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First Aid and Emergencies

Strains, Sprains, Fractures, and Dislocations

Prevention - Home Treatment - When to Call a Health Professional

A strain is an injury caused by overstretching a muscle. A sprain is an injury to the ligaments, tendons, or soft tissues around a joint. A fracture is a broken bone. A dislocation occurs when one end of a bone is pulled or pushed out of its normal position.

All four injuries cause pain and swelling. Unless a broken bone is obvious, it may be difficult to tell if an injury is a strain, sprain, fracture, or dislocation. Injuries may involve all four. Rapid swelling often indicates a more serious injury. If a bone is poking through the skin, or if a limb turns white, cold, or clammy below the injured area, immediate medical care is needed.

Most minor strains and sprains can be treated at home, but severe sprains, fractures, and dislocations need professional care. Apply Home Treatment while you wait to see your doctor.

A stress fracture is a weak spot or small crack in a bone caused by repeated overuse. Stress fractures
in the small bones of the foot are common during intensive training for basketball, running, and other sports. The most common symptom is persistent pain at the site of the fracture. The pain may improve

during exercise but will be worse before and after activity. There may be no visible swelling.

Prevention

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It may not always be possible to prevent accidents that cause sprains, strains, fractures, or dislocations. However, if you train properly for activities, try not to push too hard during activities, wear protective gear, and use equipment that is in good repair, you will improve your chances of avoiding serious injury.

Other tips for preventing accidents include the following:

  • Make sure you can always see where you are going.

  • Don't carry objects that are too heavy.

  • Use a step stool to reach objects that are above your head. Don't stand on chairs, countertops, or unstable objects.

  • Keep toddlers away from objects that may cause injuries if the child falls on them (coffee tables, stairs, and fireplaces).

  • See the Prevention tips for Sports Injuries on See Sports Injuries.

Home Treatment

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Generally speaking, whether the injury affects soft tissue or bone, the basic treatment is the same: RICE , which stands for rest, ice, compression, and elevation, to treat the acute pain or injury. Begin the RICE process immediately for most injuries.

R. Rest. Do not put weight on the injured joint for at least 24 to 48 hours.

  • Use crutches to support a badly sprained knee or ankle.

  • Support a sprained wrist, elbow, or shoulder with a sling, which will help the injury heal faster.

  • Rest a sprained finger by taping it to the healthy finger next to it (this works for toes too). Always put padding between the 2 fingers or toes you are taping together.

Injured muscle, ligament, or tendon tissue needs time and rest to heal. Stress fractures need rest for 2 to 4 months.

I. Ice. Cold will reduce pain and swelling and promote healing. Heat feels nice, but it does more harm than good if it is applied too soon (less than 72 hours) after an injury.

Apply ice or cold packs immediately to prevent or minimize swelling. For difficult-to-reach injuries, a cold pack works best. See Ice and Cold Packs.

C. Compression. Wrap the injured area with an elastic (Ace) bandage or compression sleeve to immobilize and compress the sprain. Don't wrap it too tightly, because doing so can cause more swelling. Loosen the bandage if it gets too tight. A tightly wrapped sprain may fool you into thinking you can keep using the joint. With or without a wrap, the joint needs total rest for 1 to 2 days.

E. Elevation. Elevate the injured area on pillows while you apply ice and anytime you are sitting or lying down. Try to keep the injury at or above the level of your heart to help minimize swelling.

Splinting

Splinting immobilizes a limb that you suspect is fractured to prevent further injury. There are 2 ways to immobilize a limb until you can see a health professional (ideally, within a few hours): tie a stiff object to the injured limb, or fasten the limb to some other part of the body.

For the first method, tie rolled-up newspapers or magazines, a stick, a cane, or anything that is stiff to the injured limb with a rope, a belt, or anything else that will work. Do not tie too tight.Position the splint so the injured limb cannot bend. A general rule is to splint from a joint above the suspected fracture to a joint below it. For example, splint a broken forearm from above the elbow to below the wrist.

For the second method, tape a broken toe to the next toe, or immobilize an injured arm by tying it across the victim's chest.

Note: These splinting methods are for short-term, emergency use only. Your doctor will provide you with a splint or cast that is appropriate for the specific joint and the type of injury.

Heat (hot water bottle, warm towel, heating pad) may be used after 72 hours of cold treatments if the
swelling is gone. Some experts
recommend going back and forth between heat and cold treatments.

You may be able to prevent further damage with some of the following:

  • Splint an arm, leg, finger, or toe that you suspect is broken. Use a splint and/or a sling for a short period of time (a few hours) while waiting to see your doctor. See See Splinting.

  • Apply a sling to support an injured arm.

  • Remove all rings immediately if the sprain is to a finger or part of the hand. Swelling is likely to occur, making removal of the ring more difficult later. See Removing a Ring.

  • Aspirin or ibuprofen may help ease inflammation and pain. Do not give aspirin to anyone younger than 20.

  • Gentle exercise can be started as soon as the initial pain and swelling have gone away. If you have a broken bone or a severe sprain, your doctor may put the limb in a cast.

When to Call a Health Professional

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  • If the injured limb or joint is deformed.

  • If the skin over the site of an injury is broken.

  • If there are signs of nerve or blood vessel damage:

    • Numbness, tingling, or a "pins-and-needles" sensation.

    • Skin that is pale, white, or blue, or feels colder than the skin on the limb that is not hurt.

    • Inability to move the limb normally because of weakness, not just pain.

  • If you have lost function in an injured limb (cannot bear weight, wobbles, or feels unstable).

  • If pain is severe or continues longer than 48 hours.

  • If swelling:

    • Develops within 60 minutes of the injury.

    • Does not improve after 48 hours of Home Treatment.

  • If signs of infection develop following an injury:

    • Increased pain, swelling, redness, heat, or tenderness.

    • Red streaks extending from the injured area.

    • Discharge of pus.

    • Fever of 37.8°C (100°F) or higher with no other cause.

Removing a Ring

If you did not remove a ring before an injured finger started to swell, try the following method to remove the ring:

  • Stick the end of a slick piece of string, such as dental floss, under the ring toward your hand.

  • Starting at the side of the ring closest to the middle knuckle, wrap the string snugly around your finger, wrapping beyond the middle knuckle. Each wrap should be right next to the one before it.

  • Grasp the end of the string
    that is stretched under the
    ring and start unwrapping it. Push the ring ahead of the unwrapped string as you go, until the ring passes the middle knuckle.

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