Sprains and Strains
Basics
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.
- Classified as grade 1, 2, or 3 (AMA Ligament Injury Classification)
- 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
- Classified as
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
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Citation
Domino, Frank J., et al., editors. "Sprains and Strains." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688525/all/Sprains_and_Strains.
Sprains and Strains. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688525/all/Sprains_and_Strains. Accessed October 3, 2024.
Sprains and Strains. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688525/all/Sprains_and_Strains
Sprains and Strains [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 03]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688525/all/Sprains_and_Strains.
* Article titles in AMA citation format should be in sentence-case
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