Sprains and Dislocations: Everyone Has Had Them, But Many Treat Improperly

A stretching or tearing of ligaments, the fibrous bands that bind bones together at a joint, is referred to as a sprain. Typically, the surrounding blood vessels are also injured, resulting in bruising.

Although ligaments are very strong, almost any fall or misstep that twists a joint into an unnatural position can result in a sprain; in fact, a sprained ankle is the most common of all sports injuries. The knees are also vulnerable to severe sprains, especially among skiers. Improved bindings and inflexible boots have resulted in a 90-percent decrease in broken legs and ankles, but knee sprains have increased threefold.

Some sprains are accompanied by a dislocation, in which the end of the bone is displaced from its joint. Most dislocations result from a fall, a blow, or a movement that forces the joint beyond its normal range of motion, such as may occur in wrestling, football, and gymnastics.

The finger joints are especially susceptible to dislocation; in fact, some people with lax finger joints can dislocate them at will. Of larger joints, the shoulder is the most commonly dislocated, because of the ball-and-socket construction that gives it a 360-degree range of motion. When swung by their arms, young children may suffer dislocated shoulders. The wrists, knees, ankles, and toes are other joints that are frequently dislocated.

Both sprains and dislocations cause swelling, pain, and eventual discoloration at the affected site. An obvious deformity with the bones at odd angles to each other indicates a dislocation.

Diagnostic Studies and Procedures

X-rays are taken to determine the extent of damage and whether there are any fractures. A dislocation is always X-rayed before any attempt at correction. Severely torn ligaments may also be studied by MRI scanning. In some cases, arthroscopy, a procedure in which a lighted viewing instrument is inserted into a joint, may be ordered.

Medical Treatments

Treatments of sprains vary according to their classification and which joint is involved. Grades 1 and 2 sprains can usually be handled with self-care, although physical therapy may be needed, especially if the knee or another major weight-bearing joint is injured.

Aspirin, ibuprofen, or other nonsteroidal anti-inflammmatory drugs are recommended to control pain and inflammation. If a stronger painkiller is necessary, codeine or another morphine derivative may be prescribed.
Usually, a doctor can successfully manipulate a dislocated bone back into its socket after administering a local anesthetic. In some cases, however, surgery is necessary.

Torn ligaments, especially of the knee and shoulder, often require surgical repair. This can now be done through arthroscopic surgery, in which surgeons use tiny instruments and a surgical microscope to work through a lighted viewing tube, or arthroscopy, inserted into the joint. Arthroscopic surgery requires only small puncture openings instead of a long, open incision, thereby minimizing bleeding and scarring. Thanks to this development, shoulders and knees can be stabilized with much less loss of strength and mobility than was previously possible.

Alternative Therapies

Herbal Medicine. A liniment made by boiling 1 tablespoon of cayenne pepper in 1 pint of cider vinegar and applied as a cool compress is said to reduce swelling of a simple grade 1 sprain. Rubbing marjoram oil or tincture of arnica into the area is also suggested.

Physical Therapy. Patients who have severe sprains involving the knees and perhaps other weight-bearing joints frequently require physical therapy. The objective is to strengthen the surrounding muscles in order to give the joint more stability. Physical therapy is also necessary following surgery to repair torn ligaments.

Self-Treatment

RICE -- an acronym for rest, ice, compression, and elevation -- is the basic self-treatment for sprains. It's best to refrain from using the injured joint for the first 24 hours. To reduce swelling, rest the injured part and place an ice bag wrapped in a cloth over the area. A typical regimen calls for applying ice 15 minutes of every hour for the first 12 to 24 hours.

To further minimize swelling, wrap the area with an elastic bandage and elevate the joint so that it is higher than the heart. Take care not to make the bandage too tight; loosen it if swelling increases or there is any numbness, tingling, or loss of feeling in the area below the bandage.

After the first 24 to 48 hours, heat may be substituted for the ice packs.

At this stage of healing, the application of heat, in the form of a heating pad or other warm compress, increases blood flow to the area and may speed healing

Follow your doctor's guidelines for resuming use of the joint. He may encourage some movement of the joint early in the healing process to prevent stiffness, but this advice varies according to the site and extent of injury.

To reduce the risk of recurrent sprains and dislocations, follow these commonsense precautions:

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