I really love reader questions. They are always better, and tougher, than the questions I pretend someone asked me and then try to answer in this blog. For example, nobody has asked me jack about the salmonella-tomato epidemic. Maybe people don't eat tomatoes anymore, or maybe the epidemic is not as serious as I think it is.
But people do get "sprains." I can guarantee you that you have either had a sprain at some point in your life, or you will someday. Sprains are common, but what are they?
READER QUESTION: IS A SPRAIN A REAL ENTITY, OR IS IT JUST A CATCH-ALL TERM DOCTORS USE TO SAY, "IT AIN'T BROKEN BUT WE DON'T KNOW WHAT THE F*CK IS WRONG WITH YOU"?
Answer: Really, a bit of both. The truth is that for most parts of the body, a "sprain" is actually a very vague, ill-defined, and broad term, at least when it's used by most doctors. I suppose it is meant to be reassuring to some extent, because when a doctor tells you that you have sprained something, he or she wants you to know that you probably have not "broken," "torn," or "dislocated" anything. That doesn't mean you're not in pain, and that you don't deserve a splint, a bottle of Vicodin, and some sympathy. But you're probably not going to get a cast all your friends can write on, two weeks off work, and THAT MUCH sympathy. Your friends are more likely to say "what's with the crutches bro? I thought you said it was just a sprain!"
The exception to the above is the ankle. An ankle sprain is actually a well-defined entity, generally broken down into degrees: a first degree sprain is mild, and a third degree sprain is severe. And if you've ever had a sprained ankle, you know this can be a serious injury. Clinically, a sprained ankle can be as bad-looking and painful as a fractured ankle, and the two are treated very similarly. In fact, a third degree ankle sprain often includes torn ligaments and can take even LONGER to heal than a fractured ankle. Both sprains and fractures of the ankle generally require a cast or immobilizing boot, with crutches and a lot of time off your feet. Depending on the degree of your sprain, an orthopedist or sports medicine doctor can tell you exactly which ligaments and tendons are stretched, swollen, or torn, and how long you will take to heal. Most primary care and ER doctors also take sprained ankles fairly seriously and know how to treat them.
I really think the term "sprain" is used loosely when it comes to other joints. I have had patients who were told they had a sprained arm, knee, wrist, neck, back, finger, hip, and even "pelvis." In these cases I suspect the doctor really didn't know what the hell was going on, but was trying to communicate the fact that nothing was broken. In these cases there is usually a more specific tendon, ligament, bone, or muscle that was bruised, hyperextended, or smashed. I try to be more specific in this regard, because some of these injuries will heal faster if a patient gets a splint, a course of physical therapy, or a medication.
SPRAINS: THE GOOD NEWS
-Most sprains get better eventually, even if the doctor who diagnosed you with a "sprain" doesn't really know what's wrong with you.
-Even if the pain from a sprain becomes chronic, there is a good chance it's due to an inflamed tendon (tendonitis), and it will still get better if you do some physical therapy.
-If you follow your doctor's instructions, even the worst sprain (a 3rd degree ankle sprain) can heal completely.
-If you have a sprain, the chances you will need surgery to fix it are minimal.
-If you are worried that your sprain is not going to get better and that something is permanently torn, you can always ask to see an orthopedic surgeon.
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