A. Sprain: First aid
Mayo Clinic Health Information
Your ligaments are tough, elastic-like bands that connect bone to bone and hold your joints in place. A sprain is an injury to a ligament caused by excessive stretching. The ligament can have a partial tear, or it can be completely torn apart.
Of all sprains, ankle and knee sprains occur most often. Sprained ligaments swell rapidly and are painful. Generally, the greater the pain, the more severe the injury is. For most minor sprains, you probably can treat the injury yourself.
General instructions for the, P.R.I.C.E., sprain treatment
1. Protect the injured limb from further injury by not using the joint. You can do this using anything from splints to crutches.
2. Rest the injured limb. But don’t avoid all activity. Even with an ankle sprain, you can usually still exercise other muscles to minimize deconditioning. For example, you can use an exercise bicycle with arm exercise handles, working both your arms and the uninjured leg while resting the injured ankle on another part of the bike. That way you still get three-limb exercise to keep up your cardiovascular conditioning.
3. Ice the area. Use a cold pack, a slush bath or a compression sleeve filled with cold water to help limit swelling after an injury. Try to ice the area as soon as possible after the injury and continue to ice it for 10 to 15 minutes four times a day for 48 hours. If you use ice, be careful not to use it too long, as this could cause tissue damage.
4. Compress the area with an elastic wrap or bandage. Compressive wraps or sleeves made from elastic or neoprene are best.
5. Elevate the injured limb above your heart whenever possible to help prevent or limit swelling.
After two days, gently begin using the injured area. You should feel a gradual, progressive improvement. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others), may be helpful to manage pain during the healing process.
See your doctor if your sprain isn’t improving after two or three days.
Get emergency medical assistance if:
• You’re unable to bear weight on the injured leg, the joint feels unstable or you can’t use the joint. This may mean the ligament was completely torn. On the way to the doctor, apply a cold pack.
• You have a fever higher than 100 F (37.8 C), and the area is red and hot. You may have an infection.
• You have a severe sprain. Inadequate or delayed treatment may cause long-term joint instability or chronic pain.
B. Knee injury
Mayo Clinic Health Information
Knee pain is a common complaint that affects people of all ages. Knee pain may be the result of an injury, such as a ruptured ligament or torn cartilage. Medical conditions — including arthritis, gout and infections — also can cause knee pain.
Many types of minor knee pain respond well to self-care measures. Physical therapy and knee braces also can help relieve knee pain. In some cases, however, your knee may require surgical repair.
The location and severity of knee pain may vary, depending on the cause of the problem. Signs and symptoms that sometimes accompany knee pain include:
• Swelling and stiffness
• Redness and warmth to the touch
• Weakness or instability
• Popping or crunching noises
• “Locking,” or inability to fully straighten the knee
When to see a doctor
• Can’t bear weight on your knee
• Have marked knee swelling
• Are unable to fully extend or flex your knee
• See an obvious deformity in your leg or knee
• Have a fever, in addition to redness, pain and swelling in your knee
• Fall because your knee “gives out”
Knee pain can be caused by injuries, mechanical problems, types of arthritis and other problems.
A knee injury can affect any of the ligaments, tendons or fluid-filled sacs (bursae) that surround your knee joint as well as the bones, cartilage and ligaments that form the joint itself. Some of the more common knee injuries include:
• ACL injury. An ACL injury is the tearing of the anterior cruciate ligament (ACL) — one of four ligaments that connect your shinbone to your thighbone. An ACL injury is particularly common in people who play basketball or go downhill skiing, because it’s linked to sudden changes in direction.
• Torn meniscus. The meniscus is formed of tough, rubbery cartilage and acts as a shock absorber between your shinbone and thighbone. It can be torn if you suddenly twist your knee while bearing weight on it.
• Knee bursitis. Some knee injuries cause inflammation in the bursae, the small sacs of fluid that cushion the outside of your knee joint so that tendons and ligaments glide smoothly over the joint.
• Patellar tendinitis. Tendinitis is irritation and inflammation of one or more tendons — the thick, fibrous cords that attach muscles to bones. Runners, skiers and cyclists are prone to develop inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the shinbone.
• Loose body. Sometimes injury or degeneration of bone or cartilage can cause a piece of bone or cartilage to break off and float in the joint space. This may not create any problems unless the loose body interferes with knee-joint movement — the effect is something like a pencil caught in a door hinge.
