Sprain

A sprain is an injury to the soft tissue that connects adjacent bones across a joint (ligament), in which the ligament becomes stretched or torn. The purpose of ligaments is to prevent a joint from moving out side of its intended range of motion. The most common joints of the body to suffer from a sprain are the ankles, knees, and fingers. Sprains are classified into 3 categories: grade 1, grade 2, and grade 3. Grade 1 sprains cause pain, but the tendon is not lengthened. Grade 2 sprains include a lengthened ligament due to the ligament being stretched or partially ruptured. With grade 2 sprains there is still function, although the function may be diminished. Grade 3 sprains are marked by a complete tear of the ligament and the joint usually displays a loss of function.

SYMPTOMS

  • Pain and tenderness in the area of injury; severity varies with extent of injury.

  • Swelling of the affected joint (usually).

  • Redness or bruising in the area of injury, either immediately or several hours after the injury.

  • Loss of normal mobility of the injured joint.

CAUSES

A sprain may occur as a secondary injury to a traumatic event, such as a fall or twisting injury. The ankle is susceptible to sprains because of it is a mechanically weak joint and is exposed during athletic events.

RISK INCREASES WITH:

  • Trauma, especially with high-risk activities, such as sports with a lot of jumping, for knee and ankle sprains (basketball or volleyball); sports with a lot of pivoting motions, for knee sprains (skiing, soccer, or football); and contact sports.

  • Falls onto outstretched hands and wrists (wrist sprains).

  • Catching sports, such as water polo and baseball (finger sprains).

  • Poorly fitting and high-heeled shoes.

  • Poor field conditions.

  • Poor strength and flexibility.

  • Failure to warm-up properly before activity.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Muscle strength.

  • Endurance and flexibility.

  • Cardiovascular fitness.

  • Wear properly fitted and padded protective equipment.

  • Wrap weak joints with support bandages before strenuous activity.

PROGNOSIS

If treated properly, sprains usually heal in 2 to 8 weeks. Occasionally sprains require surgery for healing to occur.

RELATED COMPLICATIONS

  • Permanent instability of a joint if the sprain is severe or if a ligament is repeatedly sprained.

  • Arthritis of the joint.

TREATMENT

Treatment involves ice and medicine to relieve pain and inflammation. Rest and immobilization of the injured joint is necessary for healing to occur. Strengthening and stretching exercises may be recommended after immobilization to regain strength and a full range of motion. For severe sprains surgery may be necessary to repair the injured ligament.

MEDICATION

  • If pain medicine is necessary, then nonsteroidal anti-inflammatory medicines, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be prescribed. Use only as directed and only as much as you need.

  • Cortisone injections are generally not advised for sprains. Cortisone may affect the healing of the ligament.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK MEDICAL CARE IF:

Symptoms get worse or do not improve in 2 to 6 weeks despite treatment.