injuries and poisoning
Overview of Sprains and Other Soft Tissue Injuries
Diagnosis of Sprains and Other Soft Tissue Injuries
A doctor's evaluation X-rays if needed to check for fractures Sometimes magnetic resonance imaging or computed tomography To diagnose sprains, strains, and tendon injuries, doctors ask detailed questions about the injury and do a thorough physical examination. They can often diagnose soft-tissue injuries based on this information and the results of the physical examination. If a musculoskeletal problem occurs suddenly, people must decide whether to go to an emergency department, call their doctor, or wait and see whether the problem (pain, swelling, or other symptoms) goes away and lessens on its own. People should be taken to an emergency department, often by ambulance, if any of the following apply: The problem is obviously serious (for example, if it resulted from a car crash or if people cannot use the injured body part). They suspect that they have a fracture (a possible exception is a toe or fingertip injury). They suspect they have a severe dislocation or soft-tissue injury (such as a torn tendon or severe sprain or strain). They have several injuries. They have symptoms of a complication—for example, if they lose sensation in the affected body part, they cannot move the affected part normally, the skin feels cool or turns blue, or the injured part is weak. They cannot put any weight on the affected body part. An injured joint feels unstable. People should call a doctor when The injury causes pain or swelling, but they do not think the injured part is fractured or severely injured. If none of the above apply and the injury seems minor, people can call the doctor or wait and see whether the problem goes away on its own. If injuries result from a serious accident, the doctor's first priority is To check for severe injuries and complications, such as an open wound, nerve damage, significant blood loss, disrupted blood flow, and Compartment Syndrome , which can develop when the blood supply to an injured limb is reduced or blocked For example, doctors check for numbness, measure blood pressure (which is low in people who have lost a lot of blood), check pulses (which are absent or weak when blood flow is disrupted), and look for other signs of disrupted blood flow, such as skin that is pale and cool. If any of these injuries and complications are present, doctors treat them as needed, then continue with the evaluation. People should be checked for fractures and dislocations as well as ligament, tendon, and muscle injuries. Sometimes doctors must first make sure that there are no fractures before they do parts of this evaluation. Doctors ask the person (or a witness) to describe what happened. The person may not remember how an injury occurred or cannot describe it accurately. Knowing how the injury occurred can help doctors determine the type of injury. For example, if a person reports that a snap or pop occurred, the cause may be an injury to a ligament or tendon (or a fracture). Also, doctors ask in which direction the joint was stressed during the injury. This information can help doctors determine which ligaments and/or bones may be damaged. Doctors also ask when the pain started. If it started immediately after the injury, the cause may be a severe sprain. If the pain began hours to days later, the injury is usually minor. If the pain is more severe than expected for the injury or if the pain steadily worsens during the first hours after the injury, compartment syndrome may have developed or blood flow may be disrupted. The person is also asked about past injuries and use of medications that can increase the risk of tendon tears (including corticosteroids and fluoroquinolone antibiotics such asciprofloxacin). The physical examination includes the following (in order of priority): Checking for damage to blood vessels near the injured body part Checking for damage to nerves near the injured part Examining and moving the injured part Examining the joints above and below the injured part To check for signs of blood vessel damage and disrupted blood flow, doctors check pulses and skin color and temperature. When blood flow is disrupted (as can occur in compartment syndrome), pulses may be absent or weak and the skin may be pale and cool. Doctors measure blood pressure, which is usually low in people who have lost a lot of blood. To check for nerve damage, doctors evaluate sensation in the skin—whether the person can feel normally—and ask whether the person has abnormal sensations, such as a pins-and-needles sensation, tingling, or numbness. Abnormal sensations suggest that nerves have been damaged. Doctors gently feel the injured part to determine whether the area is tender and whether tendons or muscles feel abnormal. If a fracture or dislocation is present, doctors may feel that bones are in pieces or out of place. Doctors also check for swelling and bruising. They ask whether the person can use, put weight on, and move the injured part. Doctors test the stability of a joint by gently moving it in a way that puts stress on the joint (called stress testing). If the joint feels very unstable, doctors suspect a severe ligament injury (or a dislocation). However, if a fracture is possible, x-rays are done first to determine whether moving the joint is safe. Sometimes, stress testing is delayed until pain lessens. Moving the affected joint can also help doctors determine the severity of an injury. For example, they can determine how severe a sprain (a torn ligament) is based on how far they can move the joint and how painful the movement is. When a ligament is partially torn, moving the joint is very painful. When a ligament is completely torn, moving the joint is less painful because the torn ligament is not being stretched as the joint is moved. A joint can usually be moved more freely when a ligament is torn than when it is not and can be moved more freely when a ligament is completely torn than when it is partially torn. Because tendons connect muscles to bone, doctors can often determine the severity of a tendon injury by moving the muscle that the tendon is attached to. When a tendon is completely torn, moving the muscle attached to the tendon may not move the bone. For example, if the Achilles tendon (which attaches the calf muscles to the heel bone) is completely torn, the foot may not move. Partial tears may be hard to detect because the joint may seem to move normally. If the physical examination does not detect a problem in the joint identified as painful, the injury may be elsewhere. This type of pain is called Pain pathways . For example, if the joint between the breastbone and collar bone is injured, people may feel pain in their shoulder. Thus, doctors always examine the joint above and below the painful joint to check for injury. If pain or muscle spasms interfere with the examination, doctors may give the person a pain reliever and/or muscle relaxant by mouth or injection, or a local anesthetic may be injected into the injured area to make the examination easier. Or the injured part may be immobilized until the spasms stop, usually for a few days, and then examined. Imaging tests are done to check for possible fractures and dislocations and to identify soft-tissue injuries. These tests include X-rays if needed Magnetic resonance imaging (MRI) Sometimes computed tomography (CT) X-raysare not always needed. They do not show injuries to ligaments, tendons, or muscles. They show only bones (and the fluid that collects around an injured joint). However, x-rays may be done to check for fractures and dislocations, which may also be present. In addition, x-rays can show abnormalities in the position of bones that may suggest a sprain or other soft-tissue injury. X-rays, if needed, are usually taken from at least two angles. If a fracture is present, two x-rays can show how the fragments of bone are aligned. MRIcan show soft tissues, which are not usually visible on x-rays. MRI thus helps detect injury to tendons, ligaments, cartilage, and muscle. CT or MRImay be done to check for subtle fractures, which may accompany a soft-tissue injury. X-rays show only bones and thus usually cannot help doctors identify injuries such as sprains, strains, and tendon injuries, even severe ones. Other testsmay be done to check for injuries that can accompany a soft-tissue injury: Angiography (x-rays or CT scans taken after a contrast agent is injected into arteries) to check for damaged blood vessels Nerve conduction studies to check for damaged nerves 