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Sprains

A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connects the end of one bone with another. Ligaments stabilize and support the body's joints. For example, ligaments in the knee connect your thighbone (femur) with your shinbone (tibia), enabling you to walk.

The areas of the body that are most vulnerable to sprains are the ankles, knees, and wrists. A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee can result from a sudden twist, and a wrist sprain can occur if you fall onto an outstretched hand.

A twisting force to the lower leg or foot is a common cause of ankle sprains.

Reproduced from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

Sprains are classified by severity:

• Grade 1 sprain (mild):  Slight stretching and some damage to the fibers of the ligament.
• Grade 2 sprain (moderate):  Partial tearing of the ligament. There is abnormal looseness (laxity) in the joint when it is moved in certain ways.
• Grade 3 sprain (severe):  Complete tear of the ligament. This may cause significant instability.

While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains. Treatment for sprains begins with the RICE protocol and physical therapy. Moderate sprains often require a period of bracing (for example, a CAM walking boot can be worn to help support and immobilize a sprained ankle). The most severe sprains may require surgery to repair torn ligaments.

Strains

A strain is an injury to a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone. Strains often occur in the back or leg (typically, the hamstring).

Similar to a sprain, a strain may be a simple stretch of your muscle or tendon, or it may involve a partial or complete tear of the muscle and tendon.  Symptoms of a strain may include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.

• Soccer, football, hockey, boxing, wrestling and other contact sports put athletes at risk for hamstring strains, as do sports that feature quick starts, such as hurdling, long jumping, and running races.
• Calf strains are common in runners, as well as sports that involve a lot of running, such as football, soccer, tennis, and basketball.
• Gymnastics, tennis, rowing, golf and other sports that require extensive gripping have a high incidence of hand sprains.
• Elbow strains frequently occur in racquet, throwing, and contact sports.

The recommended treatment for a strain is the same as for a sprain: rest, ice, compression and elevation. This should be followed by simple exercises to relieve pain and restore mobility. Surgery may be required for a more severe tear.

Contusions (Bruises)

Contusions occur when a direct blow (or repeated blows) by a blunt object strikes part of the body, crushing underlying muscle fibers and connective tissue without breaking the skin.  A contusion can result from falling or jamming the body against a hard surface. Discoloration of the skin is caused by blood pooling around the injury.

Most contusions are mild and respond well to the RICE protocol. If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.

Tendinitis

Tendinitis is an inflammation or irritation of a tendon or the covering of a tendon (called a sheath). It is caused by a series of small stresses that repeatedly aggravate the tendon. Symptoms typically include swelling and pain that worsens with activity.

Tiny tears in the Achilles tendon cause it to swell and thicken.

Professional baseball players, swimmers, tennis players, and golfers are susceptible to tendinitis in their shoulders and elbows. Soccer and basketball players, runners, and aerobic dancers are prone to tendon inflammation in their knees and ankles.

Tendinitis may be treated by rest to eliminate stress, anti-inflammatory medication, steroid injections, splinting, and exercises to correct muscle imbalance and improve flexibility. Persistent inflammation may cause significant damage to the tendon, which may require surgery.

Bursitis

Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is inflammation of a bursa. Repeated small stresses and overuse can cause the bursa to swell. Many people experience bursitis in association with tendinitis.

Swelling associated with elbow bursitis.

Bursitis can usually be relieved with changes in activity and anti-inflammatory medications, such as ibuprofen. If swelling and pain do not respond to these measures, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken by mouth. Corticosteroid injections usually help relieve pain and swelling.

Although surgery is rarely necessary for bursitis, if the bursa becomes infected, an operation to drain the fluid from the bursa may be necessary. In addition, if the bursa remains infected or the bursitis returns after all nonsurgical treatments have been tried, your doctor may recommend removal of the bursa.

Removal (excision) of the bursa can be done using a standard incision (open procedure), or as an arthroscopic procedure with small incisions and miniature surgical instruments. Your doctor will talk with you about which procedure is appropriate for your situation.