Sprain
Encyclopedia
A sprain is an injury in a joint
, caused by the ligament
being stretched beyond its capacity. A muscular tear caused in the same manner is referred to as a strain
. In cases where either ligament or muscle tissue is torn, immobilization and surgical repair may be necessary. Ligaments are tough, fibrous tissues that connect bones to other bones. Sprains can occur in any joint but are most common in the ankle and wrist.
of sprain injury is made by a physical examination
. In most cases an x-ray
of the affected joint is obtained to ensure that there are no fractures. If a tear in the ligament is suspected, then an MRI
is obtained. MRI is usually ordered after swelling has subsided and can readily identify the presence of a ligament injury.
, 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 of sprains is not difficult but in most cases X-ray
s are obtained to ensure that there is no fracture
. In many cases, if the injury is prolonged, magnetic resonance imaging
(MRI) is performed to look at surrounding soft tissue
s and the ligament.
. The treatment of sprains depends on the extent of injury and the joint involved. Medications like non-steroidal anti-inflammatory drugs can relieve pain. Weight bearing
should be gradual and advanced as tolerated.
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.
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.
Joint
A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally.-Classification:...
, caused by the ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
being stretched beyond its capacity. A muscular tear caused in the same manner is referred to as a strain
Strain (injury)
A strain is an injury to a muscle or tendon in which the muscle fibres tear as a result of overstretching. A strain is also colloquially known as a pulled muscle...
. In cases where either ligament or muscle tissue is torn, immobilization and surgical repair may be necessary. Ligaments are tough, fibrous tissues that connect bones to other bones. Sprains can occur in any joint but are most common in the ankle and wrist.
Symptoms
- PainPainPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
- SwellingSwelling (medical)In medical parlance, swelling is the transient enlargement or protuberance in the body and may include tumors. According to cause, it may be congenital, traumatic, inflammatory, neoplastic or miscellaneous....
- BruisingBruiseA bruise, also called a contusion, is a type of relatively minor hematoma of tissue in which capillaries and sometimes venules are damaged by trauma, allowing blood to seep into the surrounding interstitial tissues. Bruises can involve capillaries at the level of skin, subcutaneous tissue, muscle,...
- Decreased ability to move the limb
- If the ligament is ruptured, one may hear a popping sound
- Difficulty using the affected extremityLimb (anatomy)A limb is a jointed, or prehensile , appendage of the human or other animal body....
Diagnosis
The diagnosisDiagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
of sprain injury is made by a physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
. In most cases an x-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
of the affected joint is obtained to ensure that there are no fractures. If a tear in the ligament is suspected, then an MRI
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
is obtained. MRI is usually ordered after swelling has subsided and can readily identify the presence of a ligament injury.
Causes
Sprains typically occur when the joint is overextended. This can cause over stretching of the joints, tear or slipping of the ligament.Joints involved
Although any joint can experience a sprain, some of the more common include:- the ankleAnkleThe ankle joint is formed where the foot and the leg meet. The ankle, or talocrural joint, is a synovial hinge joint that connects the distal ends of the tibia and fibula in the lower limb with the proximal end of the talus bone in the foot...
. 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. See sprained ankleSprained ankleA sprained ankle, also known as an ankle sprain, twisted ankle, rolled ankle, ankle injury or ankle ligament injury, is a common medical condition where one or more of the ligaments of the ankle is torn or partially torn.-Cause:...
for more details. - the kneeKneeThe knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
. Perhaps one of the more talked about sprains is that to the anterior cruciate ligamentAnterior cruciate ligamentThe anterior cruciate ligament is a cruciate ligament which is one of the four major ligaments of the human knee. In the quadruped stifle , based on its anatomical position, it is referred to as the cranial cruciate ligament.The ACL originates from deep within the notch of the distal femur...
(ACL) of the knee. This is a disabling sprain common to athletes, especially in American footballAmerican footballAmerican football is a sport played between two teams of eleven with the objective of scoring points by advancing the ball into the opposing team's end zone. Known in the United States simply as football, it may also be referred to informally as gridiron football. The ball can be advanced by...
, football (soccer), basketballBasketballBasketball is a team sport in which two teams of five players try to score points by throwing or "shooting" a ball through the top of a basketball hoop while following a set of rules...
