Details of a Sprain Flashcards
What is a sprain of a Joint?
It is a over stretched ligament.
What is a Ligament?
It is a flexible connective tissue that is non-contractile.
It surrounds a joint and blends into the periosteum.
Holds bones together and limits ROM.
What can cause a Sprain?
Trauma - like wrenching or twisting the joint beyond the normal ROM.
What are factors that can making Spraining your joints easier?
Weakened muscles, Hyper-mobility of the joints and Altered biomechanics.
Also having a sprain previously can make it easier.
What are the Classifications of Sprains?
There is grades 1-2-3
What does Grade 1 Sprain mean?
Mild primary, minor stretch or tear, No stability on PR (passive relaxed)
What does Grade 2 Sprain mean?
Moderate secondary, Moderate stretch or tears of the fibres.
Snapping noise/ Joint gives way.
Hypermobile but stable on PR.
Decreased ALD (Active daily life).
What does Grade 3 Sprain mean?
Sever, Complete Tear, Snapping noise and gives way, Instability with no end point on PR.
No ADL due to the pain and instability.
How long can it take for the full stability to return to the joint after a Sprain?
ligaments have little blood supply so this can take up to 6 months.
What are common sites for sprains?
Ankle, Wrist, knee, elbow and Shoulder.
What are symptoms of an Acute grade 1 Sprain?
Mild Prish, Joint is Stable, Slight to no Bruising.
What are symptoms of an Acute Grade 2 Sprain?
Tearing of Fibres, Joint gives way/ Snapping, Moderate Prish (Worsened with activities that stress the ligaments), Hypermobile but stable, Bruising.
What are the symptoms of a Acute Grade 3 Sprain?
Complete Rupture of the Ligament, Snapping/Joint gives way, Sever Prish, Instability and client has to stop ADL.
What is true for all grade 2-3 Sprains?
Protective muscle spasming, Decreased ROM (AF), Possible vascular or nerve complications with Grade 2-3.
What usually gets torn at the ankle when you get a sprain?
1st Anterior Tibiofibular Ligament and Second Calcaneo Fibular ligament.
(These both only occur during Inversion)
What are symptoms of Sub acute Sprains?
o Bruising
o PRISH decreasing Grade 1: Stable
Grade 2: Stable but hypermobile Grade 3: Unstable and hypermobile
o Adhesions (in grade 2 and 3 especially)
o Trigger points and hypertension
o Decreased AF ROM
o Splints/casts/taping
o Loss of proprioception
What are symptoms of a Chronic Sprain?
o Local pain if stretched
o Bruising minimal or gone
o Adhesions, scar tissue, trigger points and hypertension
o Decreased AF ROM
o Possible chronic edema
o Coolness due to ischemia
o Loss of proprioception
o If surgery, up to 10 weeks after the joint may be immobilized
o Unstable (grade 3)
o Weakness/atrophy
o Taping/splints/crutches
What usually gets torn at the Elbow when you get a sprain?
These occur with a fracture.
What usually gets torn at the Shoulder when you get a sprain?
Acromial Clavicular ligament (occurs with Separation).
A/C joint Ligament.
What usually gets torn at the Shoulder when you get a sprain?
Acromial Clavicular ligament (occurs with Separation).
A/C joint Ligament.
During an Assessment What can you observe in an Acute Sprain?
Redness
● Swelling
● Bruising
● Antalgic gait/posture
● Facial expression of pain
● Taping/splints SUBACUTE
● Bruise-yellow/green/brown
● Antalgic gait
● Supports
● Residual edema
● Scars is surgery CHRONIC
● Habituated gait/posture
● Taping/splints/crutches
● Residual edema
● Minimal bruising
● Scars
During an Assessment What can you observe in an Acute Sprain?
Redness
● Swelling
● Bruising
● Antalgic gait/posture
● Facial expression of pain
● Taping/splints SUBACUTE
● Bruise-yellow/green/brown
● Antalgic gait
● Supports
● Residual edema
● Scars is surgery CHRONIC
● Habituated gait/posture
● Taping/splints/crutches
● Residual edema
● Minimal bruising
● Scars
When Palpating an Acute Sprain what can you feel?
Heat
● Swelling (firm)
● Protective muscle spasming
● Pain on palpation
When Palpating a Sub acute sprain what can you find?
Warmth
● Pain on palpation
● Boggy swelling
● Adhesions/trigger points CHRONIC
● Coolness
● Pain on palpation
● Residual edema
● Adhesions/ trigger points/hypertension
● Disuse atrophy
When doing test on a client with An Acute Sprain what must you do?
You must work proximally to the injury.
The affected joint will have decreased ROM.
(the higher the grade of the Sprain the lower the ROM of the joint)
How would you perform a special test on a client with an acute sprain?
They are all CI’d besides (Joint effusion of the knee).
What is testing a client’s ROM like in the Sub acute stage?
● Proximally/affected/distally
● AF is decreased by pain but less than in the acute stage
PR
● Proximally/affected/distally
● ROM that stresses joint is tested last. May see empty end feel
AR
● If strictly ligamentous-no pain
● If muscle injury as well-pain and weakness
What are Special test you could do on the Knee after a sprain?
● Valgus/varus stress
● Apley’s distraction
● Ballottable patella
● Brush test
● Anterior and poster drawer test
● Lachman’s
● McMurray’s
● Bragards Sign
● Apley’s compression
What are some test you could on the A/C joint after a Sprain?
A/C Shear test.
What are some test you could do on the SI joint after a sprain?
SI joint gapping
● SI joint squish test
● Galenslen’s
What are some test you could do on the wrist after a Sprain?
Radial stress/ulnar stress
● PR wrist extension/flexion
What does treatment to a client with an Acute sprain involve?
Rice
● MLD
● Comp. structure – GSM
● Mid range PR ROM proximally (not it muscle crosses affected joint)
What are CI’s for treating a client with an Acute Sprain?
Testing other than AF
● Removal of muscle spasm
● Distal work past injury site
● Heat SUBACUTE and CHRONIC
● Heat if casted
● Overstretching hypermobile or repaired lig
● Joint play if unstable
● Frictions if on anti-inflammatories
***Screws/pins/plates: no hydro or deep work/frictioning
What would treatment to a client with A sub acute sprain involve?
Contrast hydro
● Cool if edema
● Comp. structures – GSM
● GTO’s , O and I’s
● Onsite – start with vibrations/shaving/gentle petrissage 🡪 increases as client can
tolerate pain/pleasure
● Mid range PR ROM
● Distally muscle squeezing and stroking 🡪 increase pressure and techniques
● Gentle frictioning 🡪 use joint play to stretch ligament
● Strengthening
What would treatment to a client with a chronic Sprain involve?
DMH (deep moist heat)
● Deep techniques
● Frictioning (careful surgeries and pins)
● Tx Compensatory structures
● TP’s
● JT play
● PR ROM
● Strengthening
What is homecare you can give a client that has an Acute sprain?
RICE
What is some homecare you can give to a client with A Sub acute Sprain?
Contrast hydro
● Strengthening CHRONIC
● DMH
● Strengthening
