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Sprain

Sprain is a condition, characterized by damage to one or more ligaments due to trauma. This causes the area or joint to be used beyond its range of motion. The condition is often referred to as torn ligament.


Presentation

Sprain injury presents with the following signs and symptoms [7]:

  • Development of pain in the affected joint and muscle
  • Stiffness in the affected joint
  • Swelling
  • Affected area undergoes discoloration due to injury and bruising 
  • Difficulty in moving the affected area
  • A sound of “pop” may be heard during time of injury
Disability
  • Relief of the disabling pain can then be offered by removal of the un-united fracture fragment.[ncbi.nlm.nih.gov]
  • This is a disabling sprain common to athletes, especially in American football , football (soccer) , basketball , pole vaulting , softball , baseball and some styles of martial arts . See Anterior cruciate ligament injury .[en.wikipedia.org]
  • […] from uncertain or unknown; perhaps Old French espreindre, to force out, strain from Vulgar Latin an unverified form expremere, for Classical Latin exprimere: see express an act of spraining the resulting condition, characterized by swelling, pain, and disablement[yourdictionary.com]
  • Copyright HarperCollins Publishers verb transitive 1. to wrench or twist a ligament or muscle of (a joint, as the ankle) without dislocating the bones noun 3. the resulting condition, characterized by swelling, pain , and disablement of the joint Webster[collinsdictionary.com]
Prolonged Immobilization
  • The joint may need to be supported by taping or bracing, helping protect it from re-injury. [7] Functional rehabilitation [ edit ] Prolonged immobilization delays the healing of a sprain, as it usually leads to muscle atrophy and stiff joint.[en.wikipedia.org]
  • immobilization is detrimental. 12,13 Accordingly, the use of removable external supports such as taping and bracing after day 10 has continued to be the preferred treatment of the acute ankle sprain.[podiatrytoday.com]
  • Prolonged immobilization of ankle sprains is a common treatment error. 20 , 21 Functional stress stimulates the incorporation of stronger replacement collagen. 20 Functional rehabilitation begins on the day of injury and continues until pain-free gait[aafp.org]
Overeating
  • The study was conducted within our institution over a period of 16 months. Patients with clinical signs predictive of MJS without radiographic bone lesion underwent ultrasound assessment.[ncbi.nlm.nih.gov]
  • Pain-free weight-bearing capacity increased over the 2-week course of rehabilitation and the subject was able to return to playing soccer without pain.[ncbi.nlm.nih.gov]
  • Neck pain may radiate into the shoulder and over the shoulder blade and upper back when the trapezius muscle is strained.[spine-health.com]
  • Figure 2: The Lateral Ligaments of the Ankle Figure 3: Ankle swelling and redness after an ankle sprain Physical Examination: Sprained Ankle Physical examination will reveal swelling over the outer aspect of the ankle and tenderness over the outer front[footeducation.com]
  • MATERIAL AND METHODS A cross-over randomized design was used. Twenty-two soccer players with an ankle sprain underwent 3 interventions in a random order. Subjects were randomly assigned to ankle balance taping, placebo taping, and no taping groups.[ncbi.nlm.nih.gov]
Back Pain
  • Almost everyone has at least one episode of back pain sometime in their life. The good news is the vast majority of back pain episodes never require formal treatment and get better. The causes of back pain are vast.[emoryhealthcare.org]
  • The most common cause of back pain is sprain or strain, although pain can be so intense and severe that the cause may be attributed to a vertebral fracture , disc disorder , or tumor . The most common cause of back pain is sprain or strain.[spineuniverse.com]
  • Low Back Strain and Sprain American Association of Neurological Surgeons Lumbar (lower back) muscle strains and sprains are the most common causes of low back pain.[aans.org]
  • Lower back pain and spasm is a common result of repetitive lifting injuries, but it only takes one twist or turn at the wrong time or in the wrong position to cause muscle fibers in the back to stretch and develop spasms.[medicinenet.com]
Ankle Pain
  • Some of the most common causes of ankle pain include sports injuries, walking on uneven surfaces and car accidents. Ankle Sprains Ankle sprains can range from mild to severe in nature and are commonly observed in athletes.[se-ortho.com]
  • Repeated ankle sprains can even sometimes lead to chronic ankle pain, arthritis, problems with balance and stability, or falls.[draxe.com]
  • Lateral ankle pain. Park Ridge, Ill.: American College of Foot and Ankle Surgeons, 1997: preferred practice guideline no. 1/97. Retrieved September 2000, from: . 6. McCluskey LC, Black KP. Ankle injuries in sports. In: Gould JS, et al., eds.[aafp.org]
  • One of these patients was surgically treated, and all had full ROM of the ankle. [ 34 ] In 6 cases of frank diastasis over 4- to 60-month follow-up, 4 cases had good results, and 2 had fair results in that the patients had residual mild ankle pain and[emedicine.medscape.com]
Musculoskeletal Pain
  • "Topical NSAIDs for acute musculoskeletal pain in adults". The Cochrane Database of Systematic Reviews . 6 : CD007402. doi : 10.1002/14651858.CD007402.pub3 . PMID 26068955 . a b c d "Sprained Ankle" . American Orthopedic Foot and Ankle Society.[en.wikipedia.org]
Confusion
  • The radiographic appearance of true hyperflexion sprain may be confused with that of paracervical muscle spasm.[ncbi.nlm.nih.gov]
  • The Common Difference Between A Strain And A Sprain – Part 1 In our practice, we see a lot of patients who are confused on the difference between a strain versus a sprain.[wegetyouhealthy.com]
  • It’s no wonder the two conditions are frequently confused. The main difference is that with a sprain you may have bruising around the affected joint, whereas with a strain, you may have spasms in the affected muscle.[healthline.com]
  • […] first-time ankle sprain will develop long-term residual symptoms after an ankle sprain and often develop a syndrome known as chronic ankle instability. 9,10 A number of published guidelines using evidence-based medicine can help clear up some of the confusion[podiatrytoday.com]
Neglect
  • Several studies have reported that acupuncture is effective for treatment of acute lumbar sprain, but they neglected to consider that acupuncture cannot remarkably improve lumbar activity.[ncbi.nlm.nih.gov]
  • Unfortunately, many athletes neglect this step and return to sports too soon.[verywell.com]
  • Neglecting to correct the stressed ligament will wind up weakening your ankle, sometimes long-term. This will make it more likely that you’ll suffer from future injuries and possibly even other muscular compensations.[draxe.com]

