Ligaments connect the tissues of joints and bones and consist of connective fibers. Despite their elasticity and strength, they can suddenly become damaged as a result of injury. This is fraught not only with stretching, but also with partial or complete rupture. A minor sprain can be cured on your own, but in case of ruptures you should definitely visit a doctor. Considering that after an injury it is difficult for a lay person to understand how serious the injury is, it is advisable to immediately go to the emergency room and undergo an examination.
A sprain is not considered a serious injury, and proper care will ensure a quick recovery without complications. But if you underestimate the seriousness of the injury and do not provide timely first aid for a sprained ligament, complications may occur. You can understand that the measures taken are not enough by the following symptoms that appear in the first 3 days:
- the temperature has increased;
- the pain increases;
- restriction of mobility persists or increases;
- swelling and redness of the skin appears.
The listed symptoms are a reason to urgently consult a doctor!
Main causes and signs of sprains
The ligaments in the legs in the area of the knee and ankle joints are stretched, less often in the elbow. Injuries often occur as a result of physical activity, such as jumping and running. The reason is sudden movements without pre-warming the muscles. In addition, ankle sprains occur as a result of wearing uncomfortable shoes. Often, lovers of high, unstable heels become victims. When a sprain occurs, severe pain, weakness in the muscles near the damaged joint, swelling, and sometimes hematoma (bruise) due to subcutaneous hemorrhage occur. Movement increases pain.
Trauma (from the Greek trauma - wound) is damage in the human body caused by the action of environmental factors.
There are different types of injuries:
depending on the type of traumatic factor:
1) mechanical,
2) thermal (burns, frostbite),
3) chemical,
4) barotrauma (due to a sharp change in atmospheric pressure),
5) electrical injuries, etc.
6) combined, for example a combination of mechanical trauma and burn;
on the duration of exposure to the traumatic factor:
1) sharp;
2) chronic injuries;
from the circumstances under which the injury occurred:
1) household,
2) production,
3) sports;
Mechanical injuries can be open (wounds) and closed, that is, without violating the integrity of the skin; uncomplicated and with the development of complications - suppuration, osteomyelitis, sepsis, traumatic toxicosis, etc.; isolated (within an organ or segment of a limb), multiple (damage to several organs in one cavity or several segments of a limb) and combined (simultaneous damage to internal organs and the musculoskeletal system).
There are bruises, sprains, dislocations, fractures, compression of tissues and internal organs, concussions, ruptures. They may be accompanied by bleeding, swelling, inflammatory reaction, necrosis (death) of tissue. Severe and extensive injuries are accompanied by shock and are life-threatening.
Dislocations
Dislocations are a complete displacement of the articular ends of bones, in which the contact of the articular surfaces in the articulation area is lost. Dislocation occurs as a result of injury, usually accompanied by rupture of the joint capsule and ligaments. This displacement of the ends of the bones occurs more often in the shoulder, less often in the hip, elbow and ankle joints. Even more rarely as a result of bruise.
Signs of dislocation:
Displacement of bones from their normal position in the joint, sharp pain, inability to move in the joint.
First aid for a sprain:
1) cold on the area of the damaged joint;
2) use of painkillers;
3) immobilization of the limb in the position it assumed after the injury;
4) contact a surgeon.
On the first day after injury
Reduction of a dislocation is a medical procedure ( ! ). You should not try to straighten a dislocation, as it is sometimes difficult to determine whether it is a dislocation or a fracture, especially since dislocations are often accompanied by cracks and fractures of bones.
Bruises
Bruises are injuries to tissues and organs in which the integrity of the skin and bones is not damaged. The degree of damage depends on the force of the blow, the area of the damaged surface and the significance of the bruised part of the body for the body (a bruised finger, naturally, is not as dangerous as a bruised head). Swelling quickly appears at the site of the injury, and bruising is also possible. When large vessels rupture under the skin, accumulations of blood (hematomas) can form.
Signs:
Soft tissues are damaged without compromising the integrity of the skin. Bruise (bruise), swelling (edema).
First aid for bruise:
1) first of all, it is necessary to create rest for the damaged organ.
2) a pressure bandage must be applied to the area of the bruise, giving this area of the body an elevated position, which helps stop further hemorrhage into the soft tissues.
3) to reduce pain and inflammation, cold is applied to the site of the injury - an ice pack, cold compresses.
