Sprains and Strains

Description

• Sprains are complete or partial ligamentous injuries either within the body of the ligament or at the site of attachment to bone.
  • Classified as grade 1, 2, or 3 (AMA Ligament Injury Classification)
    • Grade 1: stretch injury without ligamentous laxity
    • Grade 2: partial tear with increased ligamentous laxity but firm end point on exam
    • Grade 3: complete tear with increased ligamentous laxity and no firm end point on exam
  • Usually secondary to trauma (e.g., falls, twisting injuries, motor vehicle accidents)
  • Physical exam is the key to accurate diagnosis.
• Strains are partial or complete disruptions of the muscle, muscle–tendon junction, or tendon.
  • Classified as
    • First degree: minimal damage to muscle, tendon, or musculotendinous unit
    • Second degree: partial tear to the muscle, tendon, or musculotendinous unit
    • Third degree: complete disruption of the muscle, tendon, or musculotendinous unit
  • Often associated with overuse injuries

Geriatric Considerations
More likely to see associated bony injuries due to decreased joint flexibility and increased prevalence of osteoporosis and osteopenia

Pediatric Considerations

• Sprains and strains account for 24% of pediatric injuries.
• 3 million pediatric sports injuries occur annually.
• Consider physeal/apophyseal injuries in the skeletally immature patient.

Epidemiology

Incidence
~80% of all U.S. athletes experience a sprain or strain at some point.

Prevalence

• Ankle sprains are among the most common injuries in primary care, accounting for ~30% of sports medicine clinic visits. Most ankle sprains are due to inversion injuries (lateral sprains) involving the anterior talofibular ligament; account for 650,000 annual ER visits in the United States
• Predominant age
  • Sprains: any age in physically active patient
  • Strains: usually 15 to 40 years of age
• Predominant sex: male > female for most; female > male for sprain of anterior cruciate ligament (ACL)

Etiology and Pathophysiology

• Trauma, falls, motor vehicle accidents
• Excessive exercise; poor conditioning
• Improper footwear
• Inadequate warm-up and stretching before activity
• Prior sprain or strain

Risk Factors

• Prior history of sprain or strain is the greatest risk factor for future sprain/strain.
• Change in or improper footwear, protective gear, or environment (e.g., surface)
• Sudden increase in training schedule or volume
• Tobacco use, medication adverse effects

General Prevention

• Appropriate warm-up and cool-down exercises
• Use proper equipment and footwear.
• Balance training programs improve proprioception and reduce the risk of ankle sprains.
• Semirigid orthoses may prevent ankle sprains during high-risk sports, especially in athletes with history of sprain.
• Proprioception and strength training decrease injury risk; stretching does not

Commonly Associated Conditions

• Effusions, ecchymosis, hemarthrosis
• Stress, avulsion, and/or other fractures
• Syndesmotic injuries
• Contusions
• Dislocations/subluxations