General Orthopedics

What are Sprains and Strains?

Sprains and strains are injuries affecting the muscles and ligaments. A sprain is an injury or tear of one or more ligaments that commonly occurs at the wrist, knee, ankle or thumb. A strain is an injury or tear to the muscle. Strains occur commonly in the back and legs.

Causes of Sprains and Strains

Sprains and strains occur due to overstretching of the joints during sports activities and accidents such as falls or collisions. It may be due to fatigue or not warming up before an activity.

Symptoms of Sprains and Strains

• Pain
• Swelling
• Tenderness
• Bruising
• Joint stiffness

• Muscle spasm and weakness
• Pain in the affected area
• swelling
• Redness
• bruising

Immediate Care for Sprains and Strains

• Protection: Protect the injured area with the help of a support.
• Rest: Rest the affected area as more damage could result from putting pressure on the injury.
• Ice: Ice should be applied over a towel to the affected area for 15-20 minutes every two to three hours during the day.  Never place ice directly over the skin.
• Compression: Wrapping with an elastic bandage or an elasticated tubular bandage can help to minimize the swelling and provide support to the injured area.
• Elevation: Elevating the injured area above heart level will also help with swelling and pain. 

Diagnosis of Sprains and Strains

Diagnosis involves a thorough physical examination. Your doctor will inspect the area of injury and see how well you move the muscle or joint. X-rays or other tests may be ordered to rule out fractures or other problems.

Treatment of Sprains and Strains

Your doctor may prescribe nonsteroidal anti-inflammatory drugs to reduce the pain and inflammation of a sprain or strain. A period of bracing may be necessary. Physiotherapy may be recommended for moderate to severe injuries. Surgery is rarely needed but may be suggested for torn ligaments and tendons.
Most sprains and strains show significant improvement in about 2 weeks. Severe injuries sometimes take months to heal. Strenuous activity should be avoided for at least 8 weeks to allow proper healing.

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body's natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.

The cartilage is a padding that absorbs stress. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.

There are over 100 different types of rheumatic diseases. The most common are:

Osteoarthritis: Osteoarthritis is also called as degenerative joint disease; this is the most common type of arthritis, which occurs often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called bone spurs.

Osteoarthritis causes joint pain and can limit a person's normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine, knees and hips.

Rheumatoid Arthritis: This is an auto-immune disease in which the body's immune system (the body's way of fighting infection) attacks healthy joints, tissues and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform or change a joint. For example, the joints in a person's finger can become deformed, causing the finger to bend or curve.

Rheumatoid arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (both hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.

Post-traumatic arthritis: Arthritis developing following an injury to hand, wrist or elbow is called as post-traumatic arthritis. The condition may develop years after the trauma such as a fracture, severe sprain or ligament tears.

Psoriatic arthritis: This form of arthritis occurs in some persons with psoriasis, a scaling skin disorder, affecting the joints at the ends of the fingers and toes. It can also cause changes in the fingernails and toenails. Back pain may occur if the spine is involved.

Causes of arthritis

Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity. Primary osteoarthritis is commonly associated with ageing and general degeneration of joints.

Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.

Rheumatoid arthritis is often caused when the genes responsible for the disease are triggered by infection or any environmental factors. With this trigger, the body produces antibodies, the defense mechanism of the body, against the joint and may cause rheumatoid arthritis.

Fractures at joint surfaces and joint dislocations may predispose an individual to develop post-traumatic arthritis. It is considered that your body secretes certain hormones following injury which may cause death of the cartilage cells.

Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause deformity.

Symptoms of arthritis

There are more than 150 different forms of arthritis. Symptoms vary according to the form of arthritis. Each form affects the body differently. Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of joint, early morning stiffness, and skin changes including rashes.

Diagnosis

Doctors diagnose arthritis with a medical history, a physical exam and X-rays of the affected part. Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans are also performed to diagnose arthritis.

Treatment Options

There is no cure for arthritis. Your doctor may prescribe anti-inflammatory medicine. Your doctor may recommend occupational therapy or physiotherapy, which includes exercises and heat treatment. In severe cases, surgery may be suggested. The type of surgery will depend on your age and severity of the disease. In the elderly, with severe arthritis, joint replacement can give good results.

Initial treatment for arthritis is conservative, consisting of rest, avoidance of vigorous weight-bearing activities, and the use of non-narcotic analgesic and/or anti-inflammatory medications. With worsening symptoms, a cane or braces may be helpful. For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted, offer no relief, and have become disabling, surgery may be recommended. Surgery is usually considered if non-surgical treatment fails to give relief. There are different surgical procedures that can be used and may include:

Synovectomy: This surgery is usually indicated for early cases of inflammatory arthritis where there is significant swelling (synovitis) that is causing pain or is limiting the range of motion. Synovectomy is a surgical removal of the inflamed synovium (tissue lining the joint). The procedure may be performed using arthroscopy.

Arthroplasty: In this procedure, your surgeon removes the affected joint and replaces it with an artificial implant. It is usually performed when the joint is severely damaged by osteoarthritis, rheumatoid arthritis, post-traumatic arthritis or avascular necrosis. The goal of the surgery is to relieve pain and restore the normal functioning of the joint. Total joint replacement can be performed through an open or minimally invasive approach.

Arthrodesis: A fusion, also called an arthrodesis, involves removal of the joints and fusing the bones of the joint together using metal wires or screws. This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, damage to the surrounding ligaments and tendons, failed previous arthroplasty, and when heavy manual use is expected.

Your surgeon will discuss the options and help you decide which type of surgery is the most appropriate for you.