What is a Sprain?
Many persons get mixed up with “sprain vs. strain.” A sprain is a ligament injury to a joint such as a knee, ankle or shoulder. A strain is an inflammation or injury to a muscle.
Quickcare or ER
In general, a knee injury can be handled in a clinic. But how do you know it is just a sprain?
Go to the ER if you have the following Red flags:
- Severe pain
- skin paleness.
- severe swelling
- gross deformity
These will send you to the ER
What is the doctor going to ask?
Your doctor will want to know your symptoms before diagnosing you with a knee sprain. A symptom is your description of your pain. It is your story.
What makes the pain better?
What makes it worse? Movement? Walking?
Is there anything associated with the pain? Like numbness or paralysis
Can you bear weight/Walk on it?
What kind of injury caused the pain? Was it a direct fall or was there twisting-type injury?
Did you feel or hear a “pop?” If so, an anterior cruciate ligament tear is suspicious.
What will the doctor look for?
Your doctor will look for signs. A sign is an objective finding discovered on examination.
First, look for swelling. It is a pretty good indicator of severity of injury.
Making sure the pulses are intact. That is, there is adequate blood flow to the leg. It is not cold and pale.
Next is the hard part. It needs to be moved. Your doctor will want to evaluate the knee’s the range of motion. This is key
In looking at the anatomy, the knee joint is held together by collateral ligaments of the knee. There are knee ligaments on the inside and outside of the knee. Both combined with inner padding (meniscus) make up the major ligament structures. Additionally, the patella tendon adds greater stability. The surrounding strong muscles include the hamstring, quadriceps and gastrocnemius.
By pulling on the knee, a doctor can tell if the inside ligaments are torn. By pushing on the sides of the knee, the outside collateral ligaments may be evaluated.
Common skiing injuries include medial collateral ligament (MCL) and anterior cruciate ligament (ACL) sprains.
What is the doctor thinking?
Your doctor will create a mental list of possible reasons for your signs and symptoms. This list is called a differential diagnosis.
The knee pain could indicate a broken bone? One of the knee ligaments could be torn? It is important to keep in mind an ACL (Anterior Cruciate Ligament) tear. Given a woman’s knee-hip structure, there is an increased risk of an ACL injury such as a torn ACL. You could have a bruised knee. Or, it may be sprained.
An x-ray to look for a fracture is a good first step. A good exam (pushing and pulling the knee) is a good screen to look at the ligaments.
A more accurate study to look at the ligaments and inner padding (meniscus) is an MRI.
What is the treatment of a sprain?
Pain control is key. Anti-inflammatories such as Motrin and Naproxen work well. If the injury is a more severe tear of an ACL, then a surgery may be warranted.
Most feel better with a brace. I many times use an Ace bandage. The larger bulkier Velcro braces are great stabilizers.
If a patient still feels unsteady, then I add in crutches
For the first 24 hours, I have my patients ice an injured knee. It provides comfort and helps with inflammation.
How long will I have a sprain?
Generally sprains last 1-2 weeks. Gradually, first the crutches will not be needed. Then the brace will not be necessary after 1-2 weeks
If after 2 weeks of continuous pain, I start physical therapy- 3 sessions a week for 3 weeks.
If after physical therapy, and there is still pain, then an MRI and orthopaedic consult is needed.
Let me tell you a story
One more lift of the barbell. Grrr. His upper body took on a shape of a Greek god. Nothing was going to stop him.
The first practice with pads released a manly testosterone in these teenagers. As a runny back, the quick cuts at first came so naturally. Left then right then, AAAAHHHH!
Something went wrong. Knee injuries are so common in football. This manly looking boy hobbled off the field with the assistance of the coach.
In Jacob’s case, he had a sharp, local severe pain that got worse with movement. No associated numbness or paralysis
His exam showed no signs of a broken bone or torn ligaments. His xrays were negative. A short course of physical therapy followed.
After being benched for 2 weeks with a knee brace supporting his sprained knee, he roared back with a vengeance.
Hope this helps