Sprain – extremely widespread trauma arising at the sharp movements exceeding the normal amplitude of movements in a joint (for example, at a leg podvorachivaniye). Actually, understand microruptures of separate fibers or a part of a sheaf as the term "stretching". The trauma especially often occurs at athletes. Usually sheaves in the field of averages suffer, is more rare – large joints of extremities. Damage is shown by pain, hypostases, bruises, violation of a support and movements. The diagnosis is exposed on the basis of symptoms, the given MRT and other researches. Treatment is more often conservative.
Sprain – one of the most widespread traumatic damages. Along with bruises is high on the list in the list of the main reasons for the appeal to emergency stations. Can arise at patients of any age and a floor, it is especially often observed at the athletes and people leading active lifestyle. Most often sprains of an ankle joint, a knee joint, a shoulder joint and a luchezapyastny joint come to light. Usually active treatment continues within 3-5 weeks, and the complete recovery requires 8-9 weeks.
In most cases sprain is the isolated trauma, however also combinations to damages of other structures are possible, is more often – located in the same anatomic area. For example, at intra articulate changes and dislocations stretchings and ruptures of sheaves in the affected joint are observed. Less often sprains are combined with injuries of other anatomic areas: changes of a basin, backbone and extremities, stupid injury of a stomach, ChMT, injury of a thorax etc. Traumatologists are engaged in treatment of sprain.
Sheaves – the elastic dense soyedinitelnotkanny tyazh connecting one bone to another. It is necessary to distinguish sinews which consist of connecting fabric too from sheaves, but connect among themselves not several bones, but a bone and a muscle. Sheaves strengthen a joint and "regulate" the movements. They provide both mobility of a joint, and its fixing, allowing to make the physiologic movements, but keeping from not physiologic. Depending on the basic functional purpose distinguish the sheaves strengthening joints; the sheaves directing to the movements; the sheaves which are slowing down the movements.
At stretching the sheaf experiences the strain exceeding it durability and elasticity. As a result a part of fibers is broken off. The injured sheaf partially or completely loses ability to perform the functions, the joint becomes unstable. In ligament tissue there are a lot of small vessels and nervous terminations therefore at stretching there are hemorrhages and severe pain. Within the first three days the accruing hypostasis is observed, at multiple ruptures of fibers the struck area takes a "elephant" form – joint contours completely smooth out, hypostasis extends to underlying departments (for example, to foot at injury of ligaments of ankle joint). Perhaps local temperature increase, cyanosis and hyperaemia.
In life sprain most often results from a spotykaniye, a podvorachivaniye of a leg or falling. For example, the reason of injury of ligaments of ankle joint can become podvorachivany legs when walking high-heeled or movement on a slippery surface (ice, the rolled snow or too smooth floor). And sprain of a luchezapyastny joint is formed when falling on a hand in the same circumstances.
At athletes of injury of ligaments have the specifics connected with sport. So, the injuries of an ankle joint caused by sharp internal rotation (rotation) of foot when braking often occur at skaters and skiers. At basketball players, volleyball players, throwers is a kernel and tennis players sprains of a shoulder joint as a result of sharp swing can come to light or it is bright. At the people who are going in for powerlifting and bodybuilding the injuries of ligaments of the top extremity caused by work with big freights by a press sometimes come to light lying or from shoulders.
The factors promoting injury of ligaments to life or at sports activities are the excess weight, inconvenient footwear, clothes or sports equipment, and also pathological changes of structures of a joint as a result of arthrosis, earlier postponed injuries and infectious diseases. The probability of a ligament injury increases also at the congenital or acquired anomalies breaking normal anatomic ratios and distribution of loading between separate segments of an extremity (for example, at flat-footedness).
In traumatology allocate three degrees of sprain:
- 1 degree – ruptures of separate fibers of a sheaf at preservation of its mechanical integrity and a continuity. Hypostasis is expressed slightly, hemorrhages are absent. The support and the movements are a little limited, pains moderate.
- 2 degree – there are multiple ruptures of fibers, perhaps partial damage of the capsule. Moderate hypostasis is noted, bruises often come to light. The movements are limited, painful, the support is complicated. Some instability of a joint can be defined.
- 3 degree – a complete separation. Is followed by sharp pain, considerable hypostasis and the expressed bruises. The movements are sharply limited, the support is, as a rule, impossible. In attempt of passive movements instability of a joint comes to light.
At injury of ligaments 1-2 degrees in absolute majority of cases are required conservative treatment. Independent healing occurs in several weeks. At complete separations, despite high regenerative abilities of sheaves, independent restoration happens not always, surgical intervention can be required. At the same time the probability of independent healing depends on localization of a sheaf, the accompanying traumatic damages, timeliness and adequacy of conservative therapy.
