Strains, sprains and dislocations

For the layperson it is often difficult to diagnose these injuries. It is also quite common for two or more of these conditions to occur simultaneously with one injury.

The good news is we don’t have to diagnose them since the first aid for all three is basically the same.

First, let’s look at the mechanics of each injury. A strain or ‘pulled muscle’ occurs when there is a stretch or tear in the muscle fibers or tendons (the fibrous tissues that connect muscles to bone).

These injuries are common to the back, neck, and legs (hamstrings) due to excessive activity or improper lifting.

A sprain is a bit more serious and occurs when ligaments (the bands of cordlike tissue that connect bone to bone) also stretch or tear.

This injury is common in the wrists, knees, and ankles due to a sudden wrench or twist that forces the bones to separate.

The signs and symptoms of strains and sprains are the same and usually include pain or tenderness at the injury site. Depending on the severity of the injury there may also be swelling and bruising present.

Dislocations are a separation of the end of a bone and the joint it meets and are most common in the shoulders, fingers, elbows, ankles and hips.

Injuries related to dislocations include damage to the membrane lining the joint as well as tears to the surrounding muscles and ligaments.

A dislocated joint may appear misshapen, discoloured and swollen, and the patient may complain of severe pain.

Since it is often difficult to tell the difference between a dislocation and a fracture (broken bone) it is wise to seek medical attention if you suspect a dislocation. Also, never try to put a dislocated bone back into its socket – leave this to the professionals.

Since strains, sprains, and dislocations may be the result of a serious accident, start first aid by checking the ABCD’S of the patients ‘lifeline’. Once you have established that the patient is breathing and has circulation, and you have treated for spinal injury, serious bleeding and shock where necessary, begin treating the injury with the R.I.C.E. method.

R.I.C.E. stands for Rest, Ice, Compression and Elevation. Avoid moving the injured part while you are treating it.

If your patient will not be seeking medical attention, persuade them to rest the injury, especially for the first 24 to 48 hours. Tell them to use crutches if the injury is to an ankle or knee, or a sling if the shoulder, elbow or wrist is injured. Ice is an excellent anti-inflammatory and reduces swelling and pain. Apply a cold compress or ice pack to the injury as soon as possible and encourage your patient to continue this treatment in 20 minute intervals (20 minutes on, 20 minutes off) for at least the first two days.

If an ice pack is not available a package of frozen vegetables works great. Never apply ice directly to the skin, use a thin cloth or some kind of barrier.

Compression can help to immobilize the injury and also reduce swelling by stopping fluid from seeping into the area. Use an elastic bandage to wrap the injury and tell your patient to keep it on for at least two days.

Bandages should be snug but not too tight and should be taken off at night.

Elevation drains fluids from injured tissues and will also reduce swelling. Elevate the injury above heart level if possible and tell your patient to keep it elevated whenever they are sitting or lying down.

Anti-inflammatory pain relievers such as Ibuprophen or Aspirin (ASA) can be suggested to the patient to make them more comfortable while the injury is healing.

If the patient follows the R.I.C.E method, strains usually heal in a week or so and sprains in about three weeks. For a dislocation, once it has been reset, six weeks of R.I.C.E. or longer may be required for the injury to heal.

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