A sprain is a soft tissue injury of the ligaments within a joint , often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception , which is the body's sense of limb position and movement. Sprains may be mild (first degree), moderate (second degree), or severe (third degree), with the latter two classes involving some degree of tearing of the ligament. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a muscle or tendon is known as a strain .
44-459: The majority of sprains are mild, causing minor swelling and bruising that can be resolved with conservative treatment , typically summarized as RICE : rest, ice, compression, elevation. However, severe sprains involve complete tears, ruptures, or avulsion fractures , often leading to joint instability, severe pain, and decreased functional ability. These sprains require surgical fixation, prolonged immobilization, and physical therapy . Knowing
88-575: A condition known as varicose veins . Muscle action is needed not only to keep blood flowing through the veins but also to stimulate the lymphatic system to fulfil its "overflow" function. Long-haul flights , lengthy bed-rest , immobility caused by disability and so on, are all potential causes of water retention. Even very small exercises such as rotating ankles and wiggling toes can help to reduce it. Certain medications are prone to causing water retention. These include estrogens , thereby including drugs for hormone replacement therapy or
132-405: A decrease in adverse affects related to the surgery. These results weren't adequate for supporting the use of CPM over potentially more successful interventions, such as active exercise that is both high in intensity and velocity. Given the lack of support in current literature, the use of CPM over other treatment is not advised for most patients having undergone a TKA, nor is its use recommended as
176-431: A device was created in 1978. For people who have had total knee replacement without complications, continuous passive motion has been shown to provide clinically relevant benefits. CPM does improve long-term function, long-term knee flexion, knee extension in the short or long term. In unusual cases where the person has problems which prevent standard mobilization treatment, then CPM is found useful. Although studies in
220-555: A result of heart failure , or local conditions such as varicose veins , thrombophlebitis , insect bites, and dermatitis . Non-pitting edema is observed when the indentation does not persist. It is associated with such conditions as lymphedema , lipedema , and myxedema . Edema caused by malnutrition defines kwashiorkor , an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses , and an enlarged liver with fatty infiltrates. When possible, treatment involves resolving
264-590: A rupture of fibers, leading to a sprain. It is important to recognize that ligaments adapt to training by increasing the cross-sectional area of fibers. When a ligament is immobilized, the ligament has been shown to rapidly weaken. Normal daily activity is important for maintaining about 80–90% of the mechanical properties of a ligament. Sprains can often be diagnosed clinically based on the patient's signs and symptoms, mechanism of injury, and physical examination . However, x-rays can be obtained to help identify fractures, especially in cases of tenderness or bone pain at
308-459: A standard procedure in clinical practice. Patient compliance is key to rehabilitation. Furthermore, with patients attempting at-home therapies, must follow orders with proper form There are limited occupational therapies that are fully supported across a spectrum of patients. The fundamental movements provided by the CPM units, potentially allows for a remedial and fast progressing therapy. This
352-588: Is according to the University of California. This is an untapped potential for stroke patients that needs to be further explored, according to the same source. CPM units are a rare form of therapy that directly correlates the amount of use to the amount of progress. It is easy to neglect at-home therapeutic exercises for various reasons, but CPMs can be used while watching television or doing anything stationary. This ability to multi-task therapy with recreational activities hold higher promise for patients completing
396-438: Is an injury to the ligaments that connect bones within the foot. The recovery process for a foot sprain is crucial for restoring normal function and preventing future injuries. This article outlines the general approach to foot sprain recovery, which varies depending on the severity of the injury. Depending on the mechanism of injury, joint involvement, and severity, most sprains can be treated using conservative measures following
440-417: Is carried out by a CPM device, which constantly moves the joint through a controlled range of motion ; the exact range is dependent upon the joint, but in most cases the range of motion is increased over time. CPM is used following various types of reconstructive joint surgery such as knee replacement and ACL reconstruction . Its mechanisms of action for aiding joint recovery are dependent upon what surgery
