Strains and Sprains

At one time or another, almost all of us will suffer a strain or a sprain, most often to the
“soft tissues” (muscles, tendons, ligaments) of the wrist, ankle or knee. Heavy manual labour and
contact sports put you at particular risk of these injuries.

Because the two types of injury have similar names, causes, symptoms and treatments, they are
often mistakenly thought to be the same injury, but of different degrees of severity. Actually, the
distinction between the two depends on the type of soft tissue that’s been hurt

Sprains

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

The areas of your body that are most vulnerable to sprains are your 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 be the result of a sudden twist, and a
wrist sprain can occur when falling on an outstretched hand.

Sprains are classified by severity:

 Grade 1 sprain (mild): Slight stretching and some damage to the fibers (fibrils) 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 causes significant
instability and makes the joint nonfunctional.

Strains

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

Similar to sprains, a strain may be a simple stretch in your muscle or tendon, or it may be a
partial or complete tear in the muscle-and-tendon combination. Typical symptoms of a
strain include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.

Soccer, football, hockey, boxing, wrestling and other contact sports put athletes at risk for
strains, as do sports that feature quick starts, such as hurdling, long jump, and running races.
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, an d
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 serious tear.

Avulsion
An avulsion fracture is an injury to the bone in a location where a tendon or ligament
attaches to the bone. When an avulsion fracture occurs, the tendon or ligament pulls off a piece
of the bone. Avulsion fractures can occur anywhere in the body, but they are more common in a
few specific locations.

Avulsion fractures are more common in children than adults. In adults, the ligaments and tendons
tend to be injured first, whereas in children the bone may fail before the ligament or tendon is
injured. Children have a particularly weak point in their skeleton, called the grow plate. This is
the area of bone that is actively growing. In children, tendons or ligaments near a growth plate
can pull hard enough to cause the growth plate to fracture.

Causes

Often an avulsion fracture occurs when there is a sudden forceful pull on a tendon while
the bone is moving in the opposite direction. An example is an injury to the fifth metatarsal, the
bone on the outside of the midfoot. The peroneal tendon attaches to the base of this bone. Often
when the foot is twisted, a forceful contraction of the peroneal tendon pulls the foot in one
direction, while the twisting force is acting on the foot in the opposite direction. This causes the
bone to crack right where the tendon attaches to the bone. The good news is that these fractures
almost always heal with simple rest and time.

An avulsion injury noted on an X-ray film can also be confusing, because often these may be
related to an old injury. Sometimes a small piece of bone is pulled away from the body a long
time ago, and only when an X-ray is obtained months or years later is the fragment of bone seen.

Treatment

Most often, an avulsion fracture can be treated without surgery. Only when the pulled off
fragment of bone is pulled more than several centimeters from its normal position does surgery
need to be considered.

In addition, some avulsion fractures occur with such small pieces of bone, that often the
fragment need not be fixed. For example, ankle sprains can often cause small avulsion
fragments. These injuries can typically be treated as an ankle sprain, as the small piece of bone
really does not affect the treatment decisions or outcome of the patient.
There are some concerns about treatment when the avulsion fracture involves the growth plate in
a growing child. Because growth plates are important for normal skeletal development, these
injuries must be carefully treated. If there is concern that a growth plate is not correctly
positioned, surgery may be performed to align and stabilize the growth plate