• Knee ‘locking.’ This can occur from a cartilage tear. When a portion of cartilage from the tear flips inside the knee-joint, you may not be able to fully straighten your knee.
• Dislocated kneecap. This occurs when the triangular bone (patella) that covers the front of your knee slips out-of-place, usually to the outside of your knee. You’ll be able to see the dislocation, and your kneecap is likely to move excessively from side to side.
• Hip or foot pain. If you have hip or foot pain, you may change the way you walk to spare these painful joints. But this altered gait can interfere with the alignment of your kneecap and place more stress on your knee joint. In some cases, problems in the hip or foot can refer pain to the knee.
Types of arthritis
• Osteoarthritis: Sometimes called degenerative arthritis, osteoarthritis is the most common type of arthritis. It’s a wear-and-tear condition that occurs when the cartilage in your knee deteriorates with use and age.
• Rheumatoid arthritis: The most debilitating form of arthritis, rheumatoid arthritis is an autoimmune condition that can affect almost any joint in your body, including your knees. Although rheumatoid arthritis is a chronic disease, it tends to vary in severity and may even come and go.
• Gout: This type of arthritis occurs when uric acid crystals build up in the joint. While gout most commonly affects the big toe, it can also occur in the knee.
• Pseudogout: Often mistaken for gout, pseudogout is caused by calcium pyrophosphate crystals that develop in the joint fluid. Knees are the most common joint affected by pseudogout.
• Septic arthritis: Sometimes your knee joint can become infected, leading to swelling, pain and redness. There’s usually no trauma before the onset of pain. Septic arthritis often occurs with a fever.
• Iliotibial band syndrome. This occurs when the ligament that extends from the outside of your pelvic bone to the outside of your tibia (iliotibial band) becomes so tight that it rubs against the outer portion of your femur. Distance runners are especially susceptible to iliotibial band syndrome.
• Chondromalacia patellae (patellofemoral pain syndrome). This is a general term that refers to pain arising between your patella and the underlying thighbone (femur). It’s common in young adults, especially those who have a slight misalignment of the kneecap; in athletes; and in older adults, who usually develop the condition as a result of arthritis of the kneecap.
• Osteochondritis dissecans. Caused by reduced blood flow to the end of a bone, osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone. It occurs most often in young men, particularly after an injury to the knee.
A number of factors can increase your risk of having knee problems, including:
• Age: Certain types of knee problems are more common in young people — Osgood-Schlatter disease and patellar tendonitis, for example. Others, such as osteoarthritis, gout and pseudogout, tend to affect older adults.
• Sex: Teenage girls are more likely than are boys to experience an ACL tear or a dislocated kneecap. Boys, on the other hand, are at greater risk of Osgood-Schlatter disease and patellar tendonitis than girls are.
• Excess weight: Being overweight or obese increases stress on your knee joints, even during ordinary activities such as walking or going up and down stairs. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.
• Mechanical problems: Certain structural abnormalities, such as having one leg shorter than the other, misaligned knees and even flat feet, can make you more prone to knee problems.
• Lack of muscle flexibility or strength: A lack of strength and flexibility are among the leading causes of knee injuries. Tight or weak muscles offer less support for your knee because they don’t absorb enough of the stress exerted on the joint.
• Certain sports: Some sports put greater stress on your knees than do others: Alpine skiing with its sharp twists and turns and potential for falls, basketball’s jumps and pivots, and the repeated pounding your knees take when you run or jog all increase your risk of knee injury.
• Previous injury: Having a previous knee injury makes it more likely that you’ll injure your knee again.
Not all knee pain is serious. But some knee injuries and medical conditions, such as osteoarthritis, can lead to increasing pain, joint damage and even disability if left untreated. And having a knee injury — even a minor one — makes it more likely that you’ll have similar injuries in the future.
Treatments and drugs
Treatments will vary, depending upon what exactly is causing your knee pain.
Medications. Your doctor may prescribe medications to help relieve pain and to treat underlying conditions, such as rheumatoid arthritis or gout.
• Physical therapy. Strengthening the muscles around your knee will make it more stable. Training is likely to focus on the muscles on the front of your thigh (quadriceps) and the muscles in the back of your thigh (hamstrings). Exercises to improve your balance are also important.
• Orthotics and bracing. Arch supports, sometimes with wedges on the inner or outer aspect of the heel, can help to shift pressure away from the side of the knee most affected by osteoarthritis. Different types of braces may help protect and support the knee joint.