Sprains and ligament tears
Sprains and ruptures of joint ligaments occur as a result of sudden and rapid movements that exceed the physiological mobility of the joint. The cause may be a sudden twisting of the foot (for example, when landing unsuccessfully after a jump), or a fall on an arm or leg. Such injuries are most often observed in the ankle, knee and wrist joints.
Signs:
1) the appearance of sharp pain;
2) rapid development of edema in the area of injury;
3) significant dysfunction of the joints.
Unlike fractures and dislocations, with sprains and ruptures of ligaments, there is no sharp deformation and pain in the joint area when there is a load along the axis of the limb, for example, when pressure is placed on the heel. A few days after the injury, a bruise appears, and sharp pain subsides at this point. If the pain does not disappear after 2-3 days and you still cannot step on your foot, then a fracture of the ankle joint is possible.
First aid for sprains:
First aid for sprains is the same as for bruises, i.e.
1) first of all apply a bandage,
2) tight bandaging that fixes the joint,
3) applying a cold compress to the joint area, pressure and splint bandages, creating a motionless state.
When a tendon or ligament ruptures, first aid consists of creating complete rest for the patient and applying a tight bandage to the area of the damaged joint.
Fractures
A fracture is a partial or complete disruption of the integrity of a bone as a result of its impact, compression, crushing, bending (during a fall). Fractures are divided into closed (without damage to the skin) and open, in which there is damage to the skin in the fracture area.
Signs:
1) sharp pain, intensifying with any movement and load on the limb;
2) change in the position and shape of the limb;
3) dysfunction of a limb (inability to use it);
4) the appearance of swelling and bruising in the fracture area;
5) shortening of the limb;
6) pathological (abnormal) bone mobility.
First aid for bone fractures:
1) creating immobility of bones in the fracture area;
2) taking measures aimed at combating shock or preventing it;
3) organizing the fastest delivery of the victim to a medical facility.
Rapid immobilization of the bones in the fracture area - immobilization - reduces pain and is the main point in preventing shock. Immobilization of the limb is achieved by applying transport splints or splints made from available hard material. The splint must be applied directly at the scene of the incident and only after that the patient must be transported. In case of an open fracture, an aseptic bandage must be applied before immobilizing the limb. When bleeding from a wound, methods of temporarily stopping bleeding should be used (pressure bandage, application of a tourniquet, etc.).
Tires come in three types:
1) Hard
2) Soft
3) Anatomical
Boards, strips of metal, cardboard, several folded magazines, etc. can serve as rigid tires. Folded blankets, towels, pillows, etc. can be used as soft splints. or support bandages and dressings. With anatomical splints, the victim’s body is used as a support. For example, an injured arm can be bandaged to the victim’s chest, a leg to a healthy leg.
When carrying out transport immobilization, the following rules must be observed:
1) the splints must be securely fastened and well fix the fracture area;
2) the splint cannot be applied directly to a naked limb; the latter must first be covered with cotton wool or some kind of cloth;
3) creating immobility in the fracture zone, it is necessary to fix two joints above and below the fracture site (for example, in case of a tibia fracture, the ankle and knee joints are fixed) in a position convenient for the patient and for transportation;
4) in case of hip fractures, all joints of the lower limb (knee, ankle, hip) should be fixed.
Fractures
Fractures can be closed (without damage to the skin), open (with disruption of the integrity of the skin) and complicated (bleeding, crushing of surrounding tissues). With open fractures (bone fragments are visible in the wound), microbes enter the wound, causing inflammation of the soft tissues and bones, so these fractures are more severe than closed ones.
Signs:
pain, swelling, change in shape and shortening of the limb, the appearance of mobility at the site of injury, crunching of fragments.
First aid for fractures:
fragments, when displaced, often damage blood vessels, nerves and internal organs, so do not move a broken leg or arm under any circumstances. Everything should be left as is, but the damaged bones should be given maximum rest.
In victims with open fractures, do not try to set protruding fragments into the wound or remove fragments from the wound. You need to stop the bleeding, apply a sterile bandage, a clean handkerchief or towel to the wound. Then, carefully, so as not to increase the pain, you should apply a ready-made splint (cardboard, plywood, wood or wire) or one made from improvised means - boards, sticks, pieces of plywood, branches, umbrella, gun) and create rest for the victim and the limbs. The splint must be applied to clothing, having previously covered it with cotton wool, wrapped with a bandage, towel or soft material. After application, the splint must be bandaged or tied with something in three or four places to the body. If a large tubular bone (femur or humerus) is broken, three joints must be fixed with a splint at the same time, and if smaller bones are damaged, it is enough to immobilize the above and underlying joints.
