Sprains & Strains

General Information

Classification: Skeletal
Figure 1 Depiction of ankle sprain vs. strain. Sprains are twists/tears of ligaments, whereas strains concern muscles or tendons.

What are they?

Overstretching, twist, or tear of ligaments (Sprains) or muscles/tendons (Strains)

Risk Factors: age, previous injury, high risk sports, exercise related concerns (poor warm-up, fatigue, overloading)

Evaluation:

  • Symptoms:
    • Limited range of motion, loss of function, pain, tenderness, erythema
  • Tests:
    • Sprains: anterior drawer test/talar tilt/squeeze (ankle sprains), Lachmann test (knee), palpation
    • Strains: muscle strength, resist motion tests
  • Imaging: radiographs, CT, MRI (prefer for sprains), ultrasonography (strains)

Pathophysiology:

  • Sprain: excessive inversion/eversion forces result in stretch/tear
    • Most commonly affected area: ankle (lateral ligament complex), high ankle (tibiofibular ligaments), knee (ACL, MCL), wrist (TFCC, scapholunate ligament)
  • Strain: sudden contraction, eccentric loading (disrupts sarcomere structure)
    • Most commonly affected area: hamstring, gastrocnemius, quads, lumbar, biceps, adductor muscles (longus, magnus, brevis)

Classification

Onset: acute vs chronic

Sprain

Acute: sudden overstretching, contraction (e.g., from sports, lifting)

Chronic: chronic instability

Strain

Acute: sudden twisting, impact (e.g., from running, jumping, quickly changing directions)

Chronic: repetitive motion injuries (e.g., postural issues, long term occupational tasks)

Grading scales

Sprain

Grade I: minor ligament tears

Grade II: partial ligament tear, joint instability

Grade III: complete ligament rupture, significant joint instability

Strain

Grade I (mild strain): microscopic fiber tears

Grade II (moderate strain): partial tearing of muscle fibers, some functional impairment

Grade III (severe strain): complete rupture of muscle/tendon, significant loss of function

Treatment

Acute management (for both sprains/strains)

  • RICE: rest, ice, compression, elevation for 15-20 min
  • Braces: soft-lace up or semi-rigid, splints
  • NSAIDs for pain

Surgery

Sprains

  • Consider if chronic (>3-6 mos), significant instability/LOF , osteochondral loss
  • Ankle sprains:
    • Lateral ligament repair (Broström procedure)
    • Ligament graft reconstruction
    • Arthroscopy

Strains

  • Earlier surgery (GIII) before scarring
  • Hamstring, quads, patellar, achilles, gastrocnemius/myotendinous tendon/avulsion repair

Rehabiliatation

Physical therapy: resistance band exercises, progressive stretching, lengthening exercises (strains)

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