• Corticosteroids. Injections of a corticosteroid drug into your knee-joint may help reduce the symptoms of an arthritis flare and provide pain relief that lasts a few months. The injections aren’t effective in all cases. There is a small risk of infection.
• Hyaluronic acid. This thick fluid is normally found in healthy joints, and injecting it into damaged ones may ease pain and provide lubrication. Experts aren’t quite sure how hyaluronic acid works, but it may reduce inflammation. Relief from a series of shots may last as long as six months to a year.
If you have an injury that may require surgery, it’s usually not necessary to have the operation immediately. Before making any decision, consider the pros and cons of both nonsurgical rehabilitation and surgical reconstruction in relation to what’s most important to you. If you choose to have surgery, your options may include:
• Arthroscopic surgery. Depending on the nature of your injury, your doctor may be able to examine and repair your joint damage using a fiber-optic camera and long, narrow tools inserted through just a few small incisions around your knee. Arthroscopy may be used to remove loose bodies from your knee joint, repair torn or damaged cartilage and reconstruct torn ligaments.
• Partial knee replacement surgery. In this procedure (unicompartmental arthroplasty), your surgeon replaces only the most damaged portion of your knee with parts made of metal and plastic. The surgery can usually be performed with a small incision, and your hospital stay is typically just one night. You’re also likely to heal more quickly than you are with surgery to replace your entire knee.
• Total knee replacement. In this procedure, your surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap, and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.
Lifestyle and home remedies
Over-the-counter medications — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — may help ease knee pain. Some people find relief by rubbing their knees with creams containing such ingredients as lidocaine, a numbing agent; or capsaicin — the substance that makes chili peppers hot.
Self-care measures for an injured knee include: (Think, ‘R.I.C.E’.)
• Rest: Taking a break from your normal activities reduces repetitive strain on your knee, gives the injury time to heal and helps prevent further damage. A day or two of rest may be all that’s needed for minor injuries. More severe damage is likely to need a longer recovery time.
• Ice: A staple for most acute injuries, ice reduces both pain and inflammation. A bag of frozen peas works well because it covers your whole knee. You can also use an ice pack wrapped in a thin towel to protect your skin. Although ice therapy is generally safe and effective, don’t use ice for longer than 20 minutes at a time because of the risk of damage to your nerves and skin.
• Compression: This helps prevent fluid buildup in damaged tissues and maintains knee alignment and stability. Look for a compression bandage that’s lightweight, breathable and self-adhesive. It should be tight enough to support your knee without interfering with circulation.
• Elevation: Because gravity drains away fluids that might otherwise accumulate after an injury, elevating your knee can help reduce swelling. Try propping your injured leg on pillows or sitting in a recliner.
Although it’s not always possible to prevent knee pain, the following suggestions may help forestall injuries and joint deterioration:
• Keep extra pounds off: Maintaining a healthy weight is one of the best things you can do for your knees — every extra pound puts additional strain on your joints, increasing the risk of ligament and tendon injuries and even osteoarthritis.
• Get strong, stay limber: Because weak muscles are a leading cause of knee injuries, you’ll benefit from building up your quadriceps and hamstrings, which support your knees. Balance and stability training helps the muscles around your knees work together more effectively. And because tight muscles also can lead to injury, stretching is important. Try to include flexibility exercises in your workouts.
• Be smart about exercise: If you have osteoarthritis, chronic knee pain or recurring injuries, you may need to change the way you exercise. Consider switching to swimming, water aerobics or other low-impact activities — at least for a few days a week. Sometimes simply limiting high-impact activities will provide relief.
C. Sprained ankle
Mayo Clinic Health Information
A sprained ankle is a common injury. Sometimes, all it takes to sprain your ankle is a roll, twist or turn of your ankle in an awkward way. This unnatural movement can stretch or tear the ligaments that help hold your ankle together.
Ligaments are tough, elastic bands of fibrous tissue that connect one bone to another. They help stabilize joints, preventing excessive movement. A sprained ankle occurs when the ligaments are forced beyond their normal range of motion.
Treatment for a sprained ankle depends on the severity of the injury. Although self-care measures and over-the-counter pain medications may be all you need, a medical evaluation might be necessary to reveal how badly you’ve sprained your ankle and to put you on the right path to recovery.
Signs and symptoms of a sprained ankle include:
• Pain, especially when you bear weight on it
• Swelling and, sometimes, bruising
• Restricted range of motion
Some people hear or feel a “pop” at the time of injury.
