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 usually heal without surgical repair.
Sprains occur when there is trauma to the joint, causing the joint to move in a position it wasn’t intended to move. Strains may be caused by excessive physical effort or activity, improper warming up before an activity, or poor flexibility.
Sprains and strains cause varying signs and symptoms.
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.
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 say he 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. These conditions appear several hours after the injury.
A history of recent injury or chronic overuse, clinical findings, and an X-ray to rule out fractures establish the diagnosis.
Effective treatment differs for sprains and strains.
Sprains call for control of pain and swelling and immobilization of the injured joint to promote healing. Immediately after the injury, elevating the joint above the level of the heart and intermittently applying ice for 12 to 48 hours controls swelling. A towel between the ice pack and the skin prevents cold injuries.
An immobilized sprain usually heals in 2 to 3 weeks, and the patient can then gradually resume normal activities. Occasionally, however, torn ligaments don’t heal properly and cause recurrent dislocation, necessitating 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, then heat. Complete muscle rupture may require surgery.
Chronic strains usually don’t need treatment, but instead heat application, a nonsteroidal anti-inflammatory (such as ibuprofen), or an analgesic-muscle relaxant can relieve discomfort.
❑ For sprains, immobilize the joint, using an elastic bandage or cast or, if the sprain is severe, a soft cast or splint. Depending on the severity of the injury, an analgesic may be necessary.
CLINICAL TIP: If the patient has a sprained ankle, make sure he receives crutch gait training. Because patients with sprains seldom require hospitalization, provide patient teaching.
❑ Tell the patient with a sprain to elevate the joint for 48 to 72 hours after the injury (while sleeping, the joint can be elevated with pillows) and to apply ice intermittently for 12 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 if pain worsens or persists. An additional X-ray may detect a fracture originally missed.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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