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Damage to one or more ligaments in a joint From Wikipedia, the free encyclopedia
A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement.[1] Sprains may be mild (first degree), moderate (second degree), or severe (third degree), with the latter two classes involving some degree of tearing of the ligament. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist.[2] An equivalent injury to a muscle or tendon is known as a strain.
| Sprain | |
|---|---|
| Other names | Torn ligament, distorsion |
| |
| A sprained ankle with bruising and swelling | |
| Specialty | Sports medicine, physical medicine & rehabilitation, orthopedics, family medicine, emergency medicine |
| Symptoms | Pain, swelling, bruising, joint instability, limited range of motion of the injured joint |
| Duration | Mild cases - few days to six weeks
Severe cases - few weeks to months |
| Causes | Trauma, sports injuries, overuse, environmental hazards |
| Risk factors | Environmental factors, age, poor training or sports gear |
| Diagnostic method | Physical exam, joint x-ray |
| Differential diagnosis | Strain, fracture |
| Prevention | Frequent stretching and conditioning, bracing at risk joints during exercise |
| Treatment | Rest, ice, compression, elevation, NSAIDs |
| Medication | Non-steroidal anti-inflammatory drugs (NSAIDs) |
| Prognosis | Mild injuries resolve well on their own.
Severe injuries likely require surgery and physical therapy. |
The majority of sprains are mild, causing minor swelling and bruising that can be resolved with conservative treatment, typically summarized as RICE: rest, ice, compression, elevation. However, severe sprains involve complete tears, ruptures, or avulsion fractures, often leading to joint instability, severe pain, and decreased functional ability. These sprains require surgical fixation, prolonged immobilization, and physical therapy.[3]
Knowing the signs and symptoms of a sprain can be helpful in differentiating the injury from a strain or simple fracture. Strains typically present with pain, cramping, muscle spasm, and muscle weakness, and fractures typically present with bone tenderness, especially when bearing weight.[7]
Acute sprains typically occur when the joint is abruptly forced beyond its functional range of motion, often in the setting of trauma or sports injuries. The most common cause of sprains in general is repetitive movements (overuse).[8]
Ligaments are collagen fibers that connect bones together, providing passive stabilization to a joint. These fibers can be found in various organizational patterns (parallel, oblique, spiral, etc.) depending on the function of the joint involved. Ligaments can be extra-capsular (located outside the joint capsule), capsular (continuation of the joint capsule), or intra-articular (located within a joint capsule).[1] The location has important implications for healing as blood flow to intra-articular ligaments is diminished compared to extra-capsular or capsular ligaments.[9]
Collagen fibers have about a 4% elastic zone where fibers stretch out with increased load on the joint. However, exceeding this elastic limit causes a rupture of fibers, leading to a sprain. It is important to recognize that ligaments adapt to training by increasing the cross-sectional area of fibers.[10] When a ligament is immobilized, the ligament has been shown to rapidly weaken. Normal daily activity is important for maintaining about 80–90% of the mechanical properties of a ligament.[1]
Sprains can often be diagnosed clinically based on the patient's signs and symptoms, mechanism of injury, and physical examination. However, x-rays can be obtained to help identify fractures, especially in cases of tenderness or bone pain at the injured site.[13] In some instances, particularly if the healing process is prolonged or a more serious injury is suspected, magnetic resonance imaging (MRI) is performed to look at the surrounding soft tissue and ligaments.[14][failed verification]
Although any joint can experience a sprain, some of the more common injuries include the following:[3]
Treatment of sprains usually involves incorporating conservative measures to reduce the signs and symptoms of sprains, surgery to repair severe tears or ruptures, and rehabilitation to restore function to the injured joint. Although most sprains can be managed without surgery, severe injuries may require tendon grafting or ligament repair based on the individual's circumstances.[22] The amount of rehabilitation and time needed for recovery will depend on the severity of the sprain.[23]
A foot sprain is an injury to the ligaments that connect bones within the foot. The recovery process for a foot sprain is crucial for restoring normal function and preventing future injuries. This article outlines the general approach to foot sprain recovery, which varies depending on the severity of the injury.[24]
Depending on the mechanism of injury, joint involvement, and severity, most sprains can be treated using conservative measures following the acronym RICE within the first 24 hours of sustaining an injury.[25] However, it is important to recognize that treatments should be individualized depending on the patient's particular injury and symptoms.[26] Over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve pain, and topical NSAIDs can be as effective as medications taken by mouth.[27]
Other non-operative therapies including the continuous passive motion machine (moves joint without patient exertion) and cryocuff (type of cold compress that is activated similarly to a blood pressure cuff) have been effective in reducing swelling and improving range of motion.[33] Recent studies have shown that traction is just as effective as the RICE technique in treating ankle sprains in pediatric patients.[34]
The components of an effective rehabilitation program for all sprain injuries include increasing the range of motion of the affected joint and progressive muscle strengthening exercises.[35] After implementing conservative measures to reduce swelling and pain, mobilizing the limb within 48–72 hours following injury has been shown to promote healing by stimulating growth factors in musculoskeletal tissues linked to cellular division and matrix remodeling.[23]
Prolonged immobilization can delay the healing of a sprain, as it usually leads to muscle atrophy and weakness.[36] Although prolonged immobilization can have a negative effect on recovery, a study in 1996 suggest that the use of bracing can improve healing by alleviating pain and stabilizing the injury to prevent further damage to the ligament or re-injury.[37] When using a brace, it is necessary to ensure adequate blood flow to the extremity.[38] Ultimately, the goal of functional rehabilitation is to return the patient to full daily activities while minimizing the risk of re-injury.
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