At the time of a trauma there is sharp pain. At a rupture of a considerable part of fibers characteristic cotton is sometimes heard. Then there is an accruing hypostasis, at severe injuries hematomas and hypodermic hemorrhages are formed. Pain which sharply amplifies in attempt to turn an extremity in that party in which it was turned at the time of damage disturbs. Extent of violation of a support and movements depends on weight of a trauma – from insignificant restriction at slight stretching to impossibility at heavy anguishes and complete separations.
At survey hypostasis comes to light. Insignificant stretching is followed by formation of a local swelling in a ligament. At injuries of moderate severity hypostasis extends to all joint. At heavy damages the expressed puffiness with distribution not only on a joint, but also on a disteel part of an extremity is observed, because of hypostasis the joint completely ceases to konturirovatsya. Hemorrhages and hematomas arise mainly at average and heavy damages.
The palpation of the injured area is sharply painful, local temperature increase of skin is defined. Krepitation is absent. At slight and average injuries the passive movements are limited because of pain, at heavy damages the excessive mobility having certain differences from pathological mobility owing to a change comes to light. At changes pathological mobility arises in the field of a break, that is where it normal should not be at all. At injury of ligaments the movements are made where have to (in a joint), however their amplitude is more, than normal.
The diagnosis is exposed on the basis of symptoms and, at an opportunity, data of MRT, ultrasonography of a joint or an arthroscopy. Sheaves – myagkotkanny educations, they are not visible on roentgenograms therefore the X-ray analysis can be used only for a change exception as fractures and stretchings are followed by very similar symptomatology and are sometimes combined with each other. Besides, during differential diagnostics with changes characteristic clinical signs are considered.
At stretchings, unlike changes, there is no pain when pressing on a bone (except for pressing in the injured ligament). At the time of a trauma cotton, but not a bone crunch is heard. At rest, as a rule, there is no expressed pain syndrome interrupting a sleep and rest of the patient. At a palpation the krepitation is not defined, and deformation is formed, generally at the expense of hypostasis, but not at the expense of the shift of otlomk.
Unlike changes at which damage of the copular device of a joint is observed only in some cases dislocation is always followed by a gap or sprain. Dislocations also exclude on the basis of a X-ray analysis and lack of typical clinical signs. At stretching, unlike dislocation, there is never a sharp and rough deformation of a joint, shortening of an extremity and the springing resistance in attempt of passive movements.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
At sprain 1 and 2 degrees out-patient treatment in emergency station is carried out. At damages 3 degrees usually are required hospitalization in traumatologic office. Recommend to patients rest, sublime position of an extremity. Within the first days to the injured area put cold (the hot-water bottle or a plastic bag with ice wrapped in a towel). Since third day, use dry heat. At slight stretchings for the period of walking impose elastic bandage or put on a support (a special orthopedic bandage). At rest the holding devices are removed not to interfere with blood circulation in the struck area. At severe injuries carry out an immobilization with use plaster or plastic steaks.
Especially in the first three days, thermal procedures are contraindicated to patients with sprain: warm compresses, hot bathtubs, sauna or bath. It is not necessary to accept alcohol or to carry out massage as it promotes increase of hypostasis and increase in bruises. At the initial stage it is not recommended to make the movements in the injured joint as it can provoke additional microruptures of fibers of a sheaf and slow down the speed of its restoration. Massage and physical exercises are shown only in the recovery period.
In the first days after a trauma for elimination of pain and reduction of an inflammation if necessary it is possible to use nonsteroid anti-inflammatory medicines (diclofenac, an ibuprofen, etc.). If intensive pains remain week or more, it is necessary to see a doctor that he recommended other, safer ways of anesthesia as long reception of NPVP can provoke developing of gastritis or formation of stomach ulcer. Along with NPVP it is possible to apply safer external means from the same group to intake.
At a stage of recovery of patients direct to LFK. Exercises at first include only the easy warm-up movements, then the complex gradually extends. At the same time the general principle is absence of pain when performing exercises. It is necessary to remember that too long absolute rest, as well as too early movements in a joint, can negatively affect duration of the recovery period therefore it is necessary to go in for physiotherapy exercises in strict accordance with recommendations of the doctor and instructor of LFK.
The forecast at sprain favorable. Damages of 1 degree, as a rule, begin to live without the residual phenomena. At stretching 2 and 3 degrees at some patients in the remote period are observed a pricking and chronic joint pains. It can be caused both by formation of small small knots, and involvement of the nervous terminations in process of scarring of fibers. It is necessary to remember that restoration of a sheaf happens due to formation of hems, and, so in the subsequent this sheaf will be less steady against damages. For prevention of repeated injuries during sports activities it is necessary to use special supports.