Sprain
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Definition
A sprain is an injury that damages a ligament. A ligament is a firm, fibrous band of tissue. It connects two bones across a joint. There are ligaments crossing all of the joints in the body.

Grade 1 and 2 sprains are less severe. The internal structure of the ligament is damaged, but the ligament remains intact. Grade 3 sprains are more severe. They include complete tears of the ligament. Grade 3 sprains are sometimes called torn or ruptured ligaments.

Sprain: Grade 2

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Causes
A sprain occurs when a force pushes the bones of a joint apart. If the force is intense enough, the ligament holding the joint together has to give.

Risk Factors
Sprains can occur with everyday activities, but they are more common during sports. Sports with high speeds and risk of collision have an increased risk of sprains. These sports include:

  • Basketball
  • Football
  • Skiing
  • Gymnastics
Factors that may increase your risk of a sprain include:

  • Muscle weakness
  • Lack of flexibility
  • Coordination and balance difficulties
  • Sudden change in direction
  • Impact with object or other person
  • Misstep that causes a sudden strain at a joint
Symptoms
Symptoms of a sprain may include:

  • Pain immediately after the sprain—without treatment, the pain becomes worse over the next 24 hours
  • A popping sound
  • Local swelling, often within minutes
  • Bruising
  • Trouble moving the joint
  • Increased pain when putting pressure on the injured area
The most common joints involved include:

  • Ankle
  • Knee
  • Thumb or finger joints
  • Shoulder
Diagnosis
Your doctor will ask about your symptoms and medical history. A physical exam will be done.

Your doctor may need images of your joint. This will help check for damage to bones or other structures. Images may be taken with:

Treatment
Treatment will depend on the joint involved and the extent of the injury. Talk with your doctor about the best treatment plan for you. Options include:

Rest
Avoid activity that causes pain. Protect the joint when possible.

Decrease Swelling
Elevation will help decrease swelling.

Compression of the area with an elastic bandage also helps to control swelling. Do not pull the elastic bandage tight. Release the bandage if fingers or toes become numb.

Ice and Heat
Apply ice to the area for 15-20 minutes at a time. This may be required several times a day for the first few days. Do not apply heat until you are ready to start being more active. Check with your doctor before applying heat. It may increase swelling.

Place a towel between a heat or ice pack and your skin.

Medications
Your doctor may prescribe medication to manage pain and swelling. Medication may include:

  • Nonsteroidal anti-inflammatory pain medication, such as ibuprofen
  • Over-the-counter or prescription medication that is applied to the skin
Rehabilitation
Rehabilitation exercises may be helpful after the sprain heals. Exercises can help to strengthen muscles and increase range of motion. Medical help is often needed at this stage. It is important to strengthen the muscles involving the joint where the ligament is. Those muscles need protection against further injury.

Prevention
It may be difficult to avoid sprains. Joints are at risk during athletic activities. To reduce your chance of getting a sprain:

  • Use proper techniques to help avoid awkward motions and missteps
  • Participate in flexibility, strength, and fitness training



RESOURCES:
American Academy of Orthopaedic Surgeons

American College of Sports Medicine

CANADIAN RESOURCES:
Canadian Orthopaedic Association

Canadian Orthopaedic Foundation

References:
Ankle sprain. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated August 1, 2013. Accessed September 6, 2013.

Collateral ligament sprain (knee). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated July 9, 2013. Accessed September 6, 2013.

Sprained ankle. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00150. Updated September 2012. Accessed September 6, 2013.

Sprains, strains, and tears. American College of Sports Medicine website. Available at: http://www.acsm.org/docs/brochures/sprains-strains-and-tears.pdf. Accessed September 6, 2013.

Sprains, strains, and other soft tissue injuries. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00304. Updated July 2007. Accessed September 6, 2013.

10/26/2010 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed/what.php: Massey T, Derry S, et al. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

Last Reviewed September 2013



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