(sprān )

[O.Fr. espraindre, to wring]
Trauma to ligaments that causes pain and disability, depending on the degree of injury to the ligaments. In the most severe sprain, ligaments are completely torn. The ankle joint is the most often sprained. SEE TABLE: Grading System for SprainsSEE: fracture; SEE: strain

SYMPTOMS
Pain may be accompanied by heat, discoloration, and localized swelling in the affected area. Moderate to severe sprains are marked by joint laxity, reduced range of motion, and limitation of function. When the sprained ligament is contiguous with the joint capsule (e.g., anterior talofibular ligament, medial collateral ligament), swelling occurs in the acute stage. When the sprain involves other intracapsular or extracapsular ligaments (e.g., calcaneofibular ligament, anterior cruciate ligament), swelling is slight or absent in the acute stage and progressively increases.

DIAGNOSIS
Diagnostic imaging of the joint is often indicated to rule out an avulsion fracture of the ligament's attachment, or other associated fracture

TREATMENT
The affected part should be treated initially with ice or other cooling agents to limit inflammation and hypoxic injury. Circumferential compression, in the form of an elastic wrap, should be applied to the joint and the limb elevated to reduce swelling. Joint range of motion should be restricted to patient tolerance through the use of immobilization devices, crutches, or both. Analgesics and nonsteroidal anti-inflammatory medications may be administered for pain and swelling. In the chronic stage of the injury, massage, intermittent compression, and muscle contractions can be used to reduce swelling.

Grading System for Sprains

Grade IStretching of the ligament without tearing
Grade IIStretching of the ligament with incomplete tearing
Grade IIIComplete tearing of the ligament (also called a rupture)


CERVICAL SPRAIN This 22-year-old female sustained a hyperflexion-hyperextension sprain to her cervical spine while driving in a demolition derby contest. (A) Plain film, lateral view shows a loss of cervical lordosis and hyperkyphotic angulation at C5-6 (5th and 6th cervical vertebrae).

acromioclavicular sprain

A sprain to the acromioclavicular and coracoclavicular ligaments, commonly caused by a fall on an outstretched arm or a blow directly to the shoulder.
SYN: SEE: acromioclavicular separation; SEE: shoulder separation

sprain of ankle

Trauma to the ligaments of the ankle and foot, possibly involving tendon injury, but without an avulsion. Sprains of the lateral ligaments (most commonly the anterior talofibular ligament) account for approx. 90% of all ankle sprains.

Nursing Diagnoses Appendix



TREATMENT

SEE: sprain for treatment.

Ice should not be applied directly to the foot and ankle in patients who are elderly or who have cold allergy or circulatory insufficiency.

sprain of back

Overstretching of the spinal ligaments, often involving the surrounding muscles and spinal structures. Small fractures of the vertebrae are often associated.

TREATMENT
Treatment includes superficial moist heat and rest. If muscle spasm is present, muscle relaxants, nonsteroidal anti-inflammatory drugs, or both, may be prescribed. After the acute symptoms have subsided, strengthening and flexibility programs are prescribed.

If back pain develops after acute trauma, or if the patient has a history of cancer, the patient should not be moved until the possibility of a fracture has been ruled out. Persons with a history of back pain and fever or back pain and injection drug use should be evaluated for spinal epidural abscess.

sprain of foot

Trauma to the ligaments of the foot not involving the ankle.

high ankle sprain

SEE: Syndesmotic ankle sprain.

syndesmotic ankle sprain

Damage to the ligamentous structures of the distal tibiofibular syndesmotic joint, resulting from dorsiflexion or external rotation of the talus within the ankle mortise, or both, which in turn causes spreading of the joint. The distal tibiofibular syndesmosis is formed by the anterior tibiofibular ligament, the interosseous membrane, and the posterior tibiofibular ligament.
SYN: SEE: high ankle sprain

ETIOLOGY
The rate of syndesmotic ankle sprains may be increased when athletes are participating on artificial surfaces, because of the increased friction between the shoe and playing surface.

SYMPTOMS
Patients may describe pain along the fibula, just superior to the lateral malleolus, that worsens during dorsiflexion or external rotation of the talus, or both.