Trauma, Sprains & Strains

Key Features

• 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

Clinical Findings

• 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

Diagnosis

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

Treatment

• 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 ...