Workup

  • A preliminary physical examination would be carried out to carefully study the signs and symptoms of the injury. During this examination, tenderness will be evaluated and the extent of mobility of affected joint would also be determined. Physical examination would also give information about the type of ligament and muscle that have been damaged due to injury [8].
  • An X-ray would be required to rule out the possibility of fracture. In addition, MRI would also be necessary to analyze the extent of injury. CT scan imaging studies is indicated in cases of osteochondritis dissecans [9].
  • In case of acute swelling or clinical instability of the affected joint, stress radiograph may be necessary.

Treatment

  • In mild cases, certain home care measures would be advised along with pain reliving medications. Application of ice on the affected area soon after the injury is necessary to reduce the swelling [10]. 
  • Individuals are advised to follow the R.I.C.E approach which involves: R-rest, I-ice, C-compression and E-elevation. According to this approach, the affected area should be put at rest and ice should be applied. In addition, compressing the area with an elastic bandage is also indicated. In order to reduce the swelling, the affected area should be kept at an elevated position during night. Gravity helps in reducing the swelling by draining off the excess of fluid that has accumulated.
  • Medications such as ibuprofen are indicated to reduce swelling and associated pain. In many cases, a brace or splint may be tied in order to immobilize the affected area. Surgery is indicated in those cases, when there is a torn ligament or the muscles of the affected area have ruptured [11].

Prognosis

If sprains are treated on time then the prognosis of the condition is excellent. Individuals suffering acute ankle sprain, recover within 2 weeks to 36 months; with major amount of recovery occurring in the first 6 months [5].

It has also been reported that after about 1 year, the risk of suffering recurrent ankle sprain is similar to pre-injury levels. However, with prompt treatment, the prognosis of recurrent sprains is also excellent, with full recovery occurring within few weeks. Failure to initiate prompt treatment, can lead to functional instability which would in turn make the affected area more prone to recurrent injuries, chronic pain and degenerative bone changes that would set in at early stages [6].

Etiology

The various factors that contribute to development of sprains include:

  • Poor conditioning: Lack of appropriate physical conditioning can cause the muscles to weaken which can in turn make them more prone to injury.
  • Fatigue: Fatigued muscles cannot provide proper support to the joints, making them susceptible to injuries.
  • Warm-up: Individuals should practice proper warm-up exercises before physical activity, else it can lead to loosening of the muscles and make them prone to muscle tears and trauma.
  • Sports: Men who practice or indulge in high level of athletic sports are more prone to suffer sprains. Studies have also reported that male athletes are more prone to sustain medial ankle sprain injuries as compared to female athletes [2].

