Sprains and Strains

Sprains and strains are common musculoskeletal soft-tissue injuries affecting ligaments, muscles, or tendons without bone disruption.

• Sprain → injury to a ligament (joint stabilizer)

• Strain → injury to muscle or tendon

They occur when tissues are stretched beyond physiological limits causing microscopic or macroscopic tears.

Fracture must always be excluded using X-ray imaging, especially in severe pain or inability to bear weight.

Common causes

• Sports injuries (running, football, jumping)

• Slips and twisting movements

• Sudden acceleration or deceleration

• Overuse of muscles (repetitive motion)

• Heavy lifting

• Poor posture

• Occupational activities

Important note:In children, always consider non-accidental injury (child abuse) when history does not match clinical findings.

Pathophysiology

Injury leads to:

1. Micro-tearing of fibers

2. Local bleeding

3. Inflammatory response

4. Edema formation

5. Pain and reduced function

Healing occurs in three phases:

Early improper mobilization → chronic instability

Classification (Severity)

Grade I (Mild)

• Microscopic tears

• Minimal swelling

• No instability

• Patient can still move joint

Grade II (Moderate)

• Partial tear

• Noticeable swelling

• Painful movement

• Reduced function

Grade III (Severe)

• Complete tear

• Joint instability

• Severe swelling

• Unable to use limb

• May mimic fracture

Signs and Symptoms

• Pain (worse on movement)

• Swelling

• Bruising (ecchymosis)

• Tenderness

• Muscle spasm

• Limited range of motion

• Weakness

• Inability to bear weight (moderate–severe)

Red flags (suggest fracture/dislocation)

• Visible deformity

• Bone tenderness

• Crepitus

• Severe functional loss

Diagnostic Criteria

Diagnosis is clinical based on:

• History of trauma or overuse

• Pain on movement

• Tenderness on palpation

• Limited mobility

• Inability to use limb normally

Always rule out fracture or dislocation.

Investigation

Imaging

X-ray (mandatory if):

• Severe pain

• Unable to bear weight

• Suspected fracture

• Joint deformity

• Elderly patients

• High-energy injury

Advanced imaging (if persistent symptoms)

• Ultrasound → tendon tear

• MRI → ligament rupture (gold standard)

Treatment

Goals

• Reduce pain

• Limit swelling

• Prevent further injury

• Restore function

Non-Pharmacological Management

R.I.C.E Protocol (First 48 hours)

R – Rest

• Avoid movement

• Temporary immobilization

I – Ice

• 15–20 minutes every 2–3 hours

• Reduces swelling and bleeding

C – Compression

• Elastic bandage

• Prevent hematoma formation

E – Elevation

• Limb above heart level

• Reduces edema

Immobilization

• Firm bandage

• Splints

• Triangular sling

• Back slab

Avoid prolonged immobilization (>2 weeks) to prevent stiffness.

Rehabilitation (after acute pain subsides)

• Gentle range-of-motion exercises

• Muscle strengthening

• Gradual weight bearing

• Physiotherapy

Pharmacological Treatment

Analgesics (Children >12 years & Adults)

Ibuprofen200–400 mg orally every 8 hours

AND

Paracetamol15 mg/kg orally every 6 hours

Severe pain

Short course NSAIDs preferred over opioids

Complications

• Chronic instability

• Recurrent sprain

• Muscle weakness

• Joint stiffness

• Tendon rupture

• Chronic pain syndrome

Prevention

• Warm-up before exercise

• Proper footwear

• Strength training

• Correct posture

• Avoid overtraining

• Protective gear during sports

• Workplace ergonomic training

Patient Education

Advise patient to return immediately if:

• Increasing swelling

• Numbness

• Severe persistent pain

• Cannot move limb after 3–5 days