Femur fracture
First aid:
To create rest for the injured leg, splints are bandaged on the outside, from the foot to the axillary region, and on the inner surface - from the sole to the perineum. If the hospital or first aid station is far from the crash site, you need to bandage another splint on the back, from the foot to the shoulder blade. If there are no splints, you can bandage the injured leg to the extended healthy one.
Fractures of the shin bones
First aid:
The splint is applied along the back surface of the injured leg, from the foot to the buttocks, and secured with a bandage in the area of the knee and ankle joints.
Fractures of the bones of the hand and fingers
First aid:
Damaged bent fingers (giving a grasping position to the hand) are bandaged to a cotton roll, hung on a scarf or splinted. Fixing your fingers in a straight position is unacceptable.
Clavicle fracture
Occurs when falling. Damage to large subclavian vessels caused by displaced bone fragments is dangerous.
First aid:
Deso bandage. To create peace, hang the hand on the side of the injury on a scarf or on the raised hem of the jacket. Immobilization of clavicle fragments is achieved with a Deso bandage or by bringing the hands together behind the back using cotton-gauze rings (you can also tie the hands behind the back with a belt).
Fractures of the forearm and humerus
First aid:
bending the injured arm at the elbow joint and turning the palm towards the chest, apply a splint from the fingers to the opposite shoulder joint on the back. If there is no splint, you can bandage the injured arm to the body or hang it on a scarf, on the raised hem of the jacket. Fractures of the spine and pelvis.
A spinal fracture is an extremely serious injury.
Signs:
Severe pain appears in the damaged area, sensitivity disappears, paralysis of the legs occurs, and sometimes urination is impaired.
First aid:
It is strictly forbidden to sit down or put a victim with a suspected spinal fracture on his feet. Create peace by laying it on a flat, hard surface - a wooden board, boards. The same items are used for transport immobilization.
If there is no board and the victim is unconscious, transportation is least dangerous on a stretcher in a prone position. The victim cannot be placed on a soft stretcher. You can - only on a shield (a wide board, plywood, a door removed from its hinges), covered with a blanket or coat, on your back. It must be lifted very carefully, in one step, so as not to cause displacement of fragments and more severe destruction of the spinal cord and pelvic organs. Several people can lift the victim by holding his clothes and acting in concert, on command. If there are no boards or shields, the victim is placed on the floor of the car and driven carefully (without shaking). A person with a fracture of the cervical spine should be left on his back with a bolster under his shoulder blades, and his head and neck should be supported by placing soft objects around their sides. If the pelvic bones are damaged, the victim’s legs are slightly spread apart (the “frog” position) and a thick cushion of folded blanket or rolled up clothing is placed under the knees.
Rib fractures
First aid:
You need to tightly bandage the chest at the fracture site.
Fractures of the foot bones
First aid:
A board is bandaged to the sole.
Damage to the skull and brain
The greatest danger from head injuries is brain damage.
is classified as follows :
1) concussion;
2) bruise (concussion);
3) compression.
Brain injury is characterized by general cerebral symptoms:
1) dizziness;
2) headache;
3) nausea and vomiting.
The most common are concussions, in which the main symptoms are loss of consciousness (from several minutes to a day or more) and retrograde amnesia (the victim cannot remember the events that preceded the injury). When the brain is bruised and compressed, symptoms of focal damage appear: disturbances in speech, sensitivity, limb movements, facial expressions, etc. First aid is to create peace. The victim is placed in a horizontal position. To the head - an ice pack or a cloth moistened with cold water. If the victim is unconscious, it is necessary to clear the oral cavity of mucus and vomit, and place him in a fixed, stabilized position.
Transportation of victims with head wounds, damage to the bones of the skull and brain should be carried out on a stretcher in a supine position. Unconscious victims should be transported in a lateral position. This provides good immobilization of the head and prevents the development of asphyxia from retraction of the tongue and aspiration of vomit.
Fractures of the skull bones
Broken bones often damage the brain, which is compressed as a result of hemorrhage.
Signs:
violation of the shape of the skull, a break (dent), leakage of cranial fluid and blood from the nose and ears, loss of consciousness.
First aid:
To fix the neck and head, a cushion is placed on the neck - a collar made of soft fabric. For transportation, the victim’s body is placed on his back, on a shield, and his head is placed on a soft pillow.
