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
- Pain
This can be associated with a sense of instability, pain (some of the ligament is still intact), and altered biomechanics leading to posttraumatic arthrosis. [orthopaedicsone.com]
Typical complaints include pain, weakness, limited range of motion, and swelling. [symptoma.com]
Generally an activity aggravates the condition if: Pain increases during that activity OR Pain increases upon rest following that activity OR Pain increases the morning after that activity. [physioadvisor.com.au]
Rest from painful exercise or a movement is essential in the early injury stage. We call this active rest. "No pain. No gain." does not apply in most cases. [physioworks.com.au]
- Inflammation
Emphasis will be on rest, reducing the inflammation, load and stress on the affected area. [twinboro.com]
Ligament Injection Therapy Now that it is understood how inflammation works, we can really understand what we need to do to create inflammation. [diagnose-me.com]
Use of antiinflammatory medications is useful in controlling inflammation and pain. Ultrasound and other forms of electrotherapy treatments can also be beneficial. [epainassist.com]
- Weakness
Typical complaints include pain, weakness, limited range of motion, and swelling. [symptoma.com]
The muscles or joints may be weak and painful to use. [garibaldiactivewellness.com]
Things like ligament overuse, impact, instability, poor form, falling or weakness in the legs cause sprained ankles. [draxe.com]
However, if no other treatment makes your ankle comfortable and tests show that the ligaments are weak, an operation may help. [cambridgefootandankle.com]
Sometimes ankle sprains occur because a person is born with weak ankles. Previous ankle or foot injuries can also weaken the ankle and lead to sprains. [foothealthfacts.org]
- Severe Pain
Severe pain felt when pressing over the medial or lateral malleolus, the bony bumps on each side of the ankle. There is loss of feeling in the foot or toes. [emedicinehealth.com]
Swelling and stiffness Pain with weight bearing activities Poor balance 3 (severe) Complete tear of the ligament Severe pain followed by minimal pain Gross instability of the joint Severe swelling Possible pain with weight bearing Poor balance Immediate [sma.org.au]
A more severe ankle sprain may cause much more pain and make it tough or impossible to walk. [webmd.com]
- Fatigue
Fatigue. Tired muscles are less likely to provide good support for your joints. When you're tired, you're also more likely to succumb to forces that could stress a joint. Poor equipment. [mayoclinic.org]
Fatigue of muscles generally leads to sprains. When one suddenly starts to exercise after a sedentary lifestyle, sprains are quite common. [en.wikipedia.org]
The following may increase your risk of a sprain: Overuse of your muscles or muscle fatigue A sudden increase in the amount and intensity of sports training Wearing shoes that do not fit or are not made for the activities you do Weighing at least 20 pounds [drugs.com]
Fatigue and pain are good reasons to not exercise. Avoid the "weekend warrior" syndrome. Try to get at least 30 minutes of moderate physical activity every day. If you are truly pressed for time, you can break it up into 10-minute chunks. [orthoinfo.aaos.org]
Musculoskeletal
- Ankle Pain
The following signs and symptoms may be indicators of an ankle strain: Pain. [sports-health.com]
He is able to finish the game, but complains of ankle pain and swelling afterwards. Physical exam is notable for moderate inversion laxity with the ankle held in dorsiflexion. [orthobullets.com]
I recommend avoiding forcing your ankle to move in pain too soon. I also recommend avoiding weight bearing or walking in pain early in the course of an ankle sprain. There is no reason to start testing your ankle until it has had time to heal. [drpribut.com]
- Muscle Strain
Not all strains are equal. The local area of a muscle strain or sprain will be painful, swollen, red and possibly bruised. The muscles or joints may be weak and painful to use. [garibaldiactivewellness.com]
See Back Muscles and Low Back Pain Lower back strain, also referred to as a pulled muscle, is caused by damage to the muscles and ligaments of the lower back. [spine-health.com]
Muscle Strain Neck Headache Overuse Injuries Poor Hip Core Rheumatoid Arthritis Rotator Cuff Tear RSI - Repetitive Strain Injury Shin Splints Side Strain (Abdominal) Thigh Strain Common Ligament Injuries AC Joint Injury ACL Injury Back Muscle Pain Cramps [physioworks.com.au]
- 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]
- Wrist Pain
Examples of conditions treated by a hand surgeon are: Carpal tunnel syndrome Wrist pain Lacerations including tendons of the hand and wrist Sports injuries to the hand and wrist Dupuytren’s contracture Trigger Finger If you have pain in your fingers, [resurgenssportsmedicine.com]
[…] longus, extensor pollicis brevis, and abductor pollicis longus tendons) Scaphoid fracture Various mechanisms Tenderness over the lunate fossa (in the wrist at the base of the 3rd metacarpal) and pain with axial compression of the 3rd metacarpal Lunate [merckmanuals.com]
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.
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]
The mean duration for recovery with conservative treatment of isolated, complete tears of the MCL is normally 4-8 wk. [ncbi.nlm.nih.gov]
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]
The prognosis for a patient with ankle sprains and other traumatic injuries is related to the prognosis for the other injuries. [emedicine.medscape.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
Epidemiology Medial collateral ligament sprains are thought to be the most common sprains about the knee. Precise numbers are difficult to obtain. [orthopaedicsone.com]
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 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.