A ligament sprain is defined as a damage of the ligamentous structures due to excessive stretching and is one of the most frequently encountered musculoskeletal injuries. In fact, ankle sprains include a major share of the injuries seen in the emergency setting. In addition to the ankle, the knees, elbows, and hands are notable sites where ligament sprain occur. Typical complaints include pain, weakness, limited range of motion, and swelling. A thorough history and a proper physical examination can make the initial diagnosis, but imaging studies are necessary to rule out more serious ailments, such as fractures.
Presentation
Ligaments sprains are very common injuries in the athletic population and various joints may be affected [1] [2] [3] [4] [5] [6] [7] [8]:
- Ankle sprain - About 80% of all ankle sprains develop as a result of excessive and abrupt inversion or supination of the ankle joint when landing to the surface [3]. This phenomenon can be seen in many individual and team sports, particularly among basketball players [2]. The ligaments of the lateral aspect of the ankle are the principal sites affected by ankle sprains and signs such as weakness, reduced joint mobility, swelling, and pain are common, which may last up to 1 year after injury [1]. A significant risk exists towards reinjury of the ankle, particularly in the absence of proper treatment for the initial injury, whereas inadequate stretching prior to exercise is also identified as a risk factor [1] [2].
- Knee sprain - Various ligaments of the knee are at risk, including the collateral (medial and lateral, or MCL and LCL, respectively) and the cruciate (anterior and posterior, or ACL and PCL) ligaments [5] [6]. Studies show that teenagers (between 15-19 years of age) who engage in sports activities are most susceptible to knee sprains and increased body weight and body mass index (BMI), along with several other structural and mechanical factors that predispose to this type of injury [5] [6]. Similarly to ankle sprains, ligamentous injury of the knee is suspected if joint pain, instability, effusion, or weakness is present [5].
- Elbow and hand sprains - The medial (or ulnar) collateral ligament of the elbow can be abnormally stretched when exposed to direct force from the lateral side [7]. Athletes such as javelin throwers, or those who participate in overhead sports (volleyball, water polo, tennis, or baseball) develop this type of injury, and medial elbow pain is the principal symptom [7]. On the other hand, rock climbing is associated with ligament sprains of the hand [8].
Entire Body System
- High Fever
fever, a lot of pain, or open wounds. ligament sprain injury ~ treatment Injuries to ligaments are tougher than other injuries because the ligaments are meant to constantly move. [damfirm.com]
Respiratoric
- Rhinitis
(Rationale: This is to ensure that subjects only suffer from a soft tissue injury, so that the study group is homogeneous) Patients who have experienced bronchospasm, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria, or allergic-type reactions [clinicaltrials.gov]
Cardiovascular
- Left Ventricular Dysfunction
History of cardiac failure, left ventricular dysfunction, hypertension or pre-existing oedema. (Rationale: Inhibition of prostaglandin synthesis, as caused by these drugs, may cause fluid retention, oedema and hypertension. [clinicaltrials.gov]
Musculoskeletal
- Elbow Pain
In addition to the ankle, the knees, elbows, and hands are notable sites where ligament sprain occur. Typical complaints include pain, weakness, limited range of motion, and swelling. [symptoma.com]
Elbow sprains can happen when: You fall with your arm stretched out, such as when playing sports Your elbow is hit very hard, such as during a car accident You may notice: Elbow pain and swelling Bruising, redness, or warmth around your elbow Pain when [medlineplus.gov]
Examples of conditions treated by an upper extremity specialist are: Tennis elbow Upper arm and forearm Fractures Biceps tendon tear Ulnar nerve entrapment Elbow pain/ dislocation Sports injuries If you have pain in your elbow or any of the conditions [resurgenssportsmedicine.com]
- Buttock Pain
Iliolumbar ligament sprains cause lower back and upper buttock pain. The pain is commonly felt deep in the back and to one side of the spine. Activities such as bending, arching or twisting the back may worsen your pain. [physio.co.uk]
Workup
To make the diagnosis of a ligament sprain, the physician needs to perform a comprehensive clinical assessment [4] [5] [6]. Firstly, the circumstances under which the injury occurred needs to be disclosed, together with the present complaints and their severity. The physical examination is, perhaps, the crucial component of the workup. Confirmation of reduced range of motion, palpation of the affected area, as well as directed tests can further solidify the diagnosis [3]. Valgus instability (application of valgus stress when the elbow is in 20°-30° degree flexion) and the milking maneuver (induction of valgus stress by pulling the patient's thumb with the forearm in flexion beyond 90° and in supination) are probes used to assess of elbow ligament injury [7], whereas the anterior drawer test and the talar tilt test some of the most widely used exams for evaluating ligamentous structures of the ankle [4]. The role of imaging studies, such as X-rays, arthrography, ultrasonography, or magnetic resonance imaging (MRI), is focused on excluding more serious injuries (mainly fractures) and confirming clinical findings [4] [5], meaning that the physician plays a key role in raising suspicion toward this injury based on signs and symptoms obtained during history-taking and physical examination.