Jaw fractures
Signs:
pain, displacement of teeth, mobility and crunching of fragments. When the lower jaw is fractured, its mobility is limited. The mouth doesn't close well. Due to severe injuries, tongue retraction and breathing problems may occur.
First aid:
Before transporting victims with damaged jaws, the jaws should be immobilized: for fractures of the lower jaw - by applying a sling bandage, for fractures of the upper jaw - by inserting a strip of plywood or a ruler between the jaws and fixing it to the head.
Information prepared by: Paramedic on strengthening preventive work among healthy children Dmitrieva I.A. 2021
Feelings at different degrees of stretching
Treatment is prescribed depending on the degree of sprain. Knowing the symptoms, you can roughly determine the severity of the injury, provide first aid and decide on the urgency of calling doctors.
Taking into account the number of damaged ligaments and muscle tissue, 3 degrees are distinguished:
- A minor injury with little pain and virtually no swelling. Stretching does not prevent you from moving and doing your usual activities. No special treatment is required, but it is advisable to reduce the load until recovery.
- Moderate severity of damage with single tissue ruptures. The pain is constant, there are hematomas and swelling. Treatment will take about 1–2 months at home under the supervision of a traumatologist.
- Complete tissue rupture, severe pain, numerous hematomas and swelling. Urgent medical care is required in a hospital. Severe sprains have a poor prognosis. Recovery will take a long time.
Diagnostics
Diagnosis of ligament damage begins with a detailed medical examination of the patient, collection of complaints and medical history, as well as palpation of the affected area. To make a final diagnosis, the patient is prescribed a series of examinations that allow one to assess the condition of the internal structures of the joint, namely:
- X-ray examination (as a rule, X-rays are taken in two projections);
- ultrasound examination of the joint condition;
- magnetic resonance imaging, which is prescribed in the most difficult cases in terms of diagnosis and is the most informative method for diagnosing traumatic lesions of bone joints.
The answer to the question whether a patient has a sprain or rupture of a joint ligament can only be given by a professional doctor, based on data from an objective examination of the affected area, as well as on the results of additional diagnostic methods for the affected area.
Stages of rehabilitation
In case of a serious sprain, the doctor prescribes comprehensive treatment to alleviate the victim’s condition and speed up the recovery process. Medicines, physical therapy, and physiotherapeutic procedures are prescribed. The duration of treatment depends on the degree of injury, the age and health of the patient, as well as whether first aid was provided after the injury.
Medicines are prescribed to reduce pain and get rid of swelling. As a rule, doctors prescribe pain-relieving ointments and anti-inflammatory drugs. After the swelling subsides, local warming drugs are prescribed. Therapy is supplemented with angioprotectors and absorbable ointments.
To improve the circulation of blood and lymphatic fluid, as well as speed up recovery and prevent complications in the form of accelerated tissue fusion, lameness and other negative consequences, the following physiotherapy procedures are prescribed:
- cryotherapy;
- electrophoresis;
- ultrasound;
- UHF;
- magnetic currents;
- amplipulse therapy.
A traumatologist or physiotherapist will determine the duration and number of procedures.
Treatment
In case of a mild sprain, it is enough to provide the victim with qualified, quick assistance. For more severe injuries, you need to call a doctor - only he will determine how to treat an ankle sprain effectively and safely.
Therapy consists of taking medications with analgesic and anti-inflammatory effects. After eliminating the swelling, the doctor will recommend taking medications that improve blood microcirculation, applying absorbable ointments and warming medications.
Physical therapy: basic principles of exercises
You can start physical therapy only with the permission of a traumatologist. In some cases, simple exercises can be performed as early as 3 days after the injury, but active training begins approximately a month after the injury. Exercises are selected by the instructor taking into account the nature and extent of the injury. The goal is to improve blood circulation, strengthen muscles and ligaments. If pain occurs during class, the exercises are stopped and transferred to the next day. Exercise cannot be completely excluded from rehabilitation: muscles and ligaments will be replaced by connective tissue, which will limit their mobility.
Stretching is a vital part of physical therapy. It is necessary to avoid spasms of injured muscles and ligaments. As a rule, the exercise lasts 15 seconds, and you need to repeat it 2-3 times a day. For chronic injuries, the duration of stretching is increased to 30 seconds, and the number of repetitions is increased to 3-5 times per day. If you do everything correctly, you will not feel pain the next day. If discomfort occurs, this indicates muscle overstrain, and the intensity of stretching is reduced.
