Advanced Pathophysiology

Sprains vs. Strains

Carlo A.J. Oller, MD: Hello. My name is Dr. Carlo Oller. I am an emergency physician. And in this video we're going to try to explain the difference between a sprain and a strain. Strains and sprains are among the most common injuries in sports. Here's some facts about sprains and strains. This is from the American Academy of Orthopedic Surgeons' website. The link is below.

Although these two words are often used interchangeably, they are actually different types of injuries. What is a sprain? A sprain is a stretch and/or a tear of a ligament, the fibrous band of connective tissue that joins the end of one bone to the other. Ligaments stabilize and support the body's joints. What are the signs of a sprain? While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains, mild, moderate, or severe. The individual will usually feel a tear or a pop in the joint. A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely, or separate from the bone. This loosening makes the joint non-functional. A moderate sprain partially tears the ligament, producing joint instability, and some swelling. A ligament is stretched in a mild sprain, but there is no joint loosening.

What is a strain, with a T? A strain is an injury of a muscle and/or tendon. Tendons are the fibrous cores of tissue that attach muscles to the bone. What are the signs of a strain? Typical indications include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. In severe strains, the muscle and/or tendon is partially or completely ruptured, often incapacitating the individual. So muscle function will be lost with a moderate strain, where the muscle/tendon is overstretched and slightly torn. With a mild strain, the muscle and tendon is stretched or pulled slightly.

Let's talk about the severity of sprains and strains. A grade one or mild sprain or strain involves some stretching or minor tearing of the ligament or muscle. Grade two is moderate, and this is partially torn, but still intact. And a grade three, which is a severe sprain or strain, means that the ligament or muscle is completely torn, resulting in joint instability.

What is the treatment? Well, it depends on the grade of the injury. Grade one injuries usually heal quickly, with rest, ice, compression, elevation, in short, acronym, RICE. Therapeutic exercise can also help restore strength and flexibility. Grade two injuries are treated similarly, but may require immobilization of the injured area to permit healing. Grade three sprains and strains usually require immobilization and possibly surgery, to restore function.

How will the ER physician tell the difference between a sprain or strain, or between the different grades of sprain and strain? Well, most of the times, we don't. We will do an x-ray to make sure that there is no fracture. If there isn't a fracture, and the patient can tolerate it, we will do a thorough examination of the involved joint. And if tolerated by the patient, we can stress the ligaments and tendons and find out if there's functional deficits, or instability. We will then be able to tell if there's complete or partial sprain or strains.

The joint will then be placed on a splint, and the patient referred to an orthopedic physician for delayed evaluation. Even then, physical exam alone will not be enough, and he or she will have to do ultrasounds and/or MRIs and further testing for a more definitive diagnosis.

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