Simple Sprain Research Articles

Sideline Evaluation and Treatment of Bone and Joint Injury

Athletes can sustain a large variety of injuries, from simple soft-tissue sprains to complex fractures and dislocations. This article reviews and provides the most recent information for sports medicine professionals on the initial assessment and treatment from the sports sidelines without the benefit of imaging of bone and joint injuries (excluding facial injuries). This information will aid sports medicine professionals by giving them basic suggestions that may allow for the safe and prompt return of athletes to the field of play.

(i) Current understanding of low back pain and intervertebral disc degeneration: epidemiological perspectives and phenotypes for genetic studies

Summary Low back pain is now considered more an illness syndrome, rather than a distinct disease. There are many causes of back pain from simple sprain, to complex anatomical derangements to psychosocial issues. Lumbar disc degeneration is one of the more common causes of pathological low back pain. In recent years, there has been a dramatic shift in the understanding of the aetiology of back pain, from an environmental and mechanically based model, to one of a polygenic genetic disorder. This review will summarise the current knowledge on low back pain, and present the latest evidence that this is a genetic disorder.

Neurologic symptoms in simple neck sprain: Comment on the review by Ferrari and Russell

Neurologic symptoms in simple neck sprain: Comment on the review by Ferrari and Russell

Ankle Sprains

Most ankle injuries occur from excessive inversion, but it is important to be able to differentiate a simple inversion sprain from a potentially disabling injury. Expedient diagnosis includes first screening for deformities and then performing specific tests like the anterior drawer and side-to-side test. To optimize assessment, the examiner needs to take advantage of the preswelling period on the sidelines. Physicians can treat most ankle injuries nonoperatively, taking steps to ensure a quick return to play. Fracture signs and treatment are covered in a comprehensive table.

PRIMARY CARE OF HAND AND WRIST ATHLETIC INJURIES

Athletic injures to the hand and wrist can range from simple sprains to severe fractures or soft-tissue disruptions that can permanently threaten the normal function of the extremity. This article deals with some of the more commonly noted sports-related injures to the hand and wrist to help the team physician make the correct diagnosis and establish the most effective treatment plan, so that the athlete may achieve maximum results and ultimately return to full participation in their sport.

Subfailure injury of the rabbit anterior cruciate ligament.

Ligamentous injuries range in severity from a simple sprain to a complete rupture. Although sprains occur more frequently than complete failures, only a few studies have investigated the phenomena of these subfailure injuries. The purpose of our study was to document the changes in the load-deformation curve until the failure point, after the ligament has been subjected to an 80% subfailure stretch. Thirteen paired fresh rabbit bone-anterior cruciate ligament-bone preparations were used. One of the pairs (control) was stretched until failure; the other (experimental) was first stretched to 80% of the failure deformation of the control and then stretched to failure. Comparisons were made between the load-deformation curves of the experimental and control specimens. The nonlinear load-deformation curves were characterized by eight parameters: failure load (Ffail), failure deformation (Dfail), energy until failure (Efail), deformations measured at 5, 10, 25, and 50% of the failure load (D5, D10, D25, and D50, respectively), and stiffness measured at 50% of the failure force (K50). There were no significant differences in the values for Ffail, Dfail, and Efail between the experimental and control ligaments (p > 0.33). In contrast, the deformation values were all larger for the experimental than the control ligaments (p > 0.01). The deformations D5, D10, D25, and D50 (mean +/- SD) for the control were 0.36 +/- 0.13, 0.49 +/- 0.23, 0.81 +/- 0.35, and 1.23 +/- 0.41 mm. The corresponding deformations for the experimental ligaments were, respectively, 209, 186, 153, and 130% of the control values. K50 was also greater for the experimental ligament (125.0 +/- 41.7 N/mm compared with 108.7 +/- 31.4 N/mm, p < 0.03). These findings indicate that even though the strength of the ligament did not change due to a subfailure injury, the shape of the load-displacement curve, especially at low loads, was significantly altered. Under the dynamic in vivo loading conditions of daily living, this may result in increased joint laxity, additional loads being applied to other joint structures, and, with time, to joint problems.

Long-term follow-up of inversion trauma of the ankle.

