Clinical setting, such as community pharmacies.
Strains and sprains From this module, you will learn: • The definition and diagnosis of sprains and strains • How to help patients manage an injury, including self-help and nonpharmacological approaches • The advice and support pharmacists can provide to their patients to help prevent future injury This is an updated and expanded version of module 1704 (published in June 2014)
KATHERINE GASCOIGNE The terms ‘sprain’ and ‘strain’ are often used interchangeably. They are common injuries that share similar symptoms – such as pain, swelling and a loss of movement. However, they are two distinct injuries: sprains affect ligaments (the short-band connective tissue between bones or cartilage), while strains affect muscle fibres.
Sprains often affect the ankle or knee joints, but can also be seen in the wrist and thumb. The ligaments around the ankle are the most commonly sprained, causing many visits to A&E departments. However, in most cases the injury is mild and can be managed in the primary care
Sprains A sprain is defined as an injury to a ligament as a result of abnormal or excessive forces applied to a joint, but without dislocation of the joint or fracture. The severity of a sprain is graded as follows: • Grade I (mild) – A slight stretching of the ligament complex, without joint instability. • Grade II (moderate) – Partial tearing of the ligament complex, causing mild tenderness and swelling around the ankle. There is not usually joint instability. • Grade III (severe) – Complete tear of the ligament complex, with instability of the joint. This will be accompanied by significant tenderness and swelling around the ankle.
A muscle strain – or muscle pull – is a stretching or tearing of muscle fibres. This normally occurs because a muscle has been stretched beyond its limits or has been forced to contract too much. Muscle strains are also graded according to their severity: First-degree – A mild strain, where only a few muscle fibres are stretched or torn. The injured muscle is tender and painful, but still has normal strength – although power may be limited by pain. A muscle’s ‘power’ refers to its ability to generate as much force as possible, as quickly as possible, while muscle ‘strength’ is the amount of force a muscle can exert in a single transaction. Second-degree – A moderate strain. A greater number of muscle fibres are injured, causing more severe muscle pain and tenderness. There is mild swelling, as well as a noticeable loss of strength and power. In addition, there is sometimes a visible bruise. Third-degree – A severe strain that tears the muscle all the way through. There may be a
‘popping’ sensation as the muscle rips into two separate pieces or shears away from its tendon. Muscle function is lost entirely. Strains tend to be caused through sport of other physical activity. The most common types of strain affect the: • hamstrings (the muscles connecting the hip and knee joints) • calf muscles • quadriceps (thigh muscles) • lumbar muscles (muscles in the lower back).
Identifying a strain or sprain For both sprains and strains, the severity of the symptoms depends on the severity of the injury itself. Symptoms include: • tenderness and swelling • bruising • functional loss, for example pain when weight is applied • mechanical instability (movement beyond a joint’s normal range of motion can occur in severe cases). When a patient suffers from an injury and you are trying to determine if it is a strain, you can look for the following clinical attributes: • pain in the affected muscle • large haematomas – a solid swelling of clotted blood within the damaged muscle tissue – as a result of the tearing of intramuscular blood vessels • localised swelling • reduced muscle function – depending on the severity of the strain • a history of sprains or muscle pulls.