Sprains & Strains Disease

DESCRIPTION

Sprain: complete or partial ligamentous injury, either within the body of the ligament or at the site of attachment to bone. It may be classified as Grade I, II, or III. Grades I and II are incomplete tears and differ in severity; Grade III is complete dissolution of the ligamentous connection. Physical exam is key to the diagnosis. Usually secondary to trauma (falls, twisting injuries or motor vehicle accidents).
Strain: partial or complete disruption of the muscle or tendon, usually associated with overuse injuries.
System(s) affected: Musculoskeletal
Genetics: N/A
Incidence/Prevalence in USA:
- Total incidence including spine, upper and lower extremities probably occurs in close to 80% of all athletes sometime in their career
- Prevalence - approximately 30,000
Predominant age:
- Sprains - any age where patient is physically active
- Strains - usually 15-40
Predominant sex: Male > Female

SIGNS AND SYMPTOMS

Swelling
Pain
Erythema and/or ecchymosis
Tenderness
Gait disturbances if severe
Decreased range of motion of joint and joint instability

CAUSES

Falls
Motor vehicle accident
Trauma
Excessive exercise or inadequate warm-up and stretching prior to activity
Poor conditioning

RISK FACTORS

Change in or improper shoe gear, protective gear, or environment (e.g., surface)
Inappropriate increase in training schedule

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

Exam under anesthesia
Arthroscopy in some cases
For ankle, anterior drawer test, which tests the integrity of the anterior talofibular ligament

IMAGING

Ankle films - only required if there is pain in malleolar zone and
- Bone tenderness posterior edge or tip of lateral malleolus
- Bone tenderness posterior edge or tip of medial malleolus
- Unable to bear weight, both immediately and in emergency department
Foot films - only required if there is midfoot zone pain and
- Bone tenderness at base of 5th metatarsal
- Bone tenderness at navicular
- Unable to bear weight, both immediately and in emergency department
X-rays to rule out bony injury. Stress views may be helpful.
CT scan of the affected area
MRI
Exam under anesthesia in difficult cases

DIAGNOSTIC PROCEDURES

Sprains/strains
- Grade I - pain/tenderness without loss of motion
- Grade II - pain/tenderness; ecchymosis with some loss of range of motion
- Grade III - pain/tenderness; swelling and ecchymosis and complete loss of range of motion

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

History and physical exam along with treatment of the worst possible suspected injury

Acutely
- RICE therapy - Rest, Ice, Compression, Elevation
  - Elastic bandage wrap (Ace) is comfortable
  - Jone's dressing for more severe injuries
- Orthosis (splint) for pain relief and stability; "Air Cast" type devices provide effective stability and pain relief
- Crutches and crutch gait training

SURGICAL MEASURES

Casting and surgery reserved for select Grade III injuries

ACTIVITY

Bed rest for acute injuries
Physical therapy for more severe injuries
Elevate joint while sleeping

DIET

Weight loss if obesity etiologic

PATIENT EDUCATION

Instructions on how to wrap with elastic bandage
Prevention of injury

PREVENTION/AVOIDANCE

Maintaining a reasonable level of physical fitness
Avoidance of excessive physical stresses and wearing of proper exercise gear (particularly shoes). Using proper equipment for the activity.
Knowledge of the risks associated with the intended activity
Appropriate conditioning, warm-up and cool-down exercises

POSSIBLE COMPLICATIONS

Chronic joint instability
Arthritis

EXPECTED COURSE AND PROGNOSIS

With appropriate treatment and rest, 6-8 weeks or longer for recovery, depending on severity of injury

ASSOCIATED CONDITIONS

Hemarthrosis, stress, avulsion, or other fractures, syndesmotic injuries, contusions, wounds, dislocations

AGE-RELATED FACTORS

Pediatric: Sprains and strains accounted for 24% of injuries in an analysis of 1,124 sports injuries of children in a study done in West Germany, 1980-82
Geriatric: More likely to see associated bony injuries due to decreased joint flexibility and prevalence of osteoporosis and osteopenia
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

NSAID = nonsteroidal anti-inflammatory drug

Clinical Investigations

ROLE OF HOMOEOPATHY

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