In our institution lateral ankle ligament injuries are classified into three grades according to the extent of instability found on physical examination and/or stress X-rays. Grade I and II lesions are taped, while treatment of grade III lesions consists of operative reconstruction of the ruptured ligaments. In 1989 we published the results of 1012 patients after 9 months' follow-up. About 30% had residual complaints. The nature and frequency of the complaints were equally divided among the three groups. To examine the long-term follow-up results, we conducted a retrospective study with the same group of patients after 6.5 years. Although ankle ligament injuries are still considered rather innocent lesions, we conclude that even after 6.5 years patients can still have residual complaints (pain, fear of giving-way, actual instability, swelling), which interfere with daily living and/or sport activities. The result deteriorated with time. This was especially prominent in the grade II group, where the percentage of poor and fair results doubled. The overall percentage of residual complaints was 39%. We conclude that there is no such thing as "a simple sprain".

Lisfranc Injuries In The Athlete

Injuries to the Lisfranc joint in the athlete comprise a very small proportion of tarsometatarsal injuries and are unique in several different ways. The energy involved appears to be on a much smaller order of magnitude than more commonly encountered injuries leading to obvious fracture and dislocation. Second metatarsal subluxation with diastasis between the first and second metatarsal tends to be the most commonly encountered injury; however, the true extent of injury cannot be based solely on the amount of diastasis present. Lateral weight-bearing radiographs facilitate evaluation of the normal medial cuneiform-fifth metatarsal relationship, which when disrupted indicates an injury more significant than a simple sprain and the possible need for open reduction and internal fixation. Finally, the restoration of this normal radiographic relationship between the medial cuneiform and fifth metatarsal on lateral weight-bearing views correlates well with the prognosis for achieving an asymptomatic, well-functioning foot, allowing a return to a competitive level of athletic participation.

Current concepts in management of football injuries of the hand and wrist

In 1986, 14% of injuries to high school football players were of the hand and wrist and 6% of fractures were sustained to bones of the wrist and hand. Injuries range from simple sprains to more severe fracture/dislocations. Consideration for treatment of an injury must include the athlete's age, level of competition, injury stability, position played, and desire to participate. Most fractures sustained are stable due to lower forces involved in athletic trauma. Stable injuries may be treated in a functional manner with early return to play in most cases.Sprains and dislocations of small joints of the hand are frequently seen in football players. Splints and playing casts can be utilized with stable ligament injuries, whereas more severe sprains may require surgical intervention. In most hand and wrist injuries in football players, use of protective splinting devices allow the athlete to return to play with adequate protection and limited loss of time.

Tillaux fractures of the tibia (in adolescents).

The juvenile "Tillaux" fracture occurs in a specific age group and may be misinterpreted as a simple sprain if proper examination is not performed. Anatomic reduction is necessary to prevent long term damage to the ankle joint. Computed tomography is of help in the evaluation of adequacy of reduction.

Radiographic Evaluation of Foot and Ankle Injuries in the Athlete

Injuries of the ankle and foot in athletes are quite common. They range from the extremely simple sprain to the difficult stress fracture, and may result in long-term disability. In all cases, the athlete is best treated after an accurate diagnosis is achieved.

Importance of the Thumb

To the Editor.— I've always chuckled at the irony of the robber being robbed, the plumber's pipes freezing, or the electrician's house suffering power failure. My family always laughs when I, the physician, become ill with the routine illnesses we physicians dismiss as common URI, or gastroenteritis. Recently, when such a seemingly minor ailment caused drastic changes in my routine, it forced me to consider the patient's plight under similar circumstances. What seemed like a simple sprain of the right thumb from playing ball at the gym, the next morning became a threat to my existence. The doublesized digit throbbed when I awoke; I expected that. But when I found I couldn't hold the soap in the shower, the seriousness of the occasion began to sink in. I hoped my associates would forgive me for not washing portions of the left hemithorax that were rendered inaccessible. Next I discovered

TREATMENT OF RUPTURES OF THE LATERAL LIGAMENT OF THE ANKLE

1. The results of three forms of treatment (mobilisation, immobilisation for six weeks, and suture with immobilisation for six weeks) for ruptures of the lateral ligament of the ankle have been compared in previously uninjured asymptomatic patients. 2. Only suture and immobilisation ensured final mechanical stability of the ankle as assessed by stress radiography. Unstable ankles were found after both mobilisation and immobilisation, but in these groups no ankle finally displayed more than 8 degrees of relative talar tilt. 3. The mean duration of disability in patients who finally became symptom-free was: after mobilisation, twelve weeks; after immobilisation, twenty-two weeks; and after suture and immobilisation, twenty-six weeks. 4. One year after injury 58 per cent of patients treated by mobilisation, 53 per cent of patients treated by immobilisation, but only 25 per cent of patients treated by suture and immobilisation, had become perfectly symptom-free. 5. For these reasons, and because simple sprains are satisfactorily treated by mobilisation, it is suggested that mobilisation may be the treatment of choice for most, perhaps all, ruptures of the lateral ligament of the ankle.

