A sprain, also known as a torn ligament, is damage to one or more ligaments in a joint, often caused by trauma or the joint being taken beyond its functional range of motion. The severity of sprain ranges from a minor injury which resolves in a few days to a major rupture of one or more ligaments requiring surgical fixation and a period of immobilisation. Sprains can occur in any joint but are most common in the ankle and wrist.
Signs and symptoms
- Pain
- Swelling
- Bruising
- Decreased ability to move the limb
- If a ligament ruptures, one may hear a popping sound
- Difficulty using the affected extremity
Causes
Sprains typically occur when the joint is taken beyond its functional range of motion.
There are certain factors which increase risk of sprains. Fatigue of muscles generally leads to sprains. When one suddenly starts to exercise after a sedentary lifestyle, sprains are quite common. While scientific studies are lacking, it is often thought that not warming-up is a common cause of sprains in athletes. Warming-up is thought to loosen the joint, increases blood flow and makes the joint more flexible.
Diagnosis
A diagnosis of a sprain can often be made with a good degree of certainty by physical examination based on the clinical presentation and method of injury. In some cases, X-raysare obtained to ensure that there is no fracture. In some cases, particularly if the injury is prolonged or does not appear to be resolving as expected, magnetic resonance imaging(MRI) is performed to look at surrounding soft tissues and the ligament.
Classification
- First degree sprain – the fibres of the ligament are stretched but intact.
- Second degree sprain – is a tear of part of a ligament, from a third to almost all its fibres.
- Third degree sprain – is a complete rupture of the ligament, sometimes avulsing a piece of bone.
Joints involved
Although any joint can experience a sprain, some of the more common include:
- The ankle. It is the most common, and has been said that sprains such as serious ankle sprains are more painful and take longer to heal than actually breaking the bones in that area.
- The knee. One of the more talked about sprains is that to the anterior cruciate ligament (ACL) of the knee. This is a disabling sprain common to athletes, especially inAmerican football, football (soccer), basketball, pole vaulting, softball, baseball and some styles of martial arts. See Anterior cruciate ligament injury.
- Ligaments between the spinal vertebrae
- The fingers.
- The wrist.
- The toes.
Treatment
The first modality for a sprain can be remembered using the acronym RICE. The treatment of sprains depends on the extent of injury and the joint involved. Medications likenon-steroidal anti-inflammatory drugs can relieve pain. Topical NSAIDs appear to be as good as those taken by mouth.
- Rest: The sprain should be rested. No additional force should be applied on site of the sprain. In case of, for example, a sprained ankle, walking should be kept to a minimum.
- Ice: Ice should be applied immediately to the sprain to reduce swelling and pain. It can be applied for 10–15 minutes at a time (longer application of ice may cause damage instead of healing), 3-4 times a day. Ice can be combined with a wrapping to minimize swelling and provide support.
- Compression: Dressings, bandages, or ace-wraps should be used to immobilize the sprain and provide support. When wrapping the injury, more pressure should be applied at the far end of the injury and decrease in the direction of the heart; the reason for this is that it more easily causes unnecessary fluid to be flushed back up the blood stream in order to be recycled. Compression should not cut off the circulation of the limb.
- Elevation: Keeping the sprained joint elevated (in relation to the rest of the body) will also help minimize swelling.
Ice and compression (cold compression therapy) will not completely stop swelling and pain, but will help to minimize them as the sprain begins to heal itself. Careful management of swelling is critical to the healing process as additional fluid may pool in the sprained area.
The joint should be exercised again fairly soon, in milder cases from 1 to 3 days after injury. Special exercises are sometimes needed in order to regain strength and help reduce the risk of ongoing problems. The joint may need to be supported by taping or bracing, helping protect it from re-injury.
Functional rehabilitation
Prolonged immobilization delays the healing of a sprain, as it usually leads to muscle atrophy and stiff joint. The components of an effective rehabilitation for all sprain injuries include increasing range of motion and progressive muscle strengthening exercise. These should be taken care of without delay.
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Strain (Injury)
Two images of the same strain. One of the pictures was shot through a mirror.
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A strain is an injury to a muscle in which the muscle fibers tear as a result of overstretching. A strain is also colloquially known as a pulled muscle or torn muscle. The equivalent injury to a ligament is a sprain.
Signs and symptoms
Typical symptoms of a strain include localized stiffness, discoloration and bruising around the strained muscle.
Causes
Strains are a result of muscular fiber tears due to over stretching; they can range from mild annoyance to very painful. Although strains are not restricted to athletes and can happen while doing everyday tasks, people who play sports are more at risk of developing a strain.
Treatment
The first-line treatment for a muscular strain in the acute phase include five steps commonly known as P.R.I.C.E.
- Protection: Apply soft padding to minimize impact with objects.
- Rest: Rest is necessary to accelerate healing and reduce the potential for reinjury.
- Ice: Apply ice to reduce swelling by reducing blood flow to the injury site. Never ice for more than 20 minutes at a time.
- Compression: Wrap the strained area to reduce swelling with a soft-wrapped bandage.
- Elevation: Keep the strained area as close to the level of the heart as is conveniently possible to keep blood from pooling in the injured area.
The ice and compression (cold compression therapy) will stop the pain and swelling while the injury starts to heal itself. Controlling the inflammation is critical to the healing process, and the icing further restricts fluid leaking into the injured area as well as controlling pain.
Cold compression therapy wraps are a useful way to combine icing and compression to stop swelling and pain.
This immediate treatment is usually accompanied by the use of nonsteroidal anti-inflammatory drugs (e.g., ibuprofen), which both reduce the immediate inflammation and relieve pain. However, NSAIDs, including aspirin and ibuprofen, affect platelet function (this is why they are known as "blood thinners") and should not be taken during the period when tissue is bleeding because they will tend to increase blood flow, inhibit clotting, and thereby increase bleeding and swelling. After the bleeding has stopped, NSAIDs can be used with some effectiveness to reduce inflammation and pain.
It is recommended that the person injured should consult a medical provider if the injury is accompanied by severe pain, if the limb cannot be used, or if there is noticeable tenderness over an isolated spot. These can be signs of a broken or fractured bone, a sprain, or a complete muscle tear.
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