484-425: Is depends on the person's height, in the average adult person, it is 8 mm Hg while lying down and 100 mm Hg while standing. In venous insufficiency, venous stasis results in abnormally high venous pressure (venous hypertension) and greater permeability of blood capillaries (capillary hyperpermeability), to drain the blood through the lymphatic system. The lymphatic system slowly removes excess fluid and proteins from
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#1732772138689528-903: Is more concerning if it starts suddenly, or pain or shortness of breath is present. Treatment depends on the underlying cause. If the underlying mechanism involves sodium retention , decreased salt intake and a diuretic may be used. Elevating the legs and support stockings may be useful for edema of the legs. Older people are more commonly affected. The word is from the Ancient Greek οἴδημα oídēma meaning 'swelling'. An edema will occur in specific organs as part of inflammations, tendinitis or pancreatitis , for instance. Certain organs develop edema through tissue specific mechanisms. Examples of edema in specific organs: A rise in hydrostatic pressure occurs in cardiac failure. A fall in osmotic pressure occurs in nephrotic syndrome and liver failure . Causes of edema that are generalized to
572-400: Is mostly visible in the legs , feet and ankles , but water also collects in the lungs , where it causes a chronic cough . This condition is usually treated with diuretics ; otherwise, the water retention may cause breathing problems and additional stress on the heart. Another cause of severe water retention is kidney failure , where the kidneys are no longer able to filter fluid out of
616-470: Is performed. One mechanism is the movement of synovial fluid to allow for better diffusion of nutrients into damaged cartilage , and diffusion of other materials out; such as blood and metabolic waste products. Another mechanism is the prevention of fibrous scar tissue formation in the joint, which tends to decrease the range of motion for a joint. The concept was created by Robert B. Salter M.D in 1970 and, along with help from engineer John Saringer ,
660-427: Is seen in untreated chronic venous insufficiency and is the most common type of edema (approx. 90%). It is a combination venous/lymphatic disorder that originates in defective "leaky" veins that allows the blood to back flow ( venous reflux ), slowing the return of the blood to the heart ( venous stasis ). The venous pressure in the legs changes dramatically while standing compared to lying down. How much pressure there
704-404: The blood and turn it into urine . Kidney disease often starts with inflammation , for instance in the case of diseases such as nephrotic syndrome or lupus . This type of water retention is usually visible in the form of swollen legs and ankles . Cirrhosis (scarring) of the liver is a common cause of edema in the legs and abdominal cavity. Phlebetic lymphedema (or phlebolymphedema)
748-490: The combined oral contraceptive pill , as well as non-steroidal anti-inflammatory drugs and beta-blockers . Premenstrual water retention , causing bloating and breast tenderness , is common. Six factors can contribute to the formation of edema: Generation of interstitial fluid is regulated by the forces of the Starling equation . Hydrostatic pressure within blood vessels tends to cause water to filter out into
792-523: The continuous passive motion machine (moves joint without patient exertion) and cryocuff (type of cold compress that is activated similarly to a blood pressure cuff) have been effective in reducing swelling and improving range of motion. Recent studies have shown that traction is just as effective as the RICE technique in treating ankle sprains in pediatric patients. The components of an effective rehabilitation program for all sprain injuries include increasing
836-430: The enzyme protein kinase C . Edema may be described as pitting edema , or non-pitting edema . Pitting edema is when, after pressure is applied to a small area, the indentation persists after the release of the pressure. Peripheral pitting edema, as shown in the illustration, is the more common type, resulting from water retention. It can be caused by systemic diseases, pregnancy in some women, either directly or as
880-430: The acronym RICE within the first 24 hours of sustaining an injury. However, it is important to recognize that treatments should be individualized depending on the patient's particular injury and symptoms. Over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve pain, and topical NSAIDs can be as effective as medications taken by mouth. Other non-operative therapies including
924-521: The area feeling heavy, and joint stiffness. Other symptoms depend on the underlying cause. Causes may include venous insufficiency , heart failure , kidney problems , low protein levels , liver problems , deep vein thrombosis , infections, kwashiorkor , angioedema , certain medications, and lymphedema . It may also occur in immobile patients (stroke, spinal cord injury, aging), or with temporary immobility such as prolonged sitting or standing, and during menstruation or pregnancy . The condition
