lenght of time (est 30 mins straight) throbbing and stiffness because of swelling start on. I wear the boot all the time except when sitting down where I can elevate. Of course, with kids, staying that way is next to impossible. Sitting down with my foot on ground makes it swell and hurt. I get up and i have feeling of falling. Boot helps when going to store but again, after a lil bit of time, i want to go home. And night and morning.. wow...I can litterally watch the lil muscle close to my achilles tendon throb.. looks like a pulse but extremely irregular and changes in intensity. Everytime I do put weight on it if just to go to bathroom, I have to focus cause of that feeling of falling.
After a serious car accident, and it was determined that I did not have any serious injury and also had no insurance, they sent me home. Two weeks later I was still picking pieces of my dash out of my arm. My knee seemed to give me most of the problem. No insurance tho meant no follow up. for four years I dealt with an odd lil ball in my knee cap that would pop out whenever it wanted to. It would cause so much pain but I worked through it. The ball eased up (maybe overabbundance of calcium?) but the pain remained. Even to this day I would wake up crying and screaming until pain subsided and I was able to go back to sleep. Yea, let nature take its course. That was ten years ago. But that was all based on my own stupidity. A professional should not display that same type of ignorance.
You had me laugh, imagining a majical fairy coming up and waving her wand. hahaha I imagines that fairy have the nody and face of the OS.
Glad I made you laugh and hopefully forget about the pain at least for a second! Wow, you have certainly been through the ringer!! I just hope this ankle stuff gets cleared up soon! Definitely need a lawyer!