Sprains
These are acute injuries to ligaments, and the sprained ankle is one of the most common injuries seen in sport. They can be classified according to the degree of injury. In Grade 1 sprains, few ligament fibres are damaged or stretched. Often there is little swelling or loss of function, although there is ligament tenderness. In Grade 2 sprains, more fibres are damaged and there is a partial tear, which causes moderate tenderness, swelling and some loss of function. Grade 3 sprains represent complete rupture of ligaments, with widespread swelling, bruising, gross instability and disability. However, the pain response can be variable, as the nerve fibres supplying the ligaments are also damaged and tend to reduce overall pain.
Investigations such as Xrays are sometimes necessary to rule out a fracture in locations such as the ankle. This is particularly important if there is difficulty in weight bearing or widespread swelling and significant bony tenderness. Ultrasound scans may be useful, and MR scans may also be used if there is concern about secondary damage to other structures.
Treatment consists of R.I.C.E. This means Rest, which may involve the use of crutches until the patient can walk without a limp. Ice ( taking care to protect the skin) is applied for 15-20 minutes 3-5 times a day until the swelling resolves. Compression with a bandage (ice can be combined with this) or with an ankle stabilising brace, and Elevation above the level of the heart will reduce swelling. Care should be exercised when using painkillers or anti-inflammatories in the early management of these injuries. Follow-up physiotherapy may be required.
Strains
These represent pulled muscles and have a similar grading system to Sprains ( see sprains ). However, bruising and significant loss of function with secondary complications may occur. For example, a condition called Myositis Ossificans may occur if there has been a contusion injury (blunt trauma to a muscle or soft tissue) to the quadriceps (thigh) or other large muscle group. This represents the formation of calcium and new bone within the muscle itself, and can be prevented by the early application of R.I.C.E.( see sprains)
I usually use anti-inflammatory medication for between 2-4 weeks if I am concerned about this, providing the internal bleeding has stopped. I usually delay physiotherapy in cases of myositis ossificans.
Investigations such as X-rays and Ultrasound scans are helpful especially in more severe strains or contusions.
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