When to see a doctor
Call your doctor if you have pain and swelling in your ankle and you suspect a sprain. Self-care measures may be all you need, but talk to your doctor to discuss whether you should have your ankle evaluated. If your signs and symptoms are severe, it’s possible you may have broken a bone in your ankle or lower leg.
A sprain occurs when your ankle is forced to move out of its normal position, which forces one or more of the ligaments that surround and stabilize the bones out of its usual range of motion, causing the ligament to stretch or tear.
Examples of situations that can result in an ankle sprain include:
• A fall that causes your ankle to twist
• Landing awkwardly on your foot after jumping or pivoting
• Walking or exercising on an uneven surface
Factors that increase your risk of a sprained ankle include:
• Sports participation. Ankle sprains are a common sports injury. Sports that require rolling or twisting your foot, such as basketball, tennis, football, soccer and trail running, can make you vulnerable to spraining your ankle, particularly if you’re overweight. Playing sports on an uneven surface also can increase your risk.
• Prior ankle injury. Once you’ve sprained your ankle, or had another type of ankle injury, you’re more likely to sprain it again.
If a sprained ankle is left untreated, if you engage in activities too soon after spraining your ankle or if you sprain your ankle repeatedly, you may experience the following complications:
• Chronic pain
• Chronic joint instability
• Early onset arthritis in that joint
Tests and diagnosis
If the injury is severe, your doctor may recommend imaging scans to rule out a broken bone or to more precisely evaluate the soft tissue damage.
During an X-ray, a small amount of radiation passes through your body to produce images of your internal structures. This test is good for bones but is less effective at visualizing soft tissues. Tiny cracks or stress fractures in bones may not show up, especially at first, on regular X-rays.
__2. Bone scan
For a bone scan, a technician will inject a small amount of radioactive material into an intravenous line. The radioactive material is attracted to your bones, especially the parts of your bones that have been damaged. Damaged areas show up as bright spots on an image taken by a scanner. Bone scans are good at detecting stress fractures.
__3. Computerized tomography (CT)
CT scans are useful because they can reveal more detail about the joint and the soft tissues that surround it. CT scans take X-rays from many different angles and combine them to make cross-sectional images of internal structures of your body.
__4. Magnetic resonance imaging (MRI)
MRIs use radio waves and a strong magnetic field to produce detailed images of internal structures. This technology is exceptionally good at visualizing soft tissue injuries.
Treatments and drugs
Treatment for a sprained ankle depends on the severity of your injury. Many people simply treat their injury at home.
In most cases, over-the-counter pain relievers — such as ibuprofen (Advil, Motrin, others), naproxen (Aleve, others) or acetaminophen (Tylenol, others) — are enough to handle the pain caused by a sprained ankle.
A few days after your injury, after the swelling has gone down, you may want to start performing physical therapy exercises to restore your ankle’s range of motion, strength, flexibility and balance.
Balance and stability training is especially important to retrain the ankle muscles to work together to support the joint. These exercises may involve various degrees of balance challenge, such as standing on one leg.
If you sprained your ankle while exercising or participating in a sport, talk to your doctor about when you can begin your activity again. You may need to wear an ankle brace or wrap your ankle to protect it from re-injury.
__3. Surgical and other procedures
If your ankle joint is unstable, your doctor may refer you to a joint specialist for evaluation. You may need a cast or walking boot to immobilize your joint so that it can heal properly. In rare cases of severe ligament tears, or if you are an elite athlete, you may need surgery to repair the damage.
Lifestyle and home remedies
For immediate self-care of an ankle sprain, try the P.R.I.C.E. approach, see top of article.
Take the following steps to help prevent a sprained ankle:
• Warm up before you exercise or play sports.
• Be careful when walking, running or working on an uneven surface.
• Wear shoes that fit well and are made for your activity.
• Don’t wear high-heeled shoes.
• Don’t play sports or participate in activities for which you are not conditioned.
• Maintain good muscle strength and flexibility.
• Practice stability training, including balance exercises.
A physical therapist will often recommend use of an ankle brace for a year after a pretty strenuous injury. Sometimes, it’s necessary to wear it always. I’m in the latter category. I can’t run without it. And if I didn’t have it, I’d not be running any more. To order by shoe size see the chart below. I wear a 9.5
See discussion, various ankle braces and video at SportsMedInfo:
Ω Category: (Survival Manual/6. Medical/c) General Clinic/ Sprains)