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Key Features

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  • A sprain is the stretching of a ligament

  • A strain is a stretch of a muscle or tendon

  • Contusions are generally due to tissue compression, with damage to blood vessels within the tissue and the formation of a hematoma

  • Fall on outstretched hand (FOOSH) is most common mechanism

  • Rule out physeal fracture

  • Early protected motion for sprains and strains

  • Reduction and immobilization for fractures

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Clinical Findings

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  • Ankle sprains

    • History will indicate whether the injury was by either forceful inversion or eversion

      • Inversion injury is more common and results in tearing or injury to the lateral ligaments

      • Eversion injury injures the medial ligaments of the ankle

    • The injured ligaments can be identified by careful palpation for point tenderness around the ankle

  • Knee sprains

    • Sprains of the collateral and cruciate ligaments are uncommon in children

    • In adolescence, rupture of the anterior cruciate ligament can result from a rotational injury

    • Differential diagnosis

      • Torn ligament

      • Torn meniscus

      • Osteochondral fracture

  • Internal derangements of the knee

    • Meniscal injuries are uncommon in children younger than 12 years

    • Clicking or locking of the knee may occur in young children as a result of a discoid lateral meniscus, which is a rare congenital anomaly

    • As the child approaches adolescence, internal damage to the knee from a torsion weight-bearing injury may result in locking of the knee if tearing and displacement of a meniscus occurs

    • Posttraumatic synovitis may mimic a meniscal lesion

    • Epiphysial injury should be suspected in any severe injury to the knee or when there is tenderness on both sides of the femoral metaphysis after injury

    • Stress films will sometimes demonstrate separation of the distal femoral epiphysis

  • Back sprains

    • Sprains of the ligaments and muscles of the back are unusual in children but may occur as a result of violent trauma from automobile accidents or athletic injuries

    • Sprains usually cause lateral and midline pain over musculature

    • Back pain in a child may be the only symptom of significant disease and warrants clinical investigation

    • Inflammation, infection, kidney disease, or tumors can cause back pain in children, and sprain should not be accepted as a routine diagnosis

  • Contusions: Muscle contusions with hematoma formation produce the familiar "charley horse" injury

  • Myositis ossificans

    • Ossification within muscle occurs when sufficient trauma causes a hematoma that later heals in the manner of a fracture

    • Contusions of the quadriceps or the triceps are the most common injuries

    • Disability is great, with local swelling, heat and extreme pain with the slightest provocation of the adjacent joint

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Diagnosis

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  • Directed physical examination (eg, swelling, tenderness, deformity, instability) and radiographic examination

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Treatment

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  • Soft tissue trauma

    • Initial treatment of any sprain consists of ice, compression, and elevation

    • Brief splinting followed by early range of motion exercises of the affected joint protect against further injury and relieves swelling and pain

    • Ibuprofen and other nonsteroidal anti-inflammatory drugs are useful for pain

    • If ...

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