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.