Sprain & Strains

Question 1

What does a sprain involve?

Answer 1

Joints
*stretching or tearing of ligaments

Question 2

What does a sprain NOT involve?

Answer 2

Tendons

Question 3

When is a sprain less common?

Answer 3

1. In younger patients
   *they will most likely have a growth plate injury, bc the growth plates are open
   *bc the growth plate is weaker than ligaments

Question 4

What causes a sprain?

Answer 4

1. Sudden trauma
   *fall, twist

Question 5

When does pain, swelling occur during a sprain?

Answer 5

1. Usually immediate
   *will have a difficult time using joint
   *bruising occurs over 1-3 days

Question 6

How can you determine the “grade” for a sprain/strain?

Answer 6

1. Place the area/structure under stress
   EX: MCL is damaged
2. Stabilize the femur
3. Move tibia laterally
   *this puts stress under the affected area

Question 7

What is grade I (1st degree)

Answer 7

1. Partial tear without instability
   *no opening of joint under stress

Question 8

How to treat a Grade I sprain?

Answer 8

Treat the symptoms

Question 9

What is a grade II (2nd degree) sprain?

Answer 9

1. Partial tear, some instability
   *partial opening of joint under stress
   *MUST compare bilaterally (there should be a difference, between the two structures)

Question 10

What is the treatment for Grade II sprain?

Answer 10

Immobilization

Question 11

What is a grade III sprain?

Answer 11

1. Complete tear
   *there will be a complete opening joint when stress is placed upon it

Question 12

How to treat a Grade III sprain?

Answer 12

1. Immobilization or surgery

Question 13

What does a strain involve?

Answer 13

1. Muscle/ tendons
   *stretching/partial tearing of a muscle or tendon
   *can also be called a rupture if a complete tear

Question 14

What does a strain NOT involve?

Answer 14

Ligaments

Question 15

In which population are strains more common?

Answer 15

1. Middle aged and elderly
   *BC there is less collagen in the tendons/muscles
   *tissue gets brittle and less elastic

Question 16

How does a strain occur?

Answer 16

1. When the muscle is in the contracting phase and there is a sudden stretch placed upon it

Question 17

What radiologic film needs to be done for a sprain/strain?

Answer 17

X-rays
*to rule out a fracture

Question 18

What are the Ottawa guideline for determining a radiograph?

Answer 18

Ankle
1. Pain near (M/L) malleoli
2. Unable to bear weight (4 steps)
3. Bony tenderness at posterior edge or tip of malleoli
Foot
1. Midfoot pain
2. Inability to bear weight (4 steps)
3. Bony tenderness at navicular or base of fifth metatarsal

Question 19

What are some adverse outcomes of a Sprain/Strain?

Answer 19

1. CRPS
2. Compartment syndrome (uncommon)
   *happens around forearm, legs, due to the fascia being too tight, swelling will happen and damage surrounding muscles and nerves
3. Increased risk of recurrence

Question 20

What is the treatment for a sprain/strain?

Answer 20

1. RICE
2. Heat after acute phase
   *Acute phase ice for 20 mins every hour (helps decrease swelling)
   *Heat will help increase blood supply which makes the joint more mobile and promotes healing
3. NSAIDS
4. Immobilization (2/3)
5. Surgery (3)

Question 21

What test may need to be ordered if the X-rays came back inconclusive

Answer 21

MRI
*will be able to tell grade of sprain
*muscle rupture
*asses for healing

Question 22

What is tendinitis

Answer 22

1. Inflammation, irritation, swelling of a tendon

Question 23

What are the symptoms of tendinitis

Answer 23

Pain and tenderness along a tendon
Pain at night
Pain that is worse with use/activity

Question 24

What will be found on the PE

Answer 24

1. There are many special tests for tendons
2. Redness of skin
3. Tenderness over the tendon
4. Decreased muscle strength of applicable muscle

Question 25

What will be on the diagnostic tests for tendonitis

Answer 25

XRays *normal or calcification MRI *can confirm inflammatory or degenerative changes

Question 26

What is the treatment for tendinitis

Answer 26

1. Home exercises program 2. Lifestyle modifications 3. NSAIDS 4. PT 5. Corticosteroid injection *not directly into the tendon *only after failing conservative treatment

Question 27

What is the surgical option for tendinitis

Answer 27

Debridement *remove the outer part of the tendon

Question 28

What is tenosynovitis

Answer 28

Inflammation of the lining of the sheath that surrounds a tendon

Question 29

What are the symptoms of tenosynovitis

Answer 29

1. Difficulty moving a joint 2. Joint swelling 3. Pain and tenderness around a joint 4. Pain when moving a joint 5. Fever, swelling and redness may indicate and infection

Question 30

If there is an infected cut to the hand that causes tenosynovitis what should happen next

Answer 30

Surgery *it is an emergency situation

Question 31

What is tendinosis

Answer 31

Tendon degeneration (not reversible) 1. Damage to a tendon at the cellular levels 2. Chronic tendinitis 3. Avascular degenerative process *failed tendon healing

Question 32

Tendinosis will have a higher likelihood of what

Answer 32

Needing surgery *more likely to have chronic pain

Question 33

What is tendinopathy

Answer 33

1. Used to describe both the tendonitis and tendinosis