Sprains

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The word sprain comes from the French espraindre, which means “to wring.” A sprain is damage to a ligament from excessive stretching forces. Articular ligaments are thick, semi-elastic connective tissues that connect bone to bone. The function of the ligament is to stabilize the joint and prevent movement of bones in certain directions. For example, the knuckles of the fingers are hinge joints, and interphalangeal ligaments help restrict hyperextension.

Sprains are classified as grades I, II, and III, corresponding to mild, moderate, and severe injuries. A patient may not seek medical attention for a grade I sprain because the injury is only a stretching of the ligamentous fibers, and the child may feel only mild discomfort with minimal-to-no functional loss. With a grade II sprain, ligaments are partially torn. Tenderness, swelling, and sometimes ecchymosis are present, with mild-to-moderate functional loss. A ligament is completely torn in a grade III sprain, leaving the affected joint unstable, with significant and diffuse tenderness, ecchymosis, and swelling.

The initial evaluation of a joint injury should include general inspection, neurovascular examination, palpation of bony prominences and ligaments, and finally, assessment of joint stability. On general inspection, a gross deformity may represent either a fracture with a significantly displaced bone or a dislocation. Both require emergent attention. …