not possible to look at an injury and know
whether there is a FRACTURE. A doctor should eval-
uate any injury in which
- it is difficult to bear weight or use the arm or
hand - there is numbness or tingling beyond the point
of the injury (in the foot with an ankle injury,
for example) - pain is severe though the injury looks minor
Grade 2 injuries seldom require diagnostic
imaging, though the doctor may request X-RAY,
COMPUTED TOMOGRAPHY(CT) SCAN, OR MAGNETIC RESO-
NANCE IMAGING(MRI) when there is doubt as to the
severity of the injury because this can affect the
treatment approach. Doctors assign a grade value
to a sprain or strain to identify its severity, with
grade 1 the least and grade 4 the most severe.
ARTHROSCOPYmay be necessary to accurately dis-
tinguish a grade 3 from a grade 4 injury.
Grade of Sprain/Strain Severity of Injury
grade 1 stretching and minor tearing of
fibers but structure remains intact
grade 2 partial tear of the structure and
some instability of the JOINT
grade 3 significant tear of the structure and
major instability of the joint
grade 4 complete tear of the structure and
inability to use the joint
Treatment Options and OutlookGrade 1 and grade 2 sprains and strains heal in
two to six weeks with conservative treatment that
includes continued RICE: rest, ice (or heat, after
48 hours, if heat feels better than ice), compres-
sion (elastic wrap, soft splint, tape, or brace), and
elevation of the injured body part. Some grade 3
and nearly all grade 4 sprains and strains require
surgery to repair the damage and reconstruct the
tissues. The doctor can do this repair during diag-
nostic arthroscopy or with arthroscopic surgery
after confirming the diagnosis through other
means. Recovery after surgery may take up to six
months, depending on the location and severity of
the injury.
Risk Factors and Preventive Measures
Though sprains and strains are often ATHLETIC
INJURIES, they can occur during everyday activities
such as walking or lifting as well as in MOTOR VEHI-
CLE ACCIDENTS. Proper technique for sports, includ-
ing WARM-UP, and for lifting can prevent many soft
tissue injuries. Taping or bracing vulnerable joints
such as ankles, knees, and wrists provides addi-
tional support.
See also ACCIDENTAL INJURIES; ANKLE INJURIES; HIP
FRACTURE IN OLDER ADULTS; KNEE INJURIES; SURGERY
BENEFIT AND RISK ASSESSMENT; WEAK ANKLES.spasm A sudden, involuntary, and extended
MUSCLEcontraction. Muscle spasms generally last
no longer than a few seconds and are quite
painful. Spasms may involve skeletal or involun-
tary muscle. Muscle spasms of the pulmonary sys-
tem may manifest as ASTHMAor bronchiospasms
that, when severe, may interfere with BREATHING.
Skeletal muscle spasms may result from overuse,
extreme cold, or neuromuscular disorders. Heat,
massage, and gentle stretching can relieve muscle
spasms. WARM-UP before strenuous exercise and
regular activities to stretch and strengthen the
muscles help prevent muscle spasm.
See also CHARLEYHORSE; CRAMP; MYOPATHY.spinal stenosis Narrowing of the vertebral chan-
nel, usually in the lower (lumbar) back, that com-
presses the SPINAL CORDor the spinal NERVEroots.
The narrowing may develop as a consequence of
osteoarthritic changes, the formation of BONE
spurs, or a congenital defect in which the verte-
bral channel is unusually narrow to begin with.
Symptoms of spinal stenosis are weakness or
numbness in the legs, along with disturbances of
gait (the mechanics of walking) and balance.
There may also be low BACK PAINand PAINin the
legs.
The diagnostic path typically includes compre-
hensive medical examination with full NEUROLOGIC
EXAMINATION and diagnostic imaging procedures
such as MAGNETIC RESONANCE IMAGING(MRI) orCOM-
PUTED TOMOGRAPHY(CT) SCANthat can show dimen-
sional views of the internal and external
structures of the spine. Such views help the doctor
determine the location and extent of the stenosis.356 The Musculoskeletal System