Sprain, or STRAIN, is a term employed in Surgery to designate a violent stretching of tendinous or ligamentous parts with or without rupture of some of their fibres. Sprains are very frequent in all the joints of the upper limbs, especially in the wrist and the articulations of the thumb. In the lower extremity the ankle is the joint by far the most frequently affected; and this is accounted for anatomically by the small size of the articular surfaces, the great weight the astragalus (the bone presenting the lower articular surface) has to support, and the unyielding nature of the lateral ligaments. In slight sprains of this joint the ligaments are only stretched or slightly lacerated, but in more severe cases they may be completely torn through. Sprains of the ankle are sometimes mistaken for fractures, and vice versa; and the two injuries may co-exist. The pain and swelling sometimes make an accurate diagnosis difficult, especially if the patient is not seen for some time after the accident; and if any doubt exists the case should be treated as for the more severe injury, since it is better that the treatment should be prolonged than that the patient should be maimed; and fortunately that which is the proper treatment of a fracture will also suit a sprain well, at least till the swelling subsides, and the doubt can be resolved. Sprains of the knee are not uncommon, and are characterised by great swelling from effusion of fluid within the joint. Sprains of the back are not unfrequent accidents, and are the most serious of any, but in most cases it may be anticipated that after confinement in bed or on a sofa for two or three weeks, and with proper treatment, the patient will be able to walk, although he may feel stiffness and pain for several weeks longer.
The best treatment of a sprain depends chiefly upon the time that has elapsed since the injury. If the patient is seen before swelling has occurred the application of cold by means of ice-bags or running water, especially if a thin india-rubber bandage is previously applied, does much to control the swelling and the pain. At a later stage, if the pain be severe, warm applications (hot water, hot fomentations, or poultices) are generally very soothing; or lead and opium lotion may be employed. Where the swelling is very great leeches are sometimes most useful. When the pain is not very intense the joint may be enveloped in a large quantity of cotton-wool, and gently but very firmly bandaged. It is important not to keep the injured joint too long at rest. As soon as the pain has subsided massage and gentle movements should be commenced; the patient should not be allowed to use the limb himself till these can be quite freely borne. In sprains of the back rest is the main requisite; but sometimes active antiphlogistic treatment is required; and a supporting jacket of gutta-percha or plaster of Paris may have to be worn for some time.
Amongst horses sprains or strains are very common, owing to the severe exertions required of them, often whilst they are young, and unprepared for such work. Various muscles, ligaments, and tendons are liable to strain, but none more frequently than the large tendons passing down the back of the legs. In slight cases cold water continuously applied for several hours gives relief; but in all serious cases diligent fomentation with water about the temperature of 100° is preferable; or the injured part may be swathed in a thick woollen rug, kept constantly moist and warm by frequent wetting with the hot water. Perfect rest is essential, and in order to ensure the relaxation of the large tendons of the horse's limbs he may in bad cases be kept slung for several days. Blisters, hot oils, firing, and all such irritants are on no account to be used until the inflammation abates and the part becomes cool and free from tenderness. Such remedies are then useful for causing the reabsorption of swelling, and perhaps also for invigorating the weakened part.