A sprain is a complete or incomplete tear in the supporting ligaments surrounding a joint that usually follows a sharp twist. A strain is an injury to a muscle or tendinous attachment. Both injuries usually heal without surgical repair.
Sprains and strains may result from accidental injury, various sports-related injuries, or from simple household or work-related tasks. More than 4 of 10 injuries resulting in time absent from work are due to sprains and strains, mostly affecting the back.
A sprain causes local pain (especially during joint movement), swelling, loss of mobility (which may not occur until several hours after the injury), and a black-and-blue discoloration from blood extravasating into surrounding tissues. A sprained ankle is the most common joint injury. (See Muscle-tendon ruptures, page 302.)
A strain may be acute (an immediate result of vigorous muscle overuse or overstress) or chronic (a result of repeated overuse). An acute strain causes a sharp, transient pain (the patient may report having heard a snapping noise) and rapid swelling. When severe pain subsides, the muscle is tender; after several days, ecchymoses appear. A chronic strain causes stiffness, soreness, and generalized tenderness several hours after the injury.
A history of a recent injury or chronic overuse, clinical findings, and an X-ray to rule out fractures establish the diagnosis.
Treatment of sprains consists of controlling pain and swelling and immobilizing the injured joint to promote healing. Immediately after the injury, control swelling by elevating the joint above the level of the heart and by applying ice intermittently for 24 to 48 hours. To prevent a cold injury, place a towel between the ice pack and the skin.
Support the joint, using an elastic bandage. If the sprain is severe, immobilize the joint with a splint, and instruct the patient to stay off his feet (nonweight-bearing). Codeine or another analgesic may be necessary if the injury is severe. If the patient has a sprained ankle, he may need crutch gait training. Because patients with sprains seldom require hospitalization, provide patient teaching.
An immobilized sprain usually heals in 2 to 3 weeks, after which the patient can gradually resume normal activities. Occasionally, however, torn ligaments don’t heal properly and cause recurrent dislocation, requiring surgical repair. Some athletes may request immediate surgical repair to hasten healing; to prevent sprains, they may tape their wrists and ankles before sports activities.
Acute strains require analgesics and application of ice for up to 48 hours and then application of heat. Complete muscle rupture may require surgery. Chronic strains usually don’t require treatment, but heat application, nonsteroidal anti-inflammatory drugs such as ibuprofen, or an analgesic-muscle relaxant can relieve discomfort.
❑ Tell the patient to elevate the joint for 48 to 72 hours after the injury (pillows can be used while sleeping) and to apply ice intermittently for 24 to 48 hours.
❑ If an elastic bandage has been applied, teach the patient to reapply it by wrapping from below to above the injury, forming a figure eight. For a sprained ankle, apply the bandage from the toes to midcalf. Tell the patient to remove the bandage before going to sleep and to loosen it if it causes the leg to become pale, numb, or painful.
❑ Instruct the patient to call the physician if the pain worsens or persists; if so, an additional X-ray may reveal a previously undetected fracture.
Review other book chapters online related to Sports Injuries:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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