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Article first published as Myths and Truths in Management of Sprains on Technorati.


Joints are supported and maintained by string like structures called ligaments and tendons. Sprain ordinarily mean tear of some fibers of those ligaments holding the bones together in a joint.


Usually this happens when the joint is made unstable or forcibly deformed, e.g. in accidental bending of joints while coming down the stairs. In this process some of the fibers or the whole ligament may get torn. Along with it some minute blood vessels may rapture. That is why swelling and discoloration of the injured area occurs. Common joints involved are ankle and wrist.

There may be:

• Throbbing pain in the part
• Reddish or bluish colorization of the part
• Instability in the joint
• Swelling
• Associated fracture of bone

There are some myths in the management of sprain. Those are discussed below;

1) Myth: Move the joint vigorously so that any disorder will get corrected.
Truth; The joint needs rest as is injured, if moved vigorously there will be more injury to the ligaments ; and if associated with a fracture, it will become more complicated.
2) Myth: Massage the part with pain relieving oil and/or balm.
Truth; Massage will injure more number of blood vessels and prevent arrest of bleeding; which may enhance the swelling and worsen the pain. If a fracture is already present the gap will widen creating more problem to manage.
3) Myth: Give warm compress to the part to relieve pain.
Truth; Warm compress or hot fomentation will dilate the blood vessels more and help to increase the swelling by more extravasations of blood. That will give rise to more pain and swelling.

Management;

• Patient should be examined by a doctor to learn if there is complete or partial rapture of the ligament/ligaments.
• X-Ray examination of the part should be done to rule out fracture of the bone.
  

If there is a partial rupture of ligament i.e. only sprain, the patient should follow these guidelines:

• Rest the part for two to three weeks
  
• Ice or cold compress for three to four days following the injury and thereafter moist heat fomentation.
• Analgesic spray over the area.
  
• Antibiotic and and proteolytic enzymes, if there is evidence of rapture of blood vessels.
• Some oral pain killer drugs.

All these measures will cure the patient mostly in two to three weeks. If a complete rupture of the ligament or tendon is noticed, that has to be surgically repaired and a sprain associated with fracture of bone will be treated in appropriate line.

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