Contusions,
Strains, and Sprains
A contusion is a soft tissue injury produced by blunt force, such as
a blow, kick, or fall. Many small blood vessels rupture and bleed into soft tissues
(ecchymosis, or bruising). A hematoma
develops when the bleeding is sufficient to cause an appreciable collection of
blood. Local symptoms (pain, swelling, and discoloration) are controlled with
intermittent application of cold. Most contusions resolve in 1 to 2 weeks.
A strain is a “muscle pull” caused by overuse, overstretching, or
excessive stress. Strains are microscopic, incomplete muscle tears with some
bleeding into the tissue. The patient experiences soreness or sudden pain, with
local tenderness on muscle use and isometric contraction.
A sprain is an injury to the ligaments surrounding a joint that is
caused by a wrenching or twisting motion. The function of a ligament is to
maintain stability while permitting mobility. A torn ligament loses its
stabilizing ability. Blood vessels rupture and edema occurs; the joint is
tender, and movement of the joint becomes painful. The degree of disability and
pain increases during the first 2 to 3 hours after the injury because of the
asso-ciated swelling and bleeding. An x-ray should be obtained to rule out bone
injury. Avulsion fracture (in which a bone fragment is pulled away by a
ligament or tendon) may be associated with a sprain.
Treatment of contusions,
strains, and sprains consists of resting and elevating the affected part,
applying cold, and using a com-pression bandage. (The acronym RICE—Rest, Ice, Compression, E levation—is helpful for remembering treatment interventions.)Rest
prevents additional injury and promotes healing. Moist or dry cold applied
intermittently for 20 to 30 minutes during the first 24 to 48 hours after
injury produces vasoconstriction, which decreases bleeding, edema, and
discomfort. Care must be taken to avoid skin and tissue damage from excessive
cold. An elastic compression bandage controls bleeding, reduces edema, and
pro-vides support for the injured tissues. Elevation controls the swelling. If
the sprain is severe (torn muscle fibers and disrupted ligaments), surgical
repair or cast immobilization may be neces-sary so that the joint will not lose
its stability. The neurovascular status (circulation, motion, sensation) of the
injured extremity is monitored frequently.
After the acute
inflammatory stage (eg, 24 to 48 hours after in-jury), heat may be applied intermittently
(for 15 to 30 minutes, four times a day) to relieve muscle spasm and to promote
vasodi-lation, absorption, and repair. Depending on the severity of injury,
progressive passive and active exercises may begin in 2 to 5 days. Severe
sprains may require 1 to 3 weeks of immobilization before protected exercises
are initiated. Excessive exercise early in the course of treatment delays
recovery. Strains and sprains take weeks or months to heal. Splinting may be
used to prevent reinjury.
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