Nursing Care Plan | NCP Sprains and Strains

Sprains and strains are commonplace injuries of the joints and muscles. A sprain is a stretching or tearing of a ligament—one of the tough bands of fibrous tissue that connects bones to other bones. A strain is an injury to a muscle or tendon. Both types of injury can occur in various parts of the body, depending on the location of an injury or the part of the body that has been overused. The most common locations for sprains are the ankle, knee, or thumb. The most common cause of an ankle sprain is called an inversion injury; it occurs when the foot turns inward when a person falls on the ankle or lands on it after a jump. Less commonly, the ankle is injured when the foot turns outward suddenly; this is called an eversion injury. Knee sprains are most likely to occur as the result of a blow to the knee or falling on the knee. Thumb sprains are most likely to occur in skiers. Strains most commonly affect the muscles of the back; the hamstring muscle at the back of the thigh; the muscles of the hand and forearm; and the muscles of the upper arm and elbow. Sprains can be classified according to severity as well as location.

Doctors usually distinguish three levels of sprains:

• Mild (sometimes called first-degree sprain): The ligament is mildly stretched or has a minor tear.

• Moderate (second-degree sprain): The ligament is torn but not completely ruptured.

• Severe (third-degree sprain): One or more ligaments are completely ruptured.

Strains can be categorized according to the type of damage caused to the injured muscle:

• The muscle tissue may tear.

• The area where the muscle joins its tendon may tear.

• The tendon itself may tear or rupture.

The experience of a sprain may vary from mild discomfort lasting a few minutes or hours to inability to walk or use the affected joint. In many cases the person will feel a popping or tearing sensation in the joint:

• First-degree sprain: The affected joint feels sore and hurts when it is moved, but there is not much swelling and the person can put weight on the joint.

• Second-degree sprain: The affected joint is sore, swollen, and difficult to move. There may be bruising from blood leaking into the joint. The person may feel shaky or unsteady if they try to put weight on the joint.

• Third-degree sprain: The affected joint is very painful, bruised, and swollen. The person may not be able to move it at all, and the injury may be difficult to distinguish

from a bone fracture or dislocation.

A strain is usually experienced as pain in the area of the injured muscle along with cramping or spasms in the muscle, limited range of motion, and weakness in the muscle. There may also be swelling and inflammation in the affected area.

Sprains and strains are very common injuries in the general population; according to the National Institutes of Health (NIH), there are about 25,000 ankle sprains each day in the United States. Although amateur and professional athletes are somewhat more likely to be injured, anyone whose occupation involves lifting heavy objects, repetitive movements, or the use of power tools may develop sprains or strains. Elderly people and others at risk of falls are also more likely to sprain the knee or ankle joints.

Sprains and strains are equally common in both sexes and in all races and ethnic groups. Some people are at increased risk of sprains and strains:

• People who are in poor physical condition or who exercise when they are tired or unwell.

• People who are obese.

• People who are not using the proper techniques for their sport or occupation. Dancers, skaters, or skiers who have not been taught to jump and land properly, for example, are more likely to sprain an ankle or knee.

• People who do not warm up before athletic activities.

• People with diabetes.

• People who take medications that make them drowsy or affect their sense of balance.

• People with a history of repeated joint or muscle injuries.

Nursing Care Plan Signs and Symptoms

The causes of sprains and strains include accidental falls, sports injuries, overuse of weak or injured muscles, improper techniques for lifting or carrying heavy objects, repetitive use of muscles without adequate rest, or unusual stresses on a normally healthy joint or muscle. The symptoms of sprains and strains have already been described.

Nursing Care Plan Diagnosis

Mild sprains and strains can usually be diagnosed by a primary care doctor by taking the patient’s history and examining the affected joint and the tissues surrounding it. The doctor may refer the patient to an orthopaedics specialist for further evaluation of the injury. X rays may be taken to rule out broken bones but are not usually helpful in diagnosing soft tissue injuries. The doctor may order a magnetic resonance imaging (MRI) test for better evaluation of injuries to ligaments and muscles. Numbness in the affected joint may indicate nerve damage, while coldness may indicate a problem with circulation. Either of these symptoms, or the possibility that a bone is broken or dislocated, means that the patient should go to an emergency room as quickly as possible.

Nursing Care Plan Treatment

Mild sprains and strains can be treated at home by using the PRICE approach for twenty-four to forty-eight hours:

• Protection. Protecting the injured joint or muscle involves avoiding unnecessary movement of the affected area.

• Rest. Rest means avoiding activities or body movements that make the pain or swelling in the joint worse; it doesn’t mean complete bed rest.

• Ice. An ice pack can be applied to the affected area for fifteen to twenty minutes every four to six hours for one to two days.

• Compression. Compression refers to the use of a wrap, air cast, or Ace bandage to keep swollen muscles from restricting movement in an injured joint.

• Elevation. Raising the affected arm, leg, elbow, or wrist on a pillow or cushion (above heart level) is helpful in relieving swelling in the affected muscle or joint.

Nonsteroidal anti-inflammatory drugs, or NSAIDs, can be used to relieve pain and inflammation in the sore joint or muscle. These drugs include aspirin as well as Tylenol and Advil. Moderate and severe injuries require a combination of immobilizing the affected joint with a splint or cast followed by physical therapy and rehabilitation to restore muscle strength and range ofmotion in the affected joint. In some cases, surgery may be needed to repair a ruptured ligament or muscle.

Prognosis

The prognosis for recovery from sprains and strains is very good with appropriate medical treatment and self-care at home. It is important, however, for patients to follow the doctor or physical therapist’s recommendations carefully to avoid re-injury. A mild ankle sprain may require several weeks of rehabilitation; a moderate sprain could require two to three months. With a severe sprain, it can take as long as eight to twelve months to return to full activity. These time frames may be even longer in elderly patients.

Nursing Care Plan Prevention

People can reduce their risk of sprains and strains by taking the following precautions:

• Avoiding sports or physical exercise when tired, ill, or in physical pain.

• Maintaining a healthy weight and eating a nourishing diet that keeps muscles strong.

• Wearing shoes that fit properly, and replacing athletic shoes as soon as the tread is worn or the heel wears unevenly.

• Doing daily stretching exercises. Yoga is a good low-impact way to stretch muscles.

• Warming up and stretching before participating in vigorous sports.

• Wearing appropriate protective equipment for baseball, football, hockey, and other similar sports.

• Being in good physical condition before playing sports.

• If running, running on even rather than rough or irregular surfaces.

• Putting safety measures in place to prevent falls, such as keeping stairways, walkways, yards, and driveways free of clutter and well lighted; making sure that rugs are anchored and electrical wires are secured; putting grab bars in shower stalls; and salting or sanding icy sidewalks and driveways in the winter.

The Future

Sprains and strains are likely to continue to be commonplace health problems given that so many sports and occupations put people at risk for injuries to muscles and joints.