A sprain, also known as a torn ligament, is an acute soft tissue injury of the

ligaments A ligament is the fibrous connective tissue that connects bones to other bones. It is also known as ''articular ligament'', ''articular larua'', ''fibrous ligament'', or ''true ligament''. Other ligaments in the body include the: * Peritoneal ...

within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic

fiber Fiber or fibre (from la, fibra, links=no) is a natural or artificial substance that is significantly longer than it is wide. Fibers are often used in the manufacture of other materials. The strongest engineering materials often incorporate ...

s made of

collagen Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whol ...

that connect two or more

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...

s to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a

muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of mus ...

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

is known as a strain. The majority of sprains are mild, causing minor swelling and

bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close ...

that can be resolved with conservative treatment, typically summarized as

RICE Rice is the seed of the grass species '' Oryza sativa'' (Asian rice) or less commonly ''Oryza glaberrima'' (African rice). The name wild rice is usually used for species of the genera '' Zizania'' and '' Porteresia'', both wild and domesticat ...

: rest, ice, compression, elevation. However, severe sprains involve complete tears, ruptures, or fractures, often leading to joint instability, severe pain, and decreased functional ability. These sprains require surgical fixation, prolonged immobilization, and

physical therapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, pat ...

Signs and symptoms

Pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

* Swelling *

Bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close ...

hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is ...

caused by broken blood vessels within the injured ligament *Joint instability *Difficulty with bearing weight * Decreased functional ability or range of motion of the injured joint *Ligament rupture may cause a cracking or popping sound at the time of injury Knowing the signs and symptoms of a sprain can be helpful in differentiating the injury from a strain or

fracture Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displ ...

. Strains typically present with pain, cramping, muscle spasm, and muscle

weakness Weakness is a symptom of a number of different conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, i ...

, and fractures typically present with bone tenderness, especially when bearing weight.

Causes

Acute sprains typically occur when the joint is abruptly forced beyond its functional range of motion, often in the setting of trauma or sports injuries. Chronic sprains are caused by repetitive movements leading to overuse.

Mechanism

Ligament A ligament is the fibrous connective tissue that connects bones to other bones. It is also known as ''articular ligament'', ''articular larua'', ''fibrous ligament'', or ''true ligament''. Other ligaments in the body include the: * Peritoneal l ...

s are

fibers that connect

s together, providing passive stabilization to a joint. These fibers can be found in various organizational patterns (parallel, oblique, spiral, etc.) depending on the function of the joint involved. Ligaments can be extra-capsular (located outside the joint capsule), capsular (continuation of the joint capsule), or intra-articular (located within a joint capsule). The location has important implications for healing as blood flow to intra-articular ligaments is diminished compared to extra-capsular or capsular ligaments. Collagen fibers have about a 4% elastic zone where fibers stretch out with increased load on the joint. However, exceeding this elastic limit causes a rupture of fibers, leading to a sprain. It is important to recognize that ligaments adapt to training by increasing the cross-sectional area of fibers. When a ligament is immobilized, the ligament has been shown to rapidly weaken. Normal daily activity is important for maintaining about 80–90% of the mechanical properties of a ligament.

Risk factors

Fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...

and overuse * High-intensity

contact sport Contact sports are sports that emphasize or require physical contact between players. Some sports, such as mixed martial arts, are scored on impacting an opponent, while others, including rugby football, gridiron football and Australian rules f ...

s * Environmental factors * Poor

conditioning Conditioning may refer to: Science, computing, and technology * Air conditioning, the removal of heat from indoor air for thermal comfort ** Automobile air conditioning, air conditioning in a vehicle ** Ice storage air conditioning, air conditio ...

or equipment *Age and

genetic predisposition A genetic predisposition is a genetic characteristic which influences the possible phenotypic development of an individual organism within a species or population under the influence of environmental conditions. In medicine, genetic susceptibili ...

to ligament injuries * Lack of stretching or " warming up", which when performed properly increases blood flow and joint flexibility Sprained wrist 8 days later (2)

Diagnosis

Sprains can often be diagnosed clinically based on the patient's signs and symptoms, mechanism of injury, and

physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the pati ...

. However,

x-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

s can be obtained to help identify fractures, especially in cases of tenderness or bone pain at the injured site. In some instances, particularly if the healing process is prolonged or a more serious injury is suspected,

magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio wave ...

(MRI) is performed to look at the surrounding soft tissue and

ligament A ligament is the fibrous connective tissue that connects bones to other bones. It is also known as ''articular ligament'', ''articular larua'', ''fibrous ligament'', or ''true ligament''. Other ligaments in the body include the: * Peritoneal l ...

