Lesson 1, Topic 1
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Ligament sprain

A sprain is an injury to the band of collagen tissue i.e a ligament, which connects two or more bones together. The primary function of a joint is to provide passive stabilization of a joint and it plays an important role in proprioceptive function. A sprain is usually caused by the joint being forced suddenly outside its usual range of motion and the inelastic fibres are stretched beyond their limit. A ligament rapture can occur at the proximal of the ligament or distal junction. Sometimes an avulsion fracture also occurs (the ligament pulls a piece of bone with it on injury).

Grades of injury

A sprain can range from mild (tearing of just a few fibres) to severe (complete rupture of the ligament, leading to joint instability). The severity of a sprain is graded according to how badly the ligament has been damaged and whether or not the joint has been made unstable. The joint can can become unstable when the damaged ligament is no longer able to give normal support.

Grade 1

Structural damage only on microscopic level, with slight local tenderness and without joint instability. It has minor stiffness, soreness, and tightness in the joint. There is little noticeable swelling yet normal walking gait and range of motion with some discomfort. May not be able to jog or jump.

GRADE 2

Partial tear or rupture of the ligament, visible swelling and noticeable tenderness caused by bleeding under the skin but without joint instability (or mild instability). The site of the sprain is painful to touch, characterised by limited range of motion and pain when contracting muscle.

Grade 3

This is a complete tear of the ligament, characterised by severe pain. The athlete may hear an audible “Pop” or “Snap”. There is noticeable swelling and bruising, patient may complain of instability, or giving way in the joint and difficulty walking without assistance.

Injury Management

Management of ligament sprains includes first aid immediately post injury. Acute phase is characterised by using the PRICER theory followed by early mobilization. Extreme cases may call for a surgery after investigation using modalities like x ray and MRI.

Rehabilitation

It includes prevention of abnormal scar tissue formation, joint stiffness, muscle weakness etc more on rehabilitation module .

Return to play

Ligament sprains return to play expected time .

N.B These return to play guidelines are no fixed, there may be differences from one individual to another due to a number of factors ranging from internal and external.

Common ligament injuries

Ankle sprain, shoulder sprain , wrist and ligament sprains, spinal ligament sprain, etc.