Sprains and Strains

Sprains

Ligaments are strong bands of tissue connecting bones with each other. These ligaments are encountered all over the body, in areas such as the shoulder, knee, spine, hand, and ankle. They provide stability and protection for the joint. When one or more of these ligaments is suddenly overstretched or torn, a sprain occurs.

Along with the injury to the ligament itself, sprains often involve pain, swelling, and discoloration of the adjacent soft tissue due to bleeding and inflammation of structures around the area. Sprains are divided into three grades depending on the severity of the physical injury:

• Grade 1: Small stretching of the ligament with minimal swelling and tenderness. The patient is able to move the joint and bear weight on it with minimal pain.
• Grade 2: Partial tear of the ligament with moderate swelling, tenderness, and discoloration. The patient has some difficulty moving the joint with definite pain on weight bearing.
• Grade 3: Complete tear of the ligament with severe swelling, tenderness, and discoloration. The joint has lost its stability and the patient is unable to move it or bear weight on the joint.

The physical examination is helpful in diagnosing a sprain, but often, radiographic imaging such as X-ray or magnetic resonance imaging (MRI) is needed to determine the extent of injury.

Some examples of easily sprained joints include the ankle, wrist, and knee. A sprain of the outside, or lateral, part of the ankle is the most common sports injury. This occurs when the ankle rolls outward with the foot falling inward. It is referred to as an inversion sprain and damages the ligaments and tissues on the lateral part of the ankle.

A scapholunate dissociation is common sprain occurring in the wrist. This involves damage to the ligament that connects the scaphoid and lunate bones in the wrist and usually occurs when people try to catch themselves while falling, landing on their outstretched palm. On an X-ray, if there is more than 3 mm of distance between the scaphoid and lunate, a ligamentous injury is likely. X-rays can also help determine if there is a fracture.

A third common sprain occurs at the medial collateral ligament (MCL) of the knee. This occurs when a force contacts the lateral knee, causing it to bend sideways, resulting in a widening of the joint on the inside portion. This excess stretch of the MCL often causes a tear and may lead to pain, swelling, and decreased stability of the knee.

Treatment of an acute sprain is easily remembered utilizing the acronym PRICEM:

• Protection, stabilizing the injured area with a brace or splint to help prevent further injury.
• Rest, taking stress off the injured body part. This can involve using crutches or a sling.
• Ice, should be placed on the site of injury to help reduce swelling and pain.
• Compression, used soon after the injury to help prevent further swelling from developing.
• Elevation, the injured body part should be placed above the level of the heart to decrease the amount of fluid settling in the injured area.
• Medications and manipulation. Anti-inflam-matory and pain medications as well as manual treatment can help decrease swelling and pain, and aid the healing process.

After the acute phase of a sprain injury, physical therapy and rehabilitation may be useful to rebuild the strength and stability of the injured joint.

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