Sprain

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Sprain_table_infobox_0

SprainSprain_header_cell_0_0_0
Other namesSprain_header_cell_0_1_0 Torn ligamentSprain_cell_0_1_1
SpecialtySprain_header_cell_0_2_0 Sports medicine, physical medicine & rehabilitation, orthopedics, family medicine, emergency medicineSprain_cell_0_2_1
SymptomsSprain_header_cell_0_3_0 Pain, swelling, bruising, joint instability, limited range of motion of the injured jointSprain_cell_0_3_1
DurationSprain_header_cell_0_4_0 Mild cases - few days to six weeks

Severe cases - few weeks to monthsSprain_cell_0_4_1

CausesSprain_header_cell_0_5_0 Trauma, sports injuries, overuse, environmental hazardsSprain_cell_0_5_1
Risk factorsSprain_header_cell_0_6_0 Environmental factors, age, poor training or sports gearSprain_cell_0_6_1
Diagnostic methodSprain_header_cell_0_7_0 Physical exam, joint x-raySprain_cell_0_7_1
Differential diagnosisSprain_header_cell_0_8_0 Strain, fractureSprain_cell_0_8_1
PreventionSprain_header_cell_0_9_0 Frequent stretching and conditioning, bracing at risk joints during exerciseSprain_cell_0_9_1
TreatmentSprain_header_cell_0_10_0 Rest, ice, compression, elevation, NSAIDsSprain_cell_0_10_1
MedicationSprain_header_cell_0_11_0 Non-steroidal anti-inflammatory drugs (NSAIDs)Sprain_cell_0_11_1
PrognosisSprain_header_cell_0_12_0 Mild injuries resolve well on their own. Severe injuries likely require surgery and physical therapy.Sprain_cell_0_12_1

A sprain, also known as a torn ligament, is the stretching or tearing of ligaments within a joint, often caused by an injury abruptly forcing the joint beyond its functional range of motion. Sprain_sentence_0

Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprain_sentence_1

Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. Sprain_sentence_2

An equivalent injury to a muscle or tendon is known as a strain. Sprain_sentence_3

The majority of sprains are mild, causing minor swelling and bruising that can be resolved with conservative treatment, typically summarized as RICE: rest, ice, compression, elevation. Sprain_sentence_4

However, severe sprains involve complete tears, ruptures, or fractures, often leading to joint instability, severe pain, and decreased functional ability. Sprain_sentence_5

These sprains require surgical fixation, prolonged immobilization, and physical therapy. Sprain_sentence_6

Signs and symptoms Sprain_section_0

Sprain_unordered_list_0

  • PainSprain_item_0_0
  • SwellingSprain_item_0_1
  • BruisingSprain_item_0_2
  • Joint instabilitySprain_item_0_3
  • Difficulty with bearing weightSprain_item_0_4
  • Decreased functional ability or range of motion of the injured jointSprain_item_0_5
  • Ligament rupture may cause a cracking or popping sound at the time of injurySprain_item_0_6

Knowing the signs and symptoms of a sprain can be helpful in differentiating the injury from a strain or fracture. Sprain_sentence_7

Strains typically present with pain, cramping, muscle spasm, and muscle weakness, and fractures typically present with bone tenderness, especially when bearing weight. Sprain_sentence_8

Causes Sprain_section_1

Acute sprains typically occur when the joint is abruptly forced beyond its functional range of motion, often in the setting of trauma or sports injuries. Sprain_sentence_9

Chronic sprains are caused by repetitive movements leading to overuse. Sprain_sentence_10

Mechanism Sprain_section_2

Ligaments are collagen fibers that connect bones together, providing passive stabilization to a joint. Sprain_sentence_11

These fibers can be found in various organizational patterns (parallel, oblique, spiral, etc.) depending on the function of the joint involved. Sprain_sentence_12

Ligaments can be extra-capsular (located outside the joint capsule), capsular (continuation of the joint capsule), or intra-articular (located within a joint capsule). Sprain_sentence_13

The location has important implications for healing as blood flow to intra-articular ligaments is diminished compared to extra-capsular or capsular ligaments. Sprain_sentence_14

Collagen fibers have about a 4% elastic zone where fibers stretch out with increased load on the joint. Sprain_sentence_15

However, exceeding this elastic limit causes a rupture of fibers, leading to a sprain. Sprain_sentence_16

It is important to recognize that ligaments adapt to training by increasing the cross-sectional area of fibers. Sprain_sentence_17

When a ligament is immobilized, the ligament has been shown to rapidly weaken. Sprain_sentence_18

Normal daily activity is important for maintaining about 80–90% of the mechanical properties of a ligament. Sprain_sentence_19

Risk factors Sprain_section_3

Sprain_unordered_list_1

Diagnosis Sprain_section_4

Sprains can often be diagnosed clinically based on the patient's signs and symptoms, mechanism of injury, and physical examination. Sprain_sentence_20

However, x-rays can be obtained to help identify fractures, especially in cases of tenderness or bone pain at the injured site. Sprain_sentence_21

In some instances, particularly if the healing process is prolonged or a more serious injury is suspected, magnetic resonance imaging (MRI) is performed to look at the surrounding soft tissue and ligaments. Sprain_sentence_22

