Sprained Ankle (cont.)

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What are sprain symptoms and signs?

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The first symptom of a sprain or strain injury is usually pain, though there may be a delay in onset of the symptom and the person who is injured may not recall the specific event that caused the injury. For example, a person who paints a room may develop shoulder pain the day after the repetitive effort of brushing overhead. This is because inflammation, swelling, and spasm can take time (from minutes to hours) to develop.

Pain is always a symptom that indicates that there is something wrong with the body. It is the message to the brain that warns that a muscle or joint should be protected from further harm. In work, exercise, or sport, the pain may come on after a specific incident, or it may gradually progress after many repetitions of a motion.

Swelling almost always occurs with injury, but it may take from minutes to hours to be noticed. Anytime fibers of a ligament, muscle, or tendon are damaged, some bleeding occurs. The bleeding (such as bruising on the surface of the skin) may take time to be noticed.

Because of pain and swelling, the body starts to favor the injured part. This may cause the muscles that surround the injured area to go into spasm. Hard knots of muscle might be felt near the site of the injury.

The combination of pain, swelling, and spasm causes the body to further protect the injured part, which results in difficulty with use. Limping is an example of the body trying to protect an injured leg.

How are sprains and strains diagnosed?

The diagnosis of a muscle strain or joint sprain is usually made by history and physical examination. The health care professional may want to know the circumstances of the injury and whether the body sustained damage other than the sprain or strain that brings the patient to seek care. For example, if a person injured was involved in a significant fall or car accident, the strain or sprain may not be a priority in caring for the patient with a potential internal bleeding or head injury.

Physical examination may focus on the part of the body that is injured: the tender muscle or the swollen joint. It is important to know whether or not there are broken bones or other associated injuries with the sprain or strain and the health care professional may evaluate the pulses and sensation beyond the injury site to be certain that there is no associated nerve or artery damage.

X-ray tests may be used to detect broken bones. CT or MRI are not only able to evaluate bone but can also help evaluate muscles, tendons, ligaments, cartilage, and other structures. Usually, physical examination is adequate to make the diagnosis but if surgery is suggested, imaging might be considered to help plan the operation. Most often CT and MRI tests are performed electively and scheduled to be done at a future time.

Sometimes X-rays are not recommended. For example, patients with low back pain who have not had a significant fall, car accident, or injuries and there is little concern that a broken bone exists, do not particularly require X-rays since fracture is unlikely. The health care professional may wish to minimize the exposure to radiation by avoiding these. For ankle and knee sprains, guidelines exist to help decide when X-rays of those joints might be helpful in finding an accompanying fracture. Usually, though, physical examination is enough to make rule out any bony injury.


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