Details of a Sprain

Question 1

What is a sprain of a Joint?

Answer 1

It is a over stretched ligament.

Question 2

What is a Ligament?

Answer 2

It is a flexible connective tissue that is non-contractile.
It surrounds a joint and blends into the periosteum.
Holds bones together and limits ROM.

Question 3

What can cause a Sprain?

Answer 3

Trauma - like wrenching or twisting the joint beyond the normal ROM.

Question 4

What are factors that can making Spraining your joints easier?

Answer 4

Weakened muscles, Hyper-mobility of the joints and Altered biomechanics.
Also having a sprain previously can make it easier.

Question 5

What are the Classifications of Sprains?

Answer 5

There is grades 1-2-3

Question 6

What does Grade 1 Sprain mean?

Answer 6

Mild primary, minor stretch or tear, No stability on PR (passive relaxed)

Question 7

What does Grade 2 Sprain mean?

Answer 7

Moderate secondary, Moderate stretch or tears of the fibres.
Snapping noise/ Joint gives way.
Hypermobile but stable on PR.
Decreased ALD (Active daily life).

Question 8

What does Grade 3 Sprain mean?

Answer 8

Sever, Complete Tear, Snapping noise and gives way, Instability with no end point on PR.
No ADL due to the pain and instability.

Question 9

How long can it take for the full stability to return to the joint after a Sprain?

Answer 9

ligaments have little blood supply so this can take up to 6 months.

Question 10

What are common sites for sprains?

Answer 10

Ankle, Wrist, knee, elbow and Shoulder.

Question 11

What are symptoms of an Acute grade 1 Sprain?

Answer 11

Mild Prish, Joint is Stable, Slight to no Bruising.

Question 12

What are symptoms of an Acute Grade 2 Sprain?

Answer 12

Tearing of Fibres, Joint gives way/ Snapping, Moderate Prish (Worsened with activities that stress the ligaments), Hypermobile but stable, Bruising.

Question 13

What are the symptoms of a Acute Grade 3 Sprain?

Answer 13

Complete Rupture of the Ligament, Snapping/Joint gives way, Sever Prish, Instability and client has to stop ADL.

Question 14

What is true for all grade 2-3 Sprains?

Answer 14

Protective muscle spasming, Decreased ROM (AF), Possible vascular or nerve complications with Grade 2-3.

Question 15

What usually gets torn at the ankle when you get a sprain?

Answer 15

1st Anterior Tibiofibular Ligament and Second Calcaneo Fibular ligament.
(These both only occur during Inversion)

Question 16

What are symptoms of Sub acute Sprains?

Answer 16

o Bruising

o PRISH decreasing Grade 1: Stable

Grade 2: Stable but hypermobile Grade 3: Unstable and hypermobile

o Adhesions (in grade 2 and 3 especially)

o Trigger points and hypertension

o Decreased AF ROM

o Splints/casts/taping

o Loss of proprioception

Question 17

What are symptoms of a Chronic Sprain?

Answer 17

o Local pain if stretched

o Bruising minimal or gone

o Adhesions, scar tissue, trigger points and hypertension

o Decreased AF ROM

o Possible chronic edema

o Coolness due to ischemia

o Loss of proprioception

o If surgery, up to 10 weeks after the joint may be immobilized

o Unstable (grade 3)

o Weakness/atrophy

o Taping/splints/crutches

Question 18

What usually gets torn at the Elbow when you get a sprain?

Answer 18

These occur with a fracture.

Question 19

What usually gets torn at the Shoulder when you get a sprain?

Answer 19

Acromial Clavicular ligament (occurs with Separation).

A/C joint Ligament.

Question 20

What usually gets torn at the Shoulder when you get a sprain?

Answer 20

Acromial Clavicular ligament (occurs with Separation).

A/C joint Ligament.

Question 21

During an Assessment What can you observe in an Acute Sprain?