2. Why muscle strain occurs
In the process of life, when we are awake, certain muscle groups are almost constantly working, making numerous contractions. For the most part, they are safe and do not lead to negative consequences. In this case, the muscles adjacent to the contracting muscle tissues are stretched. The elongation limit is quite high, but in extreme situations, during overloads or sudden movements, a mismatch occurs - adjacent muscles contracting simultaneously cause harm to each other. The muscles most often subject to excessive stretching are the back, neck, legs, and forearm. Regular training and warming up before heavy exercise can minimize the risk of such injury. Also important here:
- natural flexibility of the body and elasticity of tissues;
- general physical fitness;
- individual characteristics of the musculoskeletal frame;
- posture.
Factors and situations that increase the likelihood of getting a sprain are very diverse and sometimes unexpected:
- practicing sports involving monotonous movements (rowing, tennis), as well as contact team sports (football, basketball);
- long periods of static body position in an uncomfortable, monotonous position (sitting at a table, embroidering, painting and some crafts);
- sudden loss of balance, falling on ice, jumping over an obstacle/puddle/stream;
- sharp sudden cough;
- lifting weights without bending your knees;
- catching a thrown object (volleyball);
- inconsistency when performing heavy work with the participation of a partner.
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Proper first aid
In case of sprained ligaments, first aid is reduced to the following measures:
- Provide rest to the victim - sit or lay him down so that the injured limb does not move. To reduce swelling, it is advisable to slightly elevate your arm or leg.
- Apply cold. This will reduce swelling and pain. Pour ice into the bag; if there is none, use a heating pad with cold water. Apply to the damaged area for 15 minutes, take a half-hour break and repeat. It is good if there is a special cooling bandage that provides safe cold for 2 hours.
- Protect against overload. The diseased joint is fixed with an elastic bandage.
- Ointments and anti-inflammatory drugs for pain and swelling should be used only as prescribed by a specialist.
The listed measures for sprains are quite enough to reduce pain. In the next 2 days, it is important to provide fixation and rest to the injured limb. During this time, pain and swelling should decrease to a minimum. Next, it remains to begin to gradually and little by little load the limb. Full recovery occurs in 2–3 weeks.
How to distinguish a sprain from a fracture?
Tendon damage is no less serious than displacement of the integrity of the bone structure. But the stereotype that with such an injury everything will go away on its own should have become obsolete a long time ago. Just like the fact that a standard sprain is identical to a muscle fiber or tendon sprain. The problem is that the external symptoms of all these wounds are extremely similar to each other.
Without an x-ray, an inexperienced layman is unlikely to be able to figure out on the spot what exactly he is dealing with. To help make early diagnosis a little easier, experts ask you to remember a few typical rules that distinguish a fracture from a sprain:
- pronounced crunch;
- reduction or complete absence of sensitivity below the problem area;
- constant pain;
- inability to move the fingers of the limb that was affected.
It is even worse if there was a fracture of the hand or other part of the body along with displacement. Then it becomes simply impossible not to notice the deformation. It is these options that are often accompanied by additional sprains, dislocations and other difficulties associated with the ligamentous apparatus.
Advice from traumatologists
Sprains often occur in athletes, so their first aid kit is constantly stocked with tools to eliminate pain, immobilize the joint and speed up recovery. Traumatologists recommend that all people replenish their first aid kit with special medical products that may be useful in case of injury.
Self-fixing elastic sprain bandage is an excellent solution for treating damaged tendons. The product is made from fabric of a special structure and does not contain latex (only polyamide, cotton and viscose). All that remains is to choose the appropriate width of the bandage and always have it at hand. Unlike conventional elastic bandages, new medical dressings are resistant to sterilization, X-ray treatment, high temperatures (can be ironed), allow air to pass through and remove moisture from the skin.
Traumatologists recommend not only athletes, but also all active people to buy a self-fixing modern bandage. The costs will be repaid by its long service life - even with repeated use, the material retains its shape. In case of sprained ligaments, this bandage will help out both an adult, a child, and an elderly person.
Complications and prognosis
No injury goes away without a trace, especially when it comes to damage to ligaments, because the latter recover very slowly. Even a minor injury is fraught with serious complications, but after more severe injuries they occur even more often. These include:
- sprained ankle;
- flat feet;
- arthritis and arthrosis;
- tendonitis - inflammation of the tendons.
After mild to moderate sprains, the prognosis is generally favorable. In particularly severe cases, there is a high probability of an unfavorable prognosis, such as the development of lameness.