Sprain

“ The patient complains of pain, often sudden in onset, of tenderness on pressure, and of inability to carry out the particular movement by which the sprain was produced. The disability varies in different cases, and it may incapacitate the patient from following his occupation or sport for weeks or, if imperfectly treated, even for months. ”

“ A sprain, which is an overstrained condition of the ligaments surrounding a joint, frequently requires very careful treatment. When the sprain is at all serious, a physician should be called. Because of the limited supply of blood to the ligaments, they are slow to heal, and the temptation to use the joint before it is fully recovered is always great. Massage82 judiciously applied to a sprained joint, by bringing about a more rapid change in the blood and the lymph, is beneficial both in relieving the pain, and in hastening recovery. ”

“ In many cases a clear account is given of the symptoms which arise when the body is impacted between the articular surfaces, namely, sudden onset of intense sickening pain, loss of power in the limb and locking of the joint, followed by effusion and other accompaniments of a severe sprain. On some particular movement, the body is disengaged, the locking disappears, and recovery takes place. ”

“ The mobility and strength of the joint are recovered gradually.
Perhaps no injury is more frequently mismanaged, by those both in and out of the profession. Every old woman thinks she can cure a sprain; most absurd and hurtful measures are resorted to; the injured parts are kept in motion; cold lotions and cold effusions are employed, and at the same time stimulating frictions: probably attempts are made, either by leeching or by puncturing, to extract the effused blood ”

“ 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 [Pg 177] difficult or impossible ”

“ If inflammation arises, apply cold applications. The only treatment a nurse may give is to keep the patient quiet and await skilled help. [Pg 124]
SPRAINS.
There may be extreme pain, swelling, inflammation, discoloration, and inability to use the joint. Support and elevation of the limb is of the greatest importance. Use hot or cold applications to allay the inflammation and pain. Cover with a thin soft pad, and bandage evenly and firmly. A sprain should not be neglected, as it may cause future disease of the injured part. ”

“ He made an effort to raise his left hand and failed, succumbing to a pain so intense that it forced an exclamation from him.
"I thought it was a sprain," he said, when he recovered himself, "but it is a job for a surgeon. It is broken." ”

“ You remember, no doubt, how I sprained it getting out of the second-story window when the [6] false alarm of fire rang, the afternoon before the real bona fide fire. Dee's first aid to the injured was all very well for the time being, but when we arrived in Richmond a surgeon had to be called to attend to it, and the ankle was put in plaster.
"A sprain can be much more serious than a break," the surgeon said solemnly as he looked at the much swollen foot and ankle. ”

“ Where the chest muscles that cover the ribs are sprained, rubbing and moist heat should be applied over the back and round the side where the sprain is, paying especial attention to the spine opposite the sprain, and using hot olive oil before fomentation and after, as well as to rub with. ”

“ In sprain of the posterior ligaments of the coronet and in sesamoid lameness, nothing but a careful examination and manipulation of the parts will ward off error, for in each of these cases there is 'pointing' and resting of the limb, and considerable disinclination to put weight firmly upon it. If at the same time manipulation gives distinct evidence of pain, all doubt may be set at rest. ”

“ Cold, in some form, is a popular remedy for a sprain, or any injury likely to be followed by inflammatory processes. A very useful remedy for the sprain of an ankle, when it is a recent accident, is to let the patient sit with the foot elevated, with a cloth wrung out in ice water, and an ice bag applied over the affected part. ”

“ The symptoms of fracture are pain, loss12 of motion, change of position, change of contour of the fleshy parts, and most important of all, a light crackling sound when the limb is moved—crepitation the surgeons call it.
Pain following an injury that might produce a fracture is not necessarily proof positive of the existence of a fracture. Pain may and often does follow a bruise, sprain, or dislocation, in a greater degree than that following a fracture. Loss of motion, too, is quite as marked in dislocations and severe sprains as in fractures. ”

“ In many cases you will be able to bring the fever down completely, and then you will be free to exercise the muscles, and so to strengthen them that they will bring the spine to something like its proper shape. (See Assimilation; Diet; Digestion; Nerves; Nourishment; Paralysis; Massage.)
Spine, Weakness of the.—See Children's Healthy Growth.
Sprains or Racks.—A sprain is usually the result of some involuntary stress coming upon the part. If the injury be to the muscular substance only, it is easily healed ”

“ Besides those I have already spoken of as arising from the north wind, old wounds are found to burst out afresh, new ones are very difficult to heal; an apparently trivial sprain will induce a weakness of the part requiring years perhaps to recover from, as I know from my own experience; and lock-jaw from the most trifling accidents is so common as to constitute the cause of a very great portion of the deaths from hurts in the public hospitals. A cut thumb, a nail run into the hand or foot, a lacerated muscle, will generally terminate in it ”

“ In this connexion I will notice another class of cases not so numerous, in which the bone-setter either imagines or pretends there is fracture, when there is nothing but a sprain, or an injury of the nerves of the limb, producing inability of motion. Such cases, at least in old persons, recover slowly. If the bone-setter puts on his splints, he commits a great error, but it is an error that may not be detected. ”

“ The usual cause of a sprain is external violence, such as a fall or a powerful exertion of strength, with following symptoms of soreness, heat, swelling, and a suspension of function. Their termination varies from simple resolution to suppuration, and commonly fibrinous exudation difficult to remove. None of the muscles or tendons of the body are exempt from liability to this lesion, though naturally from their uses and the exposure of their situation the extremities are more liable than other regions to become their seat. ”

“ Treatment.—Since the treatment of severe sprains means first the discrimination between dislocation, a break of bone, and a rupture of muscle, ligament, or tendon, it follows that the methods herein described for treatment should only be employed in slight unmis [Pg 67] takable sprains, or until a surgeon can be secured, or when one is unavailable. Nothing is better than immediate immersion of the sprained joint in as hot water as the hand can bear for half an hour. ”