INSTABILITY OF THE FOOT AFFER INJURIES TO THE LATERAL LIGAMENT OF THE ANKLE

1. Forty-two previously asymptomatic patients presenting with a recent rupture of the lateral ligament of the ankle, and twenty similar patients with a simple sprain of this ligament, have been followed for one year. The physical and radiological findings upon the completion of treatment have been related to functional instability of the foot one year later. 2. Persistent mechanical varus instability of the talus in the ankle mortise was a possible cause of functional instability one year after injury in four (or perhaps six) patients. 3. Adhesion formation was a possible cause of functional instability in one patient. 4. Seventeen patients finally displayed no clinical or radiological abnormality after injury, but noted functional instability of the foot one year later. 5. It is concluded that the pathological process which is usually responsible for functional instability of the foot after a lateral ligament injury is at present unknown.

Acromioclavicular joint injuries: A modified conservative form of treatment

Approximately fifty-three patients with mild to moderate injury to the acromioclavicular joint were treated with the “lever type” of sling described. Sixty-five per cent were simple sprains. Thirty-five per cent were diagnosed clinically and radiologically as mild subluxations. The sprains were immobilized for variable periods ranging from four to fourteen days, or until all tenderness subsided. The subluxations were immobilized for three weeks. No case was hospitalized more than four weeks. All patients were asymptomatic and had a full range of strong, active motion upon discharge to full military duty.

Treatment of simple shoulder sprains

Treatment of simple shoulder sprains

Treatment of sprains by interligamentary injection of novocaine

As the result of clinical experience and study we have found that the interligamentary injection of novocaine satisfactorily relieves symptoms and speeds the healing of sprains, where no associated fracture or ligamental tear can be demonstrated. This treatment is based upon the conception that local anesthesia of the irritated, complex nervous elements of injured articular ligaments, quickly restores the functional state and greatly reduces the otherwise prolonged convalescence. The technique, results and contraindications are discussed. The best results are obtained in: (1) simple sprains with articular impotence but when no fracture or torn ligaments are found, (2) patients suffering from the after-effects of sprains, namely pain and muscular atrophy, and (3) orthopedic cases where surgical maneuvers may have strained the ligaments about a joint resulting in what we have termed an “operation sprain.” This simplified form of treatment should be of special value in athletic centers where sprains are common.

Experimental Reproduction of Joint Sprains

The object of the work was to study the histological changes in the soft structures and bone at varying periods of time after experimentally produced joint sprain and to determine the rate of healing. Six rabbits were used in the development of the method. Varying amounts of manual force were used on both ankle joints or both knee joints. The animals were killed immediately afterward and the extent of injury to the soft structures was determined by gross examination. In this way it was discovered how to produce a simple sprain without fracture. Sprains were produced thus on 12 rabbits. From 1 to 6 weeks later, the animals were sacrificed and autopsied. The joints were removed and examined grossly and microscopically. One week after the sprain, there was definite swelling of the joints, especially marked at the site of injury. There, the synovial membrane was thickened and oedematous with a few dilated blood vessels near its surface. The joint fluid was increased in amount, more viscid and yellow than normal. There was slight pannus formation at the osteo-cartilaginous junctions on the injured side of the joint. The subcutaneous tissue and the loose connective tissue of the mesotendons showed evidence of old hemorrhage. There was no blood within any of the tendon sheaths. Microscopic sections showed hemorrhage into and under the synovial membrane. The synovial cells had marked vacuolization. The subsynovial tissue was edematous, with capillary congestion, early fibroblastic proliferation and considerable leukocytic and lymphoid cell infiltration. In places the surface of the synovial membrane was covered with fibrin, while in others the fibrin was seen in the subsynovial tissues. Near the attachments to the bone, the injured capsule and ligaments showed similar changes consisting of oedema, fibroblastic proliferation and lymphoid-cell infiltration.

SPINAL INJURIES IN INFANTS.

The subject of spinal injuries in infants is presented to you in order that a discussion by this body of these injuries will determine their relation to the faulty development of the in the young, and to determine the relation between trauma and spinal caries. The traumatic spine may be defined as any injury to the spinal column. Injuries to the in the very young are not infrequent, though the great majority of such injuries are slight. A simple sprain, muscular or bony contusion, sometimes combined with slight shock, is the usual condition following a slight fall as from a cot or sofa. Again a very slight fall or sudden contact with a sharp corner of an object, may produce a true fracture of the spine, usually a fracture of a spinous process. If a child falls and strikes sideways we may have a green-stick fracture of one