Definition
- A SPRAIN is a complete or incomplete tear in the supporting ligaments surrounding a joint. Common locations include the ankle, knee, wrist, thumb, shoulder, neck and lower back.
- A STRAIN is an overstretching injury to a muscle or tendon. Commonly affected areas are the groin, hamstring, calf, shoulder, and back muscles, and the Achilles tendons.
Risk Factors
SPRAIN
- Wrenching or twisting motion that disrupts the stabilizing action of ligaments.
STRAIN
- From excessively vigorous movement in understretched or overstretched muscles and tendons.
Pathophysiology
- The affected ligament is unable to stabilize the joint when the client is applying weight and attempting to mobilize the affected joint. The blood vessels may be ruptured and edema produced.
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Assessment/Clinical Manifestations/Signs And Symptoms
SPRAINS
- Pain and discomfort, especially on joint movement
- Edema, possibly ecchymoses
- Decreased joint motion and function
- Feeling of joint looseness with severe sprain
STRAINS
- Edema
- Ecchymoses developing several days after injury
Pain
- Acute strain – pain may be sudden, severe, incapacitating.
- Chronic strain – gradual onset of soreness and tenderness
Laboratory and diagnostic study findings
- Radiographs are commonly done to rule out fracture or dislocation.
Medical Management
- Treatment of strains and sprains consists of resting and elevating the affected part, applying cold and using a compression bandage.
- The acronym RICE – Rest, Ice, Compression, Elevation is helpful for remembering treatment intervention.
- Rest prevents additional injury and promotes healing.
- If the sprain is severe (torn muscle fibers and disrupted ligaments), surgical repair or cast immobilization may be necessary so that the joint will not lose its stability.
- After the acute inflammatory stage (24 to 48 hours after injury), heat may be applied intermittently (for 15 to 30 minutes four times a day) to relieve spasm and to promote vasodilation, absorption and repair.
- Splinting may be used to prevent reinjury.
Nursing Diagnosis
- Acute pain
- Impaired mobility
- Risk for injury
Nursing Management
- Provide nursing care for a client who sustains a sprain
- Elevate or immobilize the affected joint, and apply ice packs immediately
- Assist with tape, splint or cast application, as necessary
- Prepare the client with a severe sprain for surgical repair or reattachment, if indicated.
- Provide nursing care for a client’s suffering muscle or tendon strain.
- Instruct the client to allow the muscle or tendon to rest and repair itself by avoiding use for approximately week and then by progressing activity gradually until healing is complete.
- Teach appropriate stretching exercises to be performed after healing to help prevent reinjury.
- Prepare the client for surgical repair in severe injury.
- Administer prescribed medications, which may include nonopioid analgesics.