Epidemiology

The exact incidence of sprains is not known, owing to the fact that such type of injuries are self treated and seldom require medical intervention. From the available data, it can be estimated that more than about 23,000 individuals per day require medical treatment for ankle sprains [3]. It has also been estimated that females who play basket ball are more likely to suffer from first time inversion injury, as compared to those playing other sports.

Sex distribution
Age distribution

Pathophysiology

A sprain occurs when the joint is exerted beyond its functional range. The ligaments that surround the joints are injured in sprain. Ligaments are fibers that are flexible in nature and strong enough to hold the bones together. Any injury to the ligaments causes the joints to swell and pain. The ligaments are responsible for providing mechanical support and give directed motion to the joint.

Any joint in the body can sustain a sprain injury. However, the common ones involved are the ankle and wrist, followed by knee joints. In addition, fingers and toes are also susceptible to suffer from sprain injury [4].

Prevention

Sprains can be prevented by practicing muscle strengthening exercises regularly. Using proper footwear that would provide adequate support and stability to the ankle can be helpful in prevention of ankle sprains.

Summary

The most common areas susceptible to sprain are the ankle and wrist; however any joint can get affected. Severity of the condition gravely depends on the type of injury suffered. Minor injuries often do not require surgical intervention, but major ones that cause ligament rupture, call for surgical fixation. This is followed by immobilization for a certain period. Swelling and pain are the common symptoms of sprains [1].

Patient Information

  • Definition: Sprains, commonly referred to as torn ligament, occurs when the joint is exerted beyond its functional range. The condition causes damage to one or more ligaments which further leads to development of swelling and pain in the affected joint. The most common joint prone to sprains is the ankle. 
  • Cause: Trauma or injury, which causes the joint to move out from its functional range leads to development of sprains. Poor conditioning, improper warm-up prior to any type of heavy physical activity and fatigue can predispose an individual to develop sprains.
  • Symptoms: Affected individuals experience pain and swelling in the joint that has suffered sprain. In addition, there may be signs of bruising and discoloration due to trauma or injury. Individuals may experience difficulty in walking if ankle is affected or moving the hand if the wrist is affected.
  • Diagnosis: A physical examination of the affected joint is sometimes enough to diagnose the condition. However, X-rays may also be required to rule out the possibility of fractures. In addition, if there is severe swelling, then stress radiography and MRI may also be done.
  • Treatment: Immediate application of ice on the affected area forms the preliminary basis of treatment regime. This should be followed by immobilization of the joint in order to reduce the swelling and pain. Pain relieving medications may also be given.

References

Article

  1. LeBlanc KE. Ankle problems masquerading as sprains. Prim Care. Dec 2004;31(4):1055-67
  2. Williams GN, Jones MH, Amendola A. Syndesmotic ankle sprains in athletes. Am J Sports Med 2007; 35:1197.
  3. Mahaffey D, Hilts M, Fields KB. Ankle and foot injuries in sports. Clin Fam Pract; 1999:1(1):233-50
  4. McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 2001; 35:103.
  5. Verhagen RA, de Keizer G, van Dijk CN. Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg. 1995;114(2):92-6.
  6. Anandacoomarasamy A, Barnsley L. Long term outcomes of inversion ankle injuries. Br J Sports Med 2005; 39:e14; discussion e14.
  7. Clanton TO, Schon LC. Athletic injuries to the soft tissues of the foot and ankle. In: Surgery of the Foot and Ankle, 6th, Mann RA, Coughlin MJ. (Eds), Mosby-Year Book, St. Louis 1993. p.1167.
  8. van Dijk CN, Lim LS, Bossuyt PM, Marti RK. Physical examination is sufficient for the diagnosis of sprained ankles. J Bone Joint Surg Br 1996; 78:958.
  9. Saxena A, Luhadiya A, Ewen B, Goumas C. Magnetic resonance imaging and incidental findings of lateral ankle pathologic features with asymptomatic ankles. J Foot Ankle Surg. Jul-Aug 2011;50(4):413-5.
  10. Sloan JP, Hain R, Pownall R. Clinical benefits of early cold therapy in accident and emergency following ankle sprain. Arch Emerg Med 1989; 6:1.
  11. Staples OS. Ruptures of the fibular collateral ligaments of the ankle. Result study of immediate surgical treatment. J Bone Joint Surg Am. Jan 1975;57(1):101-7.

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Last updated: 2017-08-09 18:22