A sprain is an acute traumatic injury to a ligament which is being stretched beyond its own capacity. A strain is an acute traumatic injury to the muscle-tendon junction. Ligaments are tough, fibrous tissues that connect bones to other bones. Sprains can occur in any joint most common in the ankle and wrist.

Symptoms

•                          Pain

•                          Swelling

•                          Bruising

•                          Decreased ability to move the limb

•                          If the ligament is ruptured, one may hear a popping sound

•                          Difficulty using the affected extremity

Classification

·                 First degree sprain -mild pain due tearing of less than one-third ligamentous fibers, with < 5mm joint laxity

·                 Second degree sprain - moderate pain and swelling, one-third to two-third fibers of ligament are torn, with 5-10 mm joint laxity

·                 Third degree sprain - severe pain arising from complete tear of the ligament causing joint instability

Diagnosis

•                          The diagnosis of a sprain injury is made by a physical examination.

•                          In most cases an x-ray (or stress x-ray) of the affected joint is obtained to rule associated fractures and joint laxity.

•                          If a tear in the ligament is suspected, then an MRI or arthroscopy is obtained.

•                          MRI is usually ordered after swelling has subsided and can readily identify the presence of a ligament injury.

Causes

Sprains typically occur when the joint is overextended. This can cause over stretching of the joints, tear or slipping of the ligament.

Joints involved

Although any joint can experience a sprain, some of the more common include:

·       The ankle. It is the most common, and has been said that sprains such as serious ankle sprains are more painful and take longer to heal than actually breaking the bones in that area.

·       The knee. Perhaps one of the more talked about sprains is that to the anterior cruciate ligament (ACL) of the knee. This is a disabling sprain common to athletes, playing basketball, pole vaulting, softball, baseball and some styles of martial arts.

·       The fingers.

·       The wrist.

·       The toes.

Risk factors

There are certain factors which increases risk of sprains. Fatigue of muscles generally leads to sprains. When one suddenly starts to exercise after a sedentary lifestyle, sprains are quite common. While scientific studies are lacking, it is often thought that not warming-up is a common cause of sprains in athletes. Warming- up is thought to loosen the joint, increases blood flow and makes the joint more flexible.

Treatment

The treatment of sprains depends on the extent of injury and the joint involved. Medications like non-steroidal anti-inflammatory drugs can relieve pain. Weight bearing should be gradual and advanced as tolerated. The first modality for a sprain can be remembered using the acronym RICE.

·                 Rest: The sprain should be rested. No additional force should be applied onsite of the sprain. In case of, for example, a sprained ankle, walking should be kept to a minimum. Preferably a POP splint should be applied.

·                 Ice: Ice should be applied immediatelyto the sprain to reduce swelling and pain. It can be applied for 10-15 minutes at a time (longer application of ice

may cause damage instead of healing), 3-4 times a day. Ice can be combined with a wrapping to minimize swelling and provide support.

·                 Compression: Dressings, bandages, or ace-wraps should be used to immobilize the sprain and provide support. When wrapping the injury, more pressure should be applied at the far end of the injury and decrease in the direction of the heart; the reason for this is that it more easily causes unnecessary fluid to be flushed back up the blood stream in order to be recycled. Compression should not cut off the circulation of the limb.

·                 Elevation: Keeping the sprained joint elevated (in relation to the rest of the body) will also help minimize swelling.

The joint should be exercised again fairly soon, in milder cases from 1 to 3 days after injury. Special exercises are sometimes needed in order to regain strength and help reduce the risk of ongoing problems. The joint may need to be supported by taping or bracing, helping protect it from re-injury.

·                 NSAIDs : Will decrease swelling and edema and increase patient comfort.

·                 Diclofenac Sodium 50 mg tds in acute phase then 50 mg SOS.

·                 Aceclofenac, Ibuprofen, Coxibs etc can also be given.

Surgical treatment is generally required in cases with grade 3 tears.

Functional rehabilitation

Prolonged immobilization delays the healing of a sprain, as it usually leads to muscle atrophy and stiff joint. The components of an effective rehabilitation for all sprain injuries include increasing range of motion and progressive muscle strengthening exercise. These should be taken care of without delay.