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Sprain and Strain S004

Document
Last amended 
7 July 2015

Current RMA Instruments:

Reasonable Hypothesis SOP
94 of 2011
Balance of Probabilities SOP
95 of 2011
Changes from Previous Instruments:

SOP Bulletin 153

ICD Coding:
  • ICD-9-CM Codes: 718.98,840-840.6,840.9-843.1,843.9-848.7,848.9
  • ICD-10-AM Codes: M24.98, S03.4-.5, S13.4-.5, S23.3-.4, S33.51, S33.6-.7, S43.7, S46.8, S53.4O-.44, S43.48, S63.50-.53, S63.58, S63.61-.62, S63.7, S73.10-.12, S83.50, S83.6, S93.48, S93.5-.6, T09.21, T14.31
Brief description:

The sprain and strain SOP covers injuries to muscles, tendons and joint ligaments with an initially acute onset, due to a discrete event.  The SOP covers the acute injury and ongoing symptoms if they persist longer term.  The SOP does not cover overuse type injuries.

Confirming the diagnosis:

The diagnosis can be confirmed based on the history and clinical findings.  Radiology (e.g. ultrasound, MRI) may also be useful for diagnosis but is not essential.

The relevant medical specialist is an orthopaedic surgeon.  A specialist report will not necessarily be required.

Additional diagnoses covered by these SOPs
  • Complete tear or rupture of ligament, tendon or muscle
Conditions not covered by these SOPs   
  • Achilles tendinopathy / tendinitis*    (Achilles tendinopathy and bursitis)
  • Chondromalacia patella*
  • Chronic overuse disorders of muscles, tendons, cartilage, ligaments#
  • Epicondylitis*
  • Gluteal tendinopathy*    (Trochanteric bursitis and gluteal tendinopathy)
  • Iliotibial band syndrome*
  • Internal derangement of knee*
  • Intervertebral disc prolapse*
  • Joint instability*
  • Patellar tendinopathy*
  • Plantar fasciitis*
  • Rotator cuff syndrome*
  • Shin splints*

* another SOP applies  - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

The clinical onset will be at the time of the causative injury or within the 24 hours after that injury if symptom onset is delayed.

Clinical worsening

Some sprains and strains will resolve completely over a period of weeks to months.  Recurrence of the same or similar symptoms may represent a new injury rather than a worsening of the previous one in such cases.  In other cases there may be ongoing problems or residual damage and further injury may represent a worsening of the initial sprain or strain.  Seek medical advice if in doubt.

Further comments on diagnosis

The sprain and strain SOP should not be applied if there is another SOP that is more specific and appropriate for the claimed condition, e.g. internal derangement of the knee.  The SOP should also not be applied to recurrent sprains due to underlying joint instability (the joint instability SOP applies).