X-Ray
- Joint Space Narrowing
Of note, medial compartment arthrosis with joint space narrowing may present with "pseudo laxity" of the medial collateral ligament. [orthopaedicsone.com]
Colonoscopy
- Polyps
(Rationale: This is to ensure that subjects only suffer from a soft tissue injury, so that the study group is homogeneous) Patients who have experienced bronchospasm, acute rhinitis, nasal polyps, angioneurotic oedema, urticaria, or allergic-type reactions [clinicaltrials.gov]
Treatment
TREATMENTS – this suggests that the athlete should seek treatments such as physiotherapy (or physiotherapy) who may also utilise other modalities with the aim of stimulating blood flow and healing. [thesportsphysiotherapist.com]
Grade III MCL or LCL sprain treatment For most Grade III MCL and LCL sprains, doctors will use many of the same conservative treatments as they do for less severe knee sprains. These treatments may include: R.I.C.E. [upmc.com]
Physiotherapy treatment for an iliolumbar ligament sprain. Physiotherapy is very important in the treatment of an iliolumbar ligament sprain. Initially, your physiotherapist can diagnose your problem and determine its severity. [physio.co.uk]
The initial treatment for foot sprains consists of the RICE treatment, or rest, ice, compression and elevation. RICE treatments aim to reduce swelling at the injury site. [livestrong.com]
Prognosis
Prognosis Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. [twinboro.com]
Maintain appropriate conditioning: Arm, forearm, and wrist flexibility Muscle strength and endurance Use proper protective technique when falling and throwing Functional braces may be effective in preventing injury, especially re-injury, in contact sports Prognosis [csosortho.com]
Prognosis of an ankle sprain In cases of a minor to moderate medial ligament ankle sprain (grades I and II), return to sport or normal activity can usually occur in 3 – 8 weeks with appropriate management. [physioadvisor.com.au]
Etiology
Etiology Medial collateral ligament injuries occur in response to a direct valgus load applied on the lateral knee or twisting mechanisms. The direct blow is more apt to cause a higher grade injury. [orthopaedicsone.com]
Etiology Mechanical forces exceeding the tensile limits of the ankle joint capsule and supportive ligaments cause ankle sprains. [emedicine.medscape.com]
Background & Etiology The lower back can be divided functionally and anatomically into three separate areas, the lumbar spine, the sacrum, and coccyx. The lumbar spine includes five lumbar vertebra (L1-L5), and five intervertebral discs. [twinboro.com]
Specific populations and sports display an increased incidence of medial ankle sprains: 7 male gender higher competition levels young populations intercollegiate rugby gymnastics soccer Potential Etiologies: Mechanism of Injury 2 Excessive pronation Excessive [morphopedics.wikidot.com]
Epidemiology
Re-injury is also very common. [27] Epidemiology [ edit ] Adolescents vs general population ankle sprain instances Ankle Sprain Epidemiology- U.S. [en.wikipedia.org]
Epidemiology Medial collateral ligament sprains are thought to be the most common sprains about the knee. Precise numbers are difficult to obtain. [orthopaedicsone.com]
Epidemiology Most ankle sprains are probably self-treated and are never reported to a health care provider; therefore, many ankle sprains are not documented. [emedicine.medscape.com]
Pathophysiology
Pathophysiology A disruption of the medial collateral ligament will lead to valgus instability of the knee, that is, medial gaping when a valgus force is applied. [orthopaedicsone.com]
Pathophysiology The lateral ankle complex, which is composed of the anterior talofibular, calcaneofibular, and posterior talofibular ligaments, is the most commonly injured site. [1, 2, 3, 4] Approximately 85% of such sprains are inversion sprains of [emedicine.medscape.com]
Prevention
It links the thigh bone and the shin bone and acts to prevent excessive inward movement of the knee joint. [physioroom.com]
The ligament will heal on its own, and the main thing to do is to prevent re-injury to the ligament during its healing. [healthline.com]
Small and simple changes to your movements, combined with adequate treatments and following the Physio-4 for Strains n Sprains tips below, can prevent muscle strains and ligament sprains from becoming chronic injuries and prevent future episodes. [garibaldiactivewellness.com]
References
- McGovern RP, Martin RL. Managing ankle ligament sprains and tears: current opinion. Open Access Journal of Sports Medicine. 2016;7:33-42.
- McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35(2):103–108
- Fong DT, Chan YY, Mok KM, Yung P, Chan KM. Understanding acute ankle ligamentous sprain injury in sports. Sports Med Arthrosc Rehabil Ther Technol. 2009;1:14
- Polzer H, Kanz KG, Prall WC, et al. Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthop Rev (Pavia). 2012;4(1):e5.
- Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ, Godges JJ. Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2010;40(4):A1-A37.
- Gray AM, Buford WL. Incidence of Patients With Knee Strain and Sprain Occurring at Sports or Recreation Venues and Presenting to United States Emergency Departments. J Athl Train. 2015;50(11):1190-1198.
- Rahman RK, Levine WN, Ahmad CS. Elbow medial collateral ligament injuries. Curr Rev Musculoskelet Med. 2008;1(3-4):197-204.
- Kubiak EN, Klugman JA, Bosco JA. Hand injuries in rock climbers. Bull NYU Hosp Jt Dis. 2006;64(3-4):172-177.