[O.Fr. espraindre, to wring]
Trauma to ligaments that causes pain and disability, depending on the degree of injury to the ligaments. In the most severe sprain, ligaments are completely torn. The ankle joint is the most often sprained. SEE TABLE: Grading System for Sprains; SEE: fracture; SEE: strain
Pain may be accompanied by heat, discoloration, and localized swelling in the affected area. Moderate to severe sprains are marked by joint laxity, reduced range of motion, and limitation of function. When the sprained ligament is contiguous with the joint capsule, e.g., anterior talofibular ligament, medial collateral ligament, swelling occurs in the acute stage. When the sprain involves other intracapsular or extracapsular ligaments, e.g., calcaneofibular ligament, anterior cruciate ligament, swelling is slight or absent in the acute stage and progressively increases.
Diagnostic imaging of the joint is often indicated to rule out an avulsion fracture of the ligament's attachment, or other associated fracture
The affected part should be treated initially with ice or other cooling agents to limit inflammation and hypoxic injury. Circumferential compression, in the form of an elastic wrap, should be applied to the joint and the limb elevated to reduce swelling. Joint range of motion should be restricted to patient tolerance through the use of immobilization devices, crutches, or both. Analgesics and nonsteroidal anti-inflammatory medications may be administered for pain and swelling. In the chronic stage of the injury, massage, intermittent compression, and muscle contractions can be used to reduce swelling.
Grading System for Sprains
|Grade I||Stretching of the ligament without tearing|
|Grade II||Stretching of the ligament with incomplete tearing|
|Grade III||Complete tearing of the ligament (also called a rupture)|
A sprain to the acromioclavicular and coracoclavicular ligaments, commonly caused by a fall on an outstretched arm or a blow directly to the shoulder.
SYN: SEE: acromioclavicular separation; SEE: shoulder separation
Trauma to the ligaments of the ankle and foot, possibly involving tendon injury, but without an avulsion. Sprains of the lateral ligaments (most commonly the anterior talofibular ligament) account for approx. 90% of all ankle sprains.
SEE: sprain for treatment.
Ice should not be applied directly to the foot and ankle in patients who are older or who have cold allergy or circulatory insufficiency.
Overstretching of the spinal ligaments, often involving the surrounding muscles and spinal structures. Small fractures of the vertebrae are often associated.
Treatment includes superficial moist heat and rest. If muscle spasm is present, muscle relaxants, nonsteroidal anti-inflammatory drugs, or both, may be prescribed. After the acute symptoms have subsided, strengthening and flexibility programs are prescribed.
If back pain develops after acute trauma, or if the patient has a history of cancer, the patient should not be moved until the possibility of a fracture has been ruled out. Persons with a history of back pain and fever or back pain and injection drug use should be evaluated for spinal epidural abscess.
Trauma to the ligaments of the foot not involving the ankle.
Damage to the ligamentous structures of the distal tibiofibular syndesmotic joint, resulting from dorsiflexion or external rotation of the talus within the ankle mortise, or both, which in turn causes spreading of the joint. The distal tibiofibular syndesmosis is formed by the anterior tibiofibular ligament, the interosseous membrane, and the posterior tibiofibular ligament.
SYN: SEE: high ankle sprain
The rate of syndesmotic ankle sprains may be increased when athletes are participating on artificial surfaces, because of the increased friction between the shoe and playing surface.
Patients may describe pain along the fibula, just superior to the lateral malleolus, that worsens during dorsiflexion or external rotation of the talus, or both.
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