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 I, II, or III (AMA Ligament Injury Classification):
    • Grade I: Stretch injury without ligamentous laxity
    • Grade II: Partial tear with increased ligamentous laxity but firm endpoint on exam
    • Grade III: Complete tear with increased ligamentous laxity and no firm endpoint on exam
  • Physical exam is the key to diagnosis.
  • Usually secondary to trauma (e.g., falls, twisting injuries, motor vehicle accidents)
• Strains are partial or complete disruptions of the muscle, muscle-tendon junction, or tendon:
  • Classified as:
    • 1st degree: Minimal damage to muscle, tendon, or musculotendinous unit
    • 2nd degree: Partial tear to the muscle, tendon, or musculotendinous unit
    • 3rd degree: Complete disruption of the muscle, tendon, or musculotendinous unit
  • Often associated with overuse injuries

Geriatric Considerations
More likely to see associated bony injuries due to decreased joint flexibility and prevalence of osteoporosis and osteopenia

• Sprains and strains have been found to account for 24% of injuries in pediatric patients.
• 3 million pediatric sports injuries occur annually.
• Must be concerned about physial/apophyseal injuries in the skeletally immature

Epidemiology

Incidence
~80% of all US athletes at some time in their career will experience a sprain or strain that involves the upper or lower extremities or spine.

• Ankle sprains are among the most common injuries seen in the primary care setting and account for up to 30% of sports medicine clinic visits.
• Most ankle sprains are due to inversion injuries (lateral sprains).
• Predominant age:
  • Sprains: Any age when patient is physically active
  • Strains: Usually 15–40 years of age
• Predominant sex: Male > Female; Female > Male for sprain of acromioclavicular ligament

Risk Factors

• Prior history of sprain or strain is greatest risk factor for future sprain/strain.
• Change in or improper shoe gear, protective gear, or environment (e.g., surface)
• Inappropriate sudden increase in training schedule

General Prevention

• Use appropriate conditions and warm-up, and cool-down exercises.
• Use proper equipment for the activity.
• Balance training programs can improve joint position sense and reduce the risk of ankle sprains (1)[A].
• Semirigid orthoses or air casts may prevent ankle sprains during high-risk sports, especially in athletes with history of sprain (2,3)[A].

Etiology

• Trauma, falls, MVA
• Excessive exercise
• Improper footwear
• Inadequate warm-up and stretching before activity
• Poor conditioning
• Prior sprain or strain

Commonly Associated Conditions

• Effusions, hemarthrosis
• Stress, avulsion, or other fractures
• Syndesmotic injuries
• Contusions
• Wounds
• Dislocations/Subluxations