Classification

#First degree sprain (mild) – There is minor stretching and structural damage to the ligament, leading to mild swelling and bruising. Patients typically present without joint instability or decreased range of motion of the joint. #Second degree sprain (moderate) – There is a partial tear of the affected ligament. Patients typically experience moderate swelling, tenderness, and some instability of the joint. There may be some difficulty bearing weight on the affected joint. #Third degree sprain (severe) – There is a complete rupture or tear of the ligament, sometimes avulsing a piece of bone. Patients typically experience severe joint instability, pain, bruising, swelling, and inability to apply weight to the joint. Sprain SAG

Joints involved

Although any joint can experience a sprain, some of the more common injuries include the following: * Ankle - Sprains most commonly occur at the ankle and can take longer to heal than ankle bone fractures. Most sprained ankles usually occur in the lateral ligaments on the outside of the ankle. Common causes include walking on uneven surfaces or during contact sports. See sprained ankle or high ankle sprain for more details. **Inversion Ankle Sprain - injury that occurs when ankle rolls inward **Eversion Ankle Sprain - injury that occurs when ankle rolls outward * Toes ** Turf toe (metatarsophalangeal joint sprain) - forced hyperextension of the big toe upwards, especially during sports (initiating a sprint on a hard surface) *

Knee In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the ...

- Sprains commonly occur at the knee, especially following intense pivoting on a planted leg during

s (

American football American football (referred to simply as football in the United States and Canada), also known as gridiron, is a team sport played by two teams of eleven players on a rectangular field with goalposts at each end. The offense, the team wi ...

football Football is a family of team sports that involve, to varying degrees, kicking a ball to score a goal. Unqualified, the word ''football'' normally means the form of football that is the most popular where the word is used. Sports commonly ...

basketball Basketball is a team sport in which two teams, most commonly of five players each, opposing one another on a rectangular Basketball court, court, compete with the primary objective of #Shooting, shooting a basketball (ball), basketball (appr ...

pole vaulting Pole vaulting, also known as pole jumping, is a track and field event in which an athlete uses a long and flexible pole, usually made from fiberglass or carbon fiber, as an aid to jump over a bar. Pole jumping competitions were known to the My ...

softball Softball is a game similar to baseball played with a larger ball on a smaller field. Softball is played competitively at club levels, the college level, and the professional level. The game was first created in 1887 in Chicago by George Hanc ...

baseball Baseball is a bat-and-ball sport played between two teams of nine players each, taking turns batting and fielding. The game occurs over the course of several plays, with each play generally beginning when a player on the fielding t ...

and some styles of

martial arts Martial arts are codified systems and traditions of combat practiced for a number of reasons such as self-defense; military and law enforcement applications; competition; physical, mental, and spiritual development; entertainment; and the preser ...

). ** Anterior cruciate ligament (ACL) injury ** Posterior cruciate ligament (PCL) injury **Medial collateral ligament (MCL) injury **Lateral collateral ligament (LCL) injury **Superior Tibiofibular Joint Sprain - typically caused by a twisting injury to the joint connecting the

tibia The tibia (; ), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia); it conn ...

(shinbone) and

fibula The fibula or calf bone is a leg bone on the lateral side of the tibia, to which it is connected above and below. It is the smaller of the two bones and, in proportion to its length, the most slender of all the long bones. Its upper extremity ...

Patellar dislocation A patellar dislocation is a knee injury in which the patella (kneecap) slips out of its normal position. Often the knee is partly bent, painful and swollen. The patella is also often felt and seen out of place. Complications may include a patel ...

Finger A finger is a limb of the body and a type of digit, an organ of manipulation and sensation found in the hands of most of the Tetrapods, so also with humans and other primates. Most land vertebrates have five fingers ( Pentadactyly). Chamber ...

s and

wrist In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; "The wrist contains eight bones, roughly aligned in two rows, known as the carp ...

s - Wrist sprains commonly occur, especially during a fall on an outstretched hand. **

Gamekeeper's thumb Gamekeeper's thumb (also known as skier's thumb or UCL tear) is a type of injury to the ulnar collateral ligament (UCL) of the thumb. The UCL may be merely stretched, or it may be torn from its insertion site into the proximal phalanx of the thumb ...

( Skier's thumb) - forceful grabbing that leads to an injury to the ulnar collateral ligament (UCL) at the metacarpophalangeal (MCP) joint of the thumb, historically found in Scottish gamekeepers *

Spine Spine or spinal may refer to: Science Biology * Vertebral column, also known as the backbone * Dendritic spine, a small membranous protrusion from a neuron's dendrite * Thorns, spines, and prickles, needle-like structures in plants * Spine (zoolo ...