Answer 21

Redness

● Swelling

● Bruising

● Antalgic gait/posture

● Facial expression of pain

● Taping/splints SUBACUTE

● Bruise-yellow/green/brown

● Antalgic gait

● Supports

● Residual edema

● Scars is surgery CHRONIC

● Habituated gait/posture

● Taping/splints/crutches

● Residual edema

● Minimal bruising

● Scars

Question 22

During an Assessment What can you observe in an Acute Sprain?

Answer 22

Redness

● Swelling

● Bruising

● Antalgic gait/posture

● Facial expression of pain

● Taping/splints SUBACUTE

● Bruise-yellow/green/brown

● Antalgic gait

● Supports

● Residual edema

● Scars is surgery CHRONIC

● Habituated gait/posture

● Taping/splints/crutches

● Residual edema

● Minimal bruising

● Scars

Question 23

When Palpating an Acute Sprain what can you feel?

Answer 23

Heat

● Swelling (firm)

● Protective muscle spasming

● Pain on palpation

Question 24

When Palpating a Sub acute sprain what can you find?

Answer 24

Warmth

● Pain on palpation

● Boggy swelling

● Adhesions/trigger points CHRONIC

● Coolness

● Pain on palpation

● Residual edema

● Adhesions/ trigger points/hypertension

● Disuse atrophy

Question 25

When doing test on a client with An Acute Sprain what must you do?

Answer 25

You must work proximally to the injury. The affected joint will have decreased ROM. (the higher the grade of the Sprain the lower the ROM of the joint)

Question 26

How would you perform a special test on a client with an acute sprain?

Answer 26

They are all CI'd besides (Joint effusion of the knee).

Question 27

What is testing a client's ROM like in the Sub acute stage?

Answer 27

● Proximally/affected/distally ● AF is decreased by pain but less than in the acute stage PR ● Proximally/affected/distally ● ROM that stresses joint is tested last. May see empty end feel AR ● If strictly ligamentous-no pain ● If muscle injury as well-pain and weakness

Question 28

What are Special test you could do on the Knee after a sprain?

Answer 28

● Valgus/varus stress ● Apley’s distraction ● Ballottable patella ● Brush test ● Anterior and poster drawer test ● Lachman’s ● McMurray’s ● Bragards Sign ● Apley’s compression

Question 29

What are some test you could on the A/C joint after a Sprain?

Answer 29

A/C Shear test.

Question 30

What are some test you could do on the SI joint after a sprain?

Answer 30

SI joint gapping ● SI joint squish test ● Galenslen’s

Question 31

What are some test you could do on the wrist after a Sprain?

Answer 31

Radial stress/ulnar stress ● PR wrist extension/flexion

Question 32

What does treatment to a client with an Acute sprain involve?

Answer 32

Rice ● MLD ● Comp. structure – GSM ● Mid range PR ROM proximally (not it muscle crosses affected joint)

Question 33

What are CI's for treating a client with an Acute Sprain?

Answer 33

Testing other than AF ● Removal of muscle spasm ● Distal work past injury site ● Heat SUBACUTE and CHRONIC ● Heat if casted ● Overstretching hypermobile or repaired lig ● Joint play if unstable ● Frictions if on anti-inflammatories ***Screws/pins/plates: no hydro or deep work/frictioning

Question 34

What would treatment to a client with A sub acute sprain involve?

Answer 34

Contrast hydro ● Cool if edema ● Comp. structures – GSM ● GTO’s , O and I’s ● Onsite – start with vibrations/shaving/gentle petrissage 🡪 increases as client can tolerate pain/pleasure ● Mid range PR ROM ● Distally muscle squeezing and stroking 🡪 increase pressure and techniques ● Gentle frictioning 🡪 use joint play to stretch ligament ● Strengthening

Question 35

What would treatment to a client with a chronic Sprain involve?

Answer 35

DMH (deep moist heat) ● Deep techniques ● Frictioning (careful surgeries and pins) ● Tx Compensatory structures ● TP’s ● JT play ● PR ROM ● Strengthening

Question 36

What is homecare you can give a client that has an Acute sprain?

Answer 36

RICE

Question 37

What is some homecare you can give to a client with A Sub acute Sprain?

Answer 37

Contrast hydro ● Strengthening CHRONIC ● DMH ● Strengthening