“ II.—STRAINS OF JOINTS. When, in consequence of muscular contraction or external violence, the bony surfaces constituting a joint are displaced so as to stretch, lacerate, or partially tear the ligaments, synovial capsule or tendons supporting the joint, so-called sprain, or strain, or wrench results. The articular surfaces are not sufficiently displaced to cause luxation, but a series of periarticular injuries result, and are followed by the symptoms which we recognise as those of strain. ”

“ The attachments of the muscles of the loins are probably the parts most affected. The back is kept rigid, and there is pain on movement, particularly on rising from the stooping posture.
Treatment.—Unless carefully treated, a sprain of the spine is liable to cause prolonged disablement. The patient should be kept at rest in bed, and, when the injury is in the cervical region, extension should be applied to the head with the nape of the neck supported on a roller-pillow. Early recourse should be had to massage, but active movements are forbidden till all acute symptoms have disappeared. ”

“ Pain in the legs as from weariness. Contusive pain at left leg. Tingling and twisting pain in the right leg. Itching and smarting at the tibia, in front, at night. 355. Beating above the right knee. Slight itching at the knee, changing to an acute pain when rubbed. Contusive pain at right knee. Spraining sensation in left knee, with cracking when walking. Pain at the left knee as if sprained. 360. Pain as from a sprain in left knee, with dartings below the pan. Violent pain in the feet. Beating pain near the right inner ankle. The left foot burns, the right foot is cold. ”

“ A Sprain is produced by the overstretching of the muscles or ligaments or both about a joint. There may also be some tearing of the fibres or tearing loose from their attachments. This always breaks capillaries or small veins, making the surface black and blue. This discoloration usually appears some time after the accident, because the broken blood vessels are far below the surface.
Treatment—For bruises and strains it is seldom necessary to call a doctor. Apply cold, either by wringing cloths out of cold water and applying, or by holding the injured part under the cold water tap. ”

“ Sprains or Strains and Dislocations Sprains of various joints or parts occur which are more or less grave or serious, depending upon the extent of injury or the joint involved. If a bone is displaced it is termed a dislocation. The joint becomes painful, swelling soon ensues, and on comparing the joint with its fellow, we perceive the distortion; the limb is longer or shorter, and the animal moves it with great difficulty or not at all. If the bone is not moved from its position, but the ligaments are merely injured, or torn, or joints otherwise bruised, it is termed a sprain. ”

“ A pain may be aggravated by position—for example, when the patient is on his feet—or worse when he is lying down—a headache, for instance. Most abdominal pains are worse when the patient is on his feet. (b) A pain may be aggravated by motion. Most of the surgical injuries, sprains, strains, tears of muscle or ligament, and fractures of bones are naturally made worse by motion. Pain may be aggravated by certain particular motions, as is the case with some of the innumerable pains in the back. ”

“ Repair of Sprains.—Blood and synovia are absorbed and torn structures become reunited, but in this process adhesions may form inside the joint and in the surrounding tendon sheaths and interfere with the movement of the joint.
Prognosis.—Stiffness, lasting for a longer or shorter time, follows most sprains, but may be largely prevented by proper treatment. In old and rheumatic persons, changes of the nature of arthritis deformans are liable to supervene, interfering greatly with movement. While suppuration is rare, tuberculous disease is alleged to have resulted from a sprain. ”

“ A scar anywhere is a locus minoris resistentiæ, more liable to be abraded, inflamed, to suffer pain and cold, than are the neighboring parts. A sprained ankle, a dislocated arm, are in danger of being sprained or dislocated again ”

“ Care of Sprains.—The seriousness of sprains is very generally underestimated, and as a consequence many persons go through life with ankles that are abnormally weak, and even painful in bad weather, and in which there is a tendency to swell and become exceedingly troublesome after a slight wrench. ”

“ HOW TO TREAT FRACTURES, SPRAINS AND DISLOCATIONS Several years ago I stood beside a cot in a hunter's cabin in the heart of the Bitter Root Mountains in Idaho, after a three days' ride, and watched a valuable young life go out as the result of an unattended compound fracture of the thigh. ”

“ Pour hot water on the injured joint for an hour at a time, repeating every two or three hours for a day. (If no receptacle is at hand to heat water in fill a hollow rock, log, or waterproof cloth pocket with water, heat a stone in camp fire and put in water for heating.) Bandage the joint and keep applying hot water. Keep the limb elevated. When the swelling goes down rub the skin with oil or grease, gently massaging the injured parts. Don’t over exercise so as to reinjure the torn ligaments. Walking off a sprain won’t cure it, in fact only prolongs recovery. ”

“ Twists or sprains are produced by movements that suddenly put the ligamentous and muscular structures of the spine on the stretch—in other words, by lesser degrees of the same forms of violence as produce dislocation. When the interspinous and muscular attachments alone are torn, the effects are confined to the site of these structures, but when the ligamenta flava are involved, blood may be extravasated and infiltrate the space between the dura and the bone and give rise to symptoms of pressure on the cord. ”

“ Such facts, joined with every one's experience of sprains, show that during the extreme exertions to which limbs are now and then subject, there is a giving way of parts not quite up to the required level of strength. ”

“ Perhaps few if any cases have ever been known, where one of that class of Bone-setters has been called and found no bone out of place. Many of their most remarkable cures have been accomplished several weeks, or perhaps months, after the injury. It is well known that in many cases of sprains, after the active inflammation has subsided, friction and passive motion are some of the best means that can be made use of—and this explains the modus operandi of many of their cures. A man has kept his foot upon a pillow a fortnight, and thinks he cannot move it. ”