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#1732772138689968-622: The body. The excessive extracellular fluid (interstitial fluid) in edemas is to a substantial degree caused by an increased permeability of the smallest blood vessels ( capillaries ). This permeability is modulated by numerous biochemical chain reactions and can therefore be unbalanced by many influences. Involved in these processes are, among others, the transmembrane proteins occludin , claudins , tight junction protein ZO-1 , cadherins , catenins and actinin , which are directed by intracellular signal chains, in particular in connection with
1012-487: The colloidal or oncotic pressure difference by allowing protein to leave the vessel more easily. Another set of vessels known as the lymphatic system acts like an "overflow" and can return much excess fluid to the bloodstream . But even the lymphatic system can be overwhelmed, and if there is simply too much fluid, or if the lymphatic system is congested, then the fluid will remain in the tissues, causing swellings in legs , ankles , feet, abdomen or any other part of
1056-399: The compressed area. Continuous passive motion Continuous passive motion (CPM) devices are used during the first phase of rehabilitation following a soft tissue surgical procedure or trauma. The goals of phase 1 rehabilitation are: control post-operative pain, reduce inflammation, provide passive motion in a specific plane of movement, and protect the healing repair or tissue. CPM
1100-403: The condition in a vicious cycle. Swollen legs , feet and ankles are common in late pregnancy . The problem is partly caused by the weight of the uterus on the major veins of the pelvis . It usually clears up after delivery of the baby, and is mostly not a cause for concern, though it should always be reported to a doctor. Lack of exercise is another common cause of water retention in
1144-432: The edema may occur before there is any significant protein in the urine ( proteinuria ) or fall in plasma protein level. Most forms of nephrotic syndrome are due to biochemical and structural changes in the basement membrane of capillaries in the kidney glomeruli, and these changes occur, if to a lesser degree, in the vessels of most other tissues of the body. Thus the resulting increase in permeability that leads to protein in
1188-445: The goal of functional rehabilitation is to return the patient to full daily activities while minimizing the risk of re-injury. Edema Edema ( American English ), also spelled oedema ( British English ), and also known as fluid retention , dropsy and hydropsy , is the build-up of fluid in the body's tissue , a type of swelling. Most commonly, the legs or arms are affected. Symptoms may include skin that feels tight,
1232-419: The healing of a sprain, as it usually leads to muscle atrophy and weakness. Although prolonged immobilization can have a negative effect on recovery, a study in 1996 suggest that the use of bracing can improve healing by alleviating pain and stabilizing the injury to prevent further damage to the ligament or re-injury. When using a brace, it is necessary to ensure adequate blood flow to the extremity. Ultimately,
1276-429: The injured site. In some instances, particularly if the healing process is prolonged or a more serious injury is suspected, magnetic resonance imaging (MRI) is performed to look at the surrounding soft tissue and ligaments . Although any joint can experience a sprain, some of the more common injuries include the following: Treatment of sprains usually involves incorporating conservative measures to reduce
1320-428: The joint capsule), capsular (continuation of the joint capsule), or intra-articular (located within a joint capsule). The location has important implications for healing as blood flow to intra-articular ligaments is diminished compared to extra-capsular or capsular ligaments. Collagen fibers have about a 4% elastic zone where fibers stretch out with increased load on the joint. However, exceeding this elastic limit causes
1364-401: The legs. Exercise helps the leg veins work against gravity to return blood to the heart . If blood travels too slowly and starts to pool in the leg veins , the pressure can force too much fluid out of the leg capillaries into the tissue spaces. The capillaries may break, leaving small blood marks under the skin . The veins themselves can become swollen, painful and distorted –
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1408-453: The lower part of the leg, usually from the calf down. Hydrops fetalis is a condition in a baby characterized by an accumulation of fluid in at least two body compartments. The pumping force of the heart should help to keep a normal pressure within the blood vessels . But if the heart begins to fail (a condition known as congestive heart failure ) the pressure changes can cause very severe water retention. In this condition water retention
1452-417: The past have shown a benefit of the use of CPM in those individuals having undergone a TKA, recent research has shown that the benefits are questionable. When groups that only received standard mobilization therapies were compared to groups that received CPM treatment in addition to this same therapy, the results suggest that there is no significant increase in functional outcomes or length of hospital stay, or
