Sprains, Strains, Dislocations and Fractures

Patience is poultice for all wounds. - Irish Proverb


A sprain is a stretch and or tear of a ligament (a band of fibrous tissue that connects two or more bones at a joint). One or more ligaments can be injured at the same time. The severity of the injury will depend on the extent of injury (whether a tear is partial or complete) and the number of ligaments involved. A sprain can result from a fall, a sudden twist, or a blow to the body that forces a joint out of its normal position and stretches or tears the ligament supporting that joint.


Grade I (mild) - is caused by overstretching or slight tearing of the ligaments with no joint instability.

  • Minimal pain
  • Swelling
  • Bruising is absent or slight
  • Little or no loss of functional ability of the joint.
  • Usually able to put weight on the affected joint.

Grade II (moderate) - is caused by further, but still incomplete, tearing of the ligament.

  • Moderate pain
  • Swelling
  • Bruising
  • Difficulty putting weight on the affected joint.
  • Experiences some loss of function of the joint.

Grade III (severe) - The sprain completely tear or rupture a ligament.

  • Severe pain
  • Severe swelling
  • Severe bruising
  • Unable to put weight on the joint.


A strain is an injury to either a muscle or a tendon (fibrous cords of tissue that connect muscle to bone). Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result from a partial or complete tear. A strain is caused by twisting or pulling a muscle or tendon. Strains can be acute or chronic. An acute strain is associated with a recent trauma or injury; it also can occur after improperly lifting heavy objects or overstressing the muscles.


Grade I (mild) - Involves some stretching or minor tearing of a ligament or muscle..

  • Minimal pain
  • Tender
  • Muscle has normal strength.

Grade II (moderate) - There is more extensive damage, with more muscle fibres involved, but the tendon is not completely ruptured.

  • Moderate pain
  • Swelling
  • Bruising
  • Muscle spasms
  • Noticeable loss of strength in the muscle.

Grade III (severe) - This is a complete rupture of a muscle, sometimes causing a "pop" sensation as the muscle rips into two separate pieces or shears away from its tendon.

  • Severe pain
  • Severe swelling
  • Severe bruising
  • Complete loss of muscle function,
  • There may be an obvious "dent" or "gap" under the skin where the ripped pieces of muscle have come apart.

First Aid for sprains and strains

It is important that moderate and severe sprains and strains be evaluated by a health care provider to allow prompt, appropriate treatment to begin. Severe sprains and strains may require surgery to repair the torn ligaments, muscle, or tendons. Basic treatments for sprains and strains are similar and should be applied in two stages.

Stage 1 - The goal during the first stage is to reduce swelling and pain. A formula of rest, ice, compression, and elevation (RICE) for the first 24 to 48 hours after the injury is usually advised at this time.

  • Rest
    Reduce regular exercise or activities of daily living as needed.
  • Ice
    Apply an ice pack wrapped in a towel to the injured area for 20 minutes at a time, four to eight times a day. To avoid cold injury and frostbite, do not apply the ice for more than 20 minutes.
  • Compression
    Swelling of an injured ankle, knee, or wrist may be reduced by using compression. Examples of compression bandages are elastic wraps, special boots, air casts, and splints.
  • Elevation
    If possible, keep the injured ankle, knee, elbow, or wrist elevated on a pillow, above the level of the heart, to help decrease swelling.

Stage 2 - The second stage of treating a sprain or strain is rehabilitation, with the overall goal of improving the condition of the injured area and restoring its function. An exercise program designed to prevent stiffness, improve range of motion, and restore the joint's normal flexibility and strength should be implemented.


A dislocation is an injury to a joint - a place where two or more of your bones come together - in which the ends of your bones are forced from their normal positions. The cause is often a fall or a blow. Some joints, such as your shoulder, may have an increased risk of repeat dislocation.


  • Visibly deformed or out of place
  • Swollen or discolored
  • May experience tingling or numbness near or below the injury
  • Intensely painful
  • Immovable

First Aid for Dislocation

1.) Immobilize Shoulder

  • Do not force arm to move.
  • Place pillow or rolled blanket between upper arm and chest.
  • Wrap towel around the person's upper body to bind arm to it.
  • Otherwise, if comfortable to do so, put the affected forearm in a sling with elbow at 90' angle.

2.) Control Swelling

  • Apply ice pack for 20 minutes 4 to 8 times a day. Do not place ice directly against the skin.

3.) Control Pain

  • Give medication such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain and swelling. Avoid ibuprofen and other NSAIDs if the person has heart failure or kidney failure.

4.) Seek advanced medical attention as soon as possible.


A fracture is a partial or complete break in the bone. Although usually the result of trauma, a fracture can be caused by an acquired disease of bone such as osteoporosis. When a fracture occurs, it is classified as either open or closed.

Types of Fractures

Closed fracture (Also called simple fracture.) - the bone is broken, but the skin is intact.

Open fracture (Also called compound fracture.) - the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin.


  • Swelling or bruising over a bone.
  • Deformity of an arm or leg.
  • Pain in the injured area that gets worse when the area is moved or pressure is applied.
  • Loss of function in the injured area.
  • In open fractures, bone protruding from the skin.

First Aid for fractures

  • Don't move the person except if necessary to avoid further injury.
  • Stop any bleeding.
  • Immobilize the injured area.
  • Apply a splint to the area above and below the fracture sites.
  • Apply ice packs to limit swelling and help relieve pain. Do not apply ice directly to the skin.
  • Treat for shock.
  • Seek advanced medical attention as soon as possible.