Classification Sprain_section_5

Sprain_ordered_list_2

  1. First degree sprain (mild) – There is minor stretching and structural damage to the ligament, leading to mild swelling and bruising. Patients typically present without joint instability or decreased range of motion of the joint.Sprain_item_2_13
  2. Second degree sprain (moderate) – There is a partial tear of the affected ligament. Patients typically experience moderate swelling, tenderness, and some instability of the joint. There may be some difficulty bearing weight on the affected joint.Sprain_item_2_14
  3. Third degree sprain (severe) – There is a complete rupture or tear of the ligament, sometimes avulsing a piece of bone. Patients typically experience severe joint instability, pain, bruising, swelling, and inability to apply weight to the joint.Sprain_item_2_15

Joints involved Sprain_section_6

Although any joint can experience a sprain, some of the more common injuries include the following: Sprain_sentence_23

Sprain_unordered_list_3

  • Ankle - Sprains most commonly occur at the ankle and can take longer to heal than ankle bone fractures. Most sprained ankles usually occur in the lateral ligaments on the outside of the ankle. Common causes include walking on uneven surfaces or during contact sports. See sprained ankle or high ankle sprain for more details.Sprain_item_3_16
    • Inversion Ankle Sprain - injury that occurs when ankle rolls inwardSprain_item_3_17
    • Eversion Ankle Sprain - injury that occurs when ankle rolls outwardSprain_item_3_18
  • ToesSprain_item_3_19
    • Turf toe (metatarsophalangeal joint sprain) - forced hyperextension of the big toe upwards, especially during sports (initiating a sprint on a hard surface)Sprain_item_3_20
  • Knee - Sprains commonly occur at the knee, especially following intense pivoting on a planted leg during contact sports (American football, football, basketball, pole vaulting, softball, baseball and some styles of martial arts).Sprain_item_3_21
  • Fingers and wrists - Wrist sprains commonly occur, especially during a fall on an outstretched hand.Sprain_item_3_28
  • SpineSprain_item_3_30
    • Neck sprain at the cervical vertebraeSprain_item_3_31
    • Whiplash (Traumatic Cervical Spine Syndrome) - forced hyperextension and flexion of the neck, classically found in rear-end auto accidentsSprain_item_3_32
    • Back sprain - Back sprains are one of the most common medical complaints, often caused by poor lifting mechanics and weak core muscles.Sprain_item_3_33

Treatment Sprain_section_7

Treatment of sprains usually involves incorporating conservative measures to reduce the signs and symptoms of sprains, surgery to repair severe tears or ruptures, and rehabilitation to restore function to the injured joint. Sprain_sentence_24

Although most sprains can be managed without surgery, severe injuries may require tendon grafting or ligament repair based on the individual's circumstances. Sprain_sentence_25

The amount of rehabilitation and time needed for recovery will depend on the severity of the sprain. Sprain_sentence_26

Conservative measures Sprain_section_8

Depending on the mechanism of injury, joint involvement, and severity, most sprains can be treated using conservative measures following the acronym RICE within the first 24 hours of sustaining an injury. Sprain_sentence_27

However, it is important to recognize that treatments should be individualized depending on the patient's particular injury and symptoms. Sprain_sentence_28

Over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve pain, and topical NSAIDs can be as effective as medications taken by mouth. Sprain_sentence_29

Sprain_unordered_list_4

  • Protect: The injured site should be protected and immobilized, as there is an increased risk of recurrent injury to the affected ligaments.Sprain_item_4_34
  • Rest: The joint affected should be immobilized and bearing weight should be minimized. For example, walking should be limited in cases of sprained ankles.Sprain_item_4_35
  • Ice: Ice should be applied immediately to the sprain to reduce swelling and pain. Ice can be applied 3–4 times a day for 10–15 minutes at a time or until the swelling subsides and can be combined with a wrapping for support. Ice can also be used to numb pain but should only be applied for a short period of time (less than twenty minutes) for this purpose. Prolonged ice exposure can reduce blood flow to the injured area and slow the healing process.Sprain_item_4_36
  • Compression: Dressings, bandages, or wraps should be used to immobilize the sprain and provide support. When wrapping the injury, more pressure should be applied to the distal end of the injury and decrease in the direction of the heart. This helps circulate the blood from the extremities to the heart. Careful management of swelling through cold compression therapy is critical to the healing process by preventing further pooling of fluid in the sprained area. However, compression should not impede circulation of the limb.Sprain_item_4_37
  • Elevation: Keeping the sprained joint elevated (in relation to the rest of the body) can minimize swelling.Sprain_item_4_38

Other non-operative therapies including the continuous passive motion machine (moves joint without patient exertion) and cryocuff (type of cold compress that is activated similarly to a blood pressure cuff) have been effective in reducing swelling and improving range of motion. Sprain_sentence_30

Functional rehabilitation Sprain_section_9

The components of an effective rehabilitation program for all sprain injuries include increasing the range of motion of the affected joint and progressive muscle strengthening exercises. Sprain_sentence_31

After implementing conservative measures to reduce swelling and pain, mobilizing the limb within 48–72 hours following injury has been shown to promote healing by stimulating growth factors in musculoskeletal tissues linked to cellular division and matrix remodeling. Sprain_sentence_32

Prolonged immobilization can delay the healing of a sprain, as it usually leads to muscle atrophy and weakness. Sprain_sentence_33

Although prolonged immobilization can have a negative effect on recovery, a study in 1996 suggest that the use of bracing can improve healing by alleviating pain and stabilizing the injury to prevent further damage to the ligament or re-injury. Sprain_sentence_34

When using a brace, it is necessary to ensure adequate blood flow to the extremity. Sprain_sentence_35

Ultimately, the goal of functional rehabilitation is to return the patient to full daily activities while minimizing the risk of re-injury. Sprain_sentence_36


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Sprain.