, pole vaulting, softballSoftballSoftball is a bat-and-ball sport played between two teams of 10 to 14 players. It is a direct descendant of baseball although there are some key differences: softballs are larger than baseballs, and the pitches are thrown underhand rather than overhand...
, baseballBaseballBaseball is a bat-and-ball sport played between two teams of nine players each. The aim is to score runs by hitting a thrown ball with a bat and touching a series of four bases arranged at the corners of a ninety-foot diamond...
and judoJudois a modern martial art and combat sport created in Japan in 1882 by Jigoro Kano. Its most prominent feature is its competitive element, where the object is to either throw or takedown one's opponent to the ground, immobilize or otherwise subdue one's opponent with a grappling maneuver, or force an...
. See Anterior cruciate ligament injuryAnterior cruciate ligament injuryAn injury to the anterior cruciate ligament can be a debilitating musculoskeletal injury to the knee, seen most often in athletes. Non-contact tears and ruptures are the most common causes of ACL injury....
. - the fingerFingerA finger is a limb of the human body and a type of digit, an organ of manipulation and sensation found in the hands of humans and other primates....
s. - the wristWristIn human anatomy, the wrist is variously defined as 1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand;...
. - the toeToeToes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being digitigrade. Humans, and other animals that walk on the soles of their feet, are described as being plantigrade; unguligrade animals are those that walk on hooves at the tips of...
s.
Risk factors
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 lifestyleSedentary lifestyle
Sedentary lifestyle is a medical term used to denote a type of lifestyle with no or irregular physical activity. A person who lives a sedentary lifestyle may colloquially be known as a couch potato. It is commonly found in both the developed and developing world...
, 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
Blood flow
Blood flow is the continuous running of blood in the cardiovascular system.The human body is made up of several processes all carrying out various functions. We have the gastrointestinal system which aids the digestion and the absorption of food...
and makes the joint more flexible.
Diagnosis of sprains is not difficult but in most cases X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s are obtained to ensure that there is no fracture
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
. In many cases, if the injury is prolonged, magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
(MRI) is performed to look at surrounding soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...
s and the ligament.
Treatment
The first modality for a strain can be remembered using the acronym RICERICE (medicine)
RICE is a treatment method for soft tissue injury which is an acronym for Rest, Ice, Compression and Elevation. When used appropriately, recovery duration is usually shortened and discomfort minimized....
. The treatment of sprains depends on the extent of injury and the joint involved. Medications like non-steroidal anti-inflammatory drugs can relieve pain. Weight bearing
Weight bearing
In orthopedics, weight-bearing is the amount of weight a patient puts on the leg on which surgery has been performed. In general, it is described as a percentage of the body weight, because each leg of a healthy person carries the full body weight when walking, in an alternating fashion.After...
should be gradual and advanced as tolerated.
- Rest: The sprain should be rested. No additional force should be applied on site of the sprain. In case of, for example, a sprained ankleSprained ankleA sprained ankle, also known as an ankle sprain, twisted ankle, rolled ankle, ankle injury or ankle ligament injury, is a common medical condition where one or more of the ligaments of the ankle is torn or partially torn.-Cause:...
, walkingWalkingWalking is one of the main gaits of locomotion among legged animals, and is typically slower than running and other gaits. Walking is defined by an 'inverted pendulum' gait in which the body vaults over the stiff limb or limbs with each step...
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 causes unnecessary fluid to be flushed back up the blood stream easier in order to be recycled. Compression should not cut off the circulation of the limb.
- Elevate: Keeping the sprained joint elevated (in relation to the rest of the body) will also help to minimize swelling.
Ice and compression (cold compression therapy
Cold compression therapy
Cold Compression Therapy combines two of the principles of R.I.C.E. to reduce pain and swelling from a sports or activity injury to soft tissues and recommended by orthopedic surgeons following surgery...
) 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 immobilizationImmobilization
Immobilization in soil science is when organic matter decomposes and is absorbed by micro-organisms, therefore preventing it being accessible to plants. Immobilization is the opposite of mineralization....
delays the healing of a sprain, as it usually leads to muscle atrophy
Muscle atrophy
Muscle atrophy, or disuse atrophy, is defined as a decrease in the mass of the muscle; it can be a partial or complete wasting away of muscle. When a muscle atrophies, this leads to muscle weakness, since the ability to exert force is related to mass...
and stiff joint. The components of an effective rehabilitation for all sprain injuries include increasing range of motion and progressive muscle strengthening exercise.