Wilderness Orthopedics – Sprains and Strains

Sprains & Strains:Sprains and strains are by far the most common backcountry injuries.
Sprains and strains are injuries to muscles, tendons, ligaments, and the supporting structures of joints.

Signs & Symptoms of a Sprain/Strain:
Think of how a sprained ankle appears.
There is generalized pain and tenderness around the affected joint.
Unlike a fracture that is no point tenderness, if there is then suspect a fracture.
There is pain with movement of the affected joint.
There is pain with weight-bearing or use of the affected joint.
Swelling can be rapid and dramatic because of bleeding from the damaged blood vessels.
The area may become discolored over several hours, “black and blue” = ecchymosis.

Evaluation of a sprain/strain:
Consider the mechanism of injury.
Expose the injured area to look at the injury and the skin.
That includes removing boots and socks.
You cannot properly evaluate an injury that is hidden by clothing.
Gently palpate the area for pain, tenderness, and crepitation.
Put the injured joint through passive range of motion, that is, you gently move the joint and monitor for pain, loss of motion, or crepitation.
Loss of motion, a locked joint, indicates a dislocation.
Crepitation indicates a fracture.

Treatment: 
The goal is to minimize swelling. The less the sprain swells the faster it will heal. We use the acronym RICE to remind us of the principles to control swelling:
REST, ICE, COMPRESSION, & ELEVATION  
Rest, put the affected joint at rest. This will minimize blood flow and chance of further injury.
Ice, keep the area cool, this causes vasoconstriction thus reducing bleeding into the damaged tissues.
Compression, with a wide ACE wrap applies counter pressure to damaged tissues, again helping to control bleeding.
Elevation, raise the affected area above the level of the heart to decrease blood pressure and aid in the control of bleeding.
Immobilize & support affected joint. Splinting the affected area puts the injury at rest allowing the healing process to begin and continue.

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