1496-400: The range of motion of the affected joint and progressive muscle strengthening exercises. After implementing conservative measures to reduce swelling and pain, mobilizing the limb within 48–72 hours following injury has been shown to promote healing by stimulating growth factors in musculoskeletal tissues linked to cellular division and matrix remodeling. Prolonged immobilization can delay
1540-424: The setting of trauma or sports injuries. The most common cause of sprains in general is repetitive movements (overuse). Ligaments are collagen fibers that connect bones together, providing passive stabilization to a joint. These fibers can be found in various organizational patterns (parallel, oblique, spiral, etc.) depending on the function of the joint involved. Ligaments can be extra-capsular (located outside
1584-408: The signs and symptoms of a sprain can be helpful in differentiating the injury from a strain or simple fracture . Strains typically present with pain, cramping , muscle spasm , and muscle weakness , and fractures typically present with bone tenderness , especially when bearing weight. Acute sprains typically occur when the joint is abruptly forced beyond its functional range of motion, often in
1628-416: The signs and symptoms of sprains, surgery to repair severe tears or ruptures, and rehabilitation to restore function to the injured joint. Although most sprains can be managed without surgery, severe injuries may require tendon grafting or ligament repair based on the individual's circumstances. The amount of rehabilitation and time needed for recovery will depend on the severity of the sprain. A foot sprain
1672-403: The tissue. This leads to a difference in protein concentration between blood plasma and tissue. As a result, the colloidal or oncotic pressure of the higher level of protein in the plasma tends to draw water back into the blood vessels from the tissue. Starling's equation states that the rate of leakage of fluid is determined by the difference between the two forces and also by the permeability of
1716-451: The underlying cause. Many cases of heart or kidney disease are treated with diuretics . Treatment may also involve positioning the affected body parts to improve drainage. For example, swelling in feet or ankles may be reduced by having the person lie down in bed or sit with the feet propped up on cushions. Intermittent pneumatic compression can be used to pressurize tissue in a limb, forcing fluids—both blood and lymph —to flow out of
1760-548: The urine can explain the edema if all other vessels are more permeable as well. As well as the previously mentioned conditions, edemas often occur during the late stages of pregnancy in some women. This is more common with those of a history of pulmonary problems or poor circulation also being intensified if arthritis is already present in that particular woman. Women who already have arthritic problems most often have to seek medical help for pain caused from over-reactive swelling. Edemas that occur during pregnancy are usually found in
1804-436: The veins in the lower legs towards the upper body; however, as it is not as efficient as an unimpaired circulatory system, swelling (edema) is visible, particularly in the ankles and lower leg. The chronic increased fluid in the lymphatic system and capillary hyperpermeability causes an inflammatory response which leads to tissue fibrosis of both veins and lymphatic system, opening of arteriovenous shunts, all of which then worsens
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1848-583: The vessel wall open up then permeability to water is increased first, but as the gaps increase in size permeability to protein also increases with a fall in reflection coefficient. Changes in the variables in Starling's equation can contribute to the formation of edemas either by an increase in hydrostatic pressure within the blood vessel, a decrease in the oncotic pressure within the blood vessel or an increase in vessel wall permeability. The latter has two effects. It allows water to flow more freely and it reduces
1892-404: The vessel wall to water, which determines the rate of flow for a given force imbalance. Most water leakage occurs in capillaries or post capillary venules , which have a semi-permeable membrane wall that allows water to pass more freely than protein. (The protein is said to be reflected and the efficiency of reflection is given by a reflection constant of up to 1.) If the gaps between the cells of
1936-429: The whole body can cause edema in multiple organs and peripherally. For example, severe heart failure can cause pulmonary edema , pleural effusions, ascites and peripheral edema . Such severe systemic edema is called anasarca . In rare cases, a parvovirus B19 infection may cause generalized edemas. Although a low plasma oncotic pressure is widely cited for the edema of nephrotic syndrome, most physicians note that
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