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A sprain is abnormal stretching or tearing of a ligament that supports a joint. A strain is abnormal stretching or tearing of a muscle or tendon. Sprains and strains may be caused by repetitive activities or by a single event. The diagnosis of a sprain or strain usually can be made after the healthcare professional takes a history of the injury and performs a physical examination. Depending upon the situation, X-rays, CAT scan, or MRI scan may be needed to help make or confirm the diagnosis. RICE (rest, ice, compression, and elevation) are the keys to treatment. Most sprains and strains resolve with time, but occasionally other treatment, including physical therapy and surgery, may be required. Anti-inflammatory medications may be helpful in decreasing the pain and inflammation of the injury.
Grade 1 strains usually cause stretching of a few of the muscle fibers. Grade 2 injury is more significant damage and some muscle fibers are damaged and torn. Grade 3 injury is a complete rupture of the muscle.
Grade 1 sprains describe fibers of the ligament that are stretched. Grade 2 sprains are injuries where part of the ligament is torn. Grade 3 sprains are when the ligament is completely torn or ruptured.
Muscles strains may involve any body area that is required to perform work. Lower back pain and spasm is a common result of repetitive lifting injuries, but it only takes one twist or turn at the wrong time or in the wrong position to cause muscle fibers in the back to tear and go into spasm. Low back strain is the most common work-related injury. Muscles of the legs can be damaged from overuse or imbalance. For example, the quadriceps muscle in the front of the thigh extends the knee and is balanced by the hamstring muscles of the back of the thigh, which flex the knee. Excess bending or straightening can cause the muscle fibers to tear. Muscles that move and stabilize the hip are prone to injury. Groin injuries or groin pulls are strains of the hip muscles that normally the thigh inward (medically termed adduction). When the leg is pulled away from the body like doing the splits, the adductors are stretched and potentially damaged. We use our arms and hands for a variety of activities and the arm muscles (biceps and triceps muscles) and the forearm can be strained because of lifting, pushing, pulling grabbing, twisting, and any other activity that you can imagine the arm and hand trying to accomplish. Chest wall muscles can be pulled because of activities as aggressive as lifting or as seemingly harmless as sneezing or coughing. Strains of the large muscles on the outside of the chest (pectoralis muscles) or the muscles between the ribs (intercostal muscles) can cause significant pain and can mimic the pain of a broken rib. The core muscles of the torso of the body, including the abdominal wall muscles and those of the back, lend stability to the trunk and are often the source of power for the arms and legs to lift and push. These muscles can be strained from many different activities that require the torso to bend, stretch, or twist.
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.
quadriceps (front of the thigh) muscle or its tendon, either the quadriceps or patellar, that allows the knee to extend or straighten tendon; hamstring muscle located in the back of the thigh and flexes the knee; Achilles tendon which attached the calf muscle to the calcaneus (heel) and allows the ankle to flex; biceps muscle or tendon, which flexes the elbow.
Surgery is a consideration for certain sprains. The decision to offer surgical operations to repair muscle, tendons, or ligaments depends upon the patient's underlying function before the injury and their expectations for activity after recovery. Not all ligaments need repair, even if completely torn. For example, a professional athlete may continue to perform at a high level even with a torn posterior cruciate ligament in the knee but cannot with a torn anterior cruciate ligament. Anti-inflammatory medications like ibuprofen (Advil) and naproxen (Aleve) are often suggested to help decrease inflammation and relieve pain. Before taking any over-the-counter medication, it is important to appreciate that side effects and medication interactions exist and it is wise to ask your health care professional or pharmacist for advice and direction. For more significant pain, prescription pain medications may be prescribed for a short period of time.
Are there work or activity restrictions or limitations that need to be observed? When can I expect to be able to return to normal daily activities? When can I expect to be fully recovered? Do I need to be re-evaluated, and if so, when?
While it may take weeks for a sprain or strain to be completely healed, the time to return to activity may be much shorter. Many minor muscle strains resolve themselves in a few days. While the injured person can return to full activity relatively quickly, the muscle may not be completely healed and is less able to withstand excessive stress and may still be more prone to future injury. Similarly, sprained joints may be functional in a couple of weeks but might take months to heal completely and return to full strength and stability. Special situations Some muscle strains take longer to heal than others due to their location and function. Chest wall muscle strains The muscles that help us to breathe operate much like a bellows. The chest wall expands to suck air into the lungs. When injuries occur to the muscles of the chest wall, healing may be measured in weeks because the muscles are unable to rest since they are involved in taking in a breath. When there is a chest wall injury, the pectoralis muscles that cover the front part of the chest and help the arms with lifting, the intercostal muscles that are located between the ribs and the upper back muscles can all go into spasm. Regardless of whether there is a broken or bruised rib or a strained muscle, attempts to take a deep breath are met with pain as the muscle is stretched. While an injured arm can be rested in a sling or crutches can be used to rest an injured leg, it is difficult to stop breathing. It means that 12-14 times a minute, the injured muscle is required to work and stretch. Each breath is painful and delays healing. Chest wall muscles strains may take weeks to heal. Neck strains Numerous muscles are required to keep the head optimally stable on the shoulders and to allow it to swivel in many directions. Injuries are common to the trapezius and sternomastoid muscles, large
muscles that do the major the work of neck turning. Smaller muscles that attach to the bony prominences of the neck can also be strained. Depending upon the injury, significant pain and spasm can occur that is long-lasting. Whiplash is a nonmedical term that describes strains and sprains of the neck that occur from violent flexion-extension injuries. Many structures can be the source of pain, and treatment results depend upon which structure, from muscle to tendon to ligament to nerve, is involved.
REFERENCE: McPhee, S.J., M. Papdakis, and M.W. Rabow. Current Medical Diagnosis and Treatment, 50th ed. New York: McGraw Hill Medical, 2011. REVIEW: William C. Shiel Jr., MD, FACP, FACR on 8/24/2012 SOURCE: http://www.onhealth.com