Sprain 

Definition. A sprain is a joint wrench due to a sudden twist or traction, the ligaments being pulled upon or lacerated and the surrounding parts being more or less damaged.

Sprains of the Ankle. On account of its flexibility and constant use in weight-bearing, the ankle is the joint most frequently sprained.

Sprains are common in a limb with weak muscles; in a deformed extremity in which the muscles act in unnatural lines, and in a joint with relaxed ligaments.

A joint, once sprained, is very liable to a repetition of the damage from slight force.

Symptoms. The symptoms manifested in a sprain are as follows: severe pain in the joint; nausea and sometimes syncope; impairment, or loss of motion; severe pain upon motion; early swelling if hemorrhage is severe—in any case swelling begins in a few hours; movement of the joint becomes difficult or impossible; the tear in the ligament may be distinctly felt; in a day or two pain and tenderness become intense and discoloration becomes marked.

Diagnosis. Usually the diagnosis is easy to make, but in all doubtful cases an X-ray picture should be taken in order to be certain that a fracture does not exist.

Treatment. The first indication is to arrest hemorrhage and to limit inflammation. For the first few hours apply pressure and an ice-bag. Wrap the joint in absorbent cotton, wet with iced water; apply a wet gauze bandage, and put on an ice bag.

In a mild sprain, use lead and opium wash. In a severe sprain, place the extremity upon a splint and apply to the joint flannel kept wet with lead-water and laudanum, iced water, tincture of arnica or alcohol and water. If the pain is severe, a small dose of morphine should be given.

Judicious bandaging limits the swelling. When the acute symptoms begin to subside, rub stimulating liniments, such as chloroform or arnica, upon the joint once or twice a day and employ firm compression by means of a bandage of flannel or rubber. Later in the case use hot and cold douches, massage, passive motion and the bandage.

Another method of treatment of sprains of the ankle is by strapping with adhesive plaster, but it is advisable only for slight injuries. In severe cases, in which extensive laceration of the ligaments is suspected from the marked extravasation, it is best to immobilize the foot in a plaster-of-Paris splint for two weeks; later baking in a hot-air oven (see “Arterial Hyperemia”) with massage, and active and passive motion are advisable.

In simple sprains, the fixation does not produce serious stiffness, and without fixation the repair of the ligaments is only partial. In the latter case, the result is weakness of the ligaments and an instability of the foot which leads to frequent recurrence. This explains many habitual sprains. On the other hand, under appropriate treatment, a sprain should recover without leaving any functional disturbance.