**Neck sprain at the

cervical vertebrae In tetrapods, cervical vertebrae (singular: vertebra) are the vertebrae of the neck, immediately below the skull. Truncal vertebrae (divided into thoracic and lumbar vertebrae in mammals) lie caudal (toward the tail) of cervical vertebrae. In ...

** Whiplash (Traumatic Cervical Spine Syndrome) - forced hyperextension and flexion of the neck, classically found in rear-end auto accidents ** Back sprain - Back sprains are one of the most common medical complaints, often caused by poor lifting mechanics and weak core muscles.

Treatment

Treatment of sprains usually involves incorporating conservative measures to reduce the signs and symptoms of sprains, surgery to repair severe tears or ruptures, and rehabilitation to restore function to the injured joint. Although most sprains can be managed without surgery, severe injuries may require tendon

grafting Grafting or graftage is a horticultural technique whereby tissues of plants are joined so as to continue their growth together. The upper part of the combined plant is called the scion () while the lower part is called the rootstock. The succ ...

or ligament repair based on the individual's circumstances. The amount of rehabilitation and time needed for recovery will depend on the severity of the sprain.

Treating Sprains

Depending on the mechanism of injury, joint involvement, and severity, most sprains can be treated using conservative measures following the acronym

within the first 24 hours of sustaining an injury. However, it is important to recognize that treatments should be individualized depending on the patient's particular injury and symptoms. Over-the-counter medications such as

non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...

(NSAIDs) can help relieve pain, and

topical A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...

NSAIDs can be as effective as medications taken by mouth. * Protect: The injured site should be protected and immobilized, as there is an increased risk of recurrent injury to the affected ligaments. * Rest: The joint affected should be immobilized and bearing weight should be minimized. For example,

walking Walking (also known as ambulation) is one of the main gaits of terrestrial locomotion among legged animals. Walking is typically slower than running and other gaits. Walking is defined by an ' inverted pendulum' gait in which the body vaults ...

should be limited in cases of sprained ankles. * Ice: Ice should be applied immediately to the sprain to reduce swelling and pain. Ice can be applied 3–4 times a day for 10–15 minutes at a time or until the swelling subsides and can be combined with a wrapping for support. Ice can also be used to numb pain but should only be applied for a short period of time (less than twenty minutes) for this purpose. Prolonged ice exposure can reduce blood flow to the injured area and slow the healing process. * Compression: Dressings, bandages, or wraps should be used to immobilize the sprain and provide support. When wrapping the injury, more pressure should be applied to the

distal Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

end of the injury and decrease in the direction of the heart. This helps circulate the blood from the extremities to the heart. Careful management of swelling through

cold compression therapy Cold compression therapy, also known as hilotherapy, combines two of the principles of rest, ice, compression, elevation to reduce pain and swelling from a sports or activity injury to soft tissues and is recommended by orthopedic surgeons follow ...

is critical to the healing process by preventing further pooling of fluid in the sprained area. However, compression should not impede circulation of the limb. * Elevation: Keeping the sprained joint elevated (in relation to the rest of the body) can minimize swelling. Other non-operative therapies including the continuous passive motion machine (moves joint without patient exertion) and cryocuff (type of cold compress that is activated similarly to a blood pressure cuff) have been effective in reducing swelling and improving range of motion. Recent studies have shown that traction is just as effective as the RICE technique in treating ankle sprains in pediatric patients.

Functional rehabilitation

The components of an effective rehabilitation program for all sprain injuries include increasing the range of motion of the affected joint and progressive muscle strengthening exercises. After implementing conservative measures to reduce swelling and pain, mobilizing the limb within 48–72 hours following injury has been shown to promote healing by stimulating growth factors in musculoskeletal tissues linked to cellular division and matrix remodeling. Prolonged immobilization can delay the healing of a sprain, as it usually leads to

muscle atrophy Muscle atrophy is the loss of skeletal muscle mass. It can be caused by immobility, aging, malnutrition, medications, or a wide range of injuries or diseases that impact the musculoskeletal or nervous system. Muscle atrophy leads to muscle weakness ...

and weakness. Although prolonged immobilization can have a negative effect on recovery, a study in 1996 suggest that the use of bracing can improve healing by alleviating pain and stabilizing the injury to prevent further damage to the ligament or re-injury. When using a brace, it is necessary to ensure adequate blood flow to the extremity. Ultimately, the goal of functional rehabilitation is to return the patient to full daily activities while minimizing the risk of re-injury.

References

External links

Questions and Answers about Sprains and Strains
nbsp;- US National Institute of Arthritis and Musculoskeletal and Skin Diseases {{Authority control Disorders of fascia Dislocations, sprains and strains Hazards of outdoor recreation