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Sprains, Strains, Breaks & Bruises

Sprains, Strains, Breaks & Bruises

The board-certified emergency physicians and experienced staff at Mercy Emergency Room provide expert care for a wide range of injuries including sprains, strains, bruising and fractures. We treat people of all ages providing the necessary care to help them get back to an active lifestyle.

What are Sprains and Strains?

Sprains and strains are injuries affecting the muscles and ligaments. A sprain is an injury or tear of one or more ligaments that commonly occurs at the wrist, knee, ankle or thumb. A strain is an injury or tears to the muscle. Strains occur commonly in the back and legs.

Causes of Sprains and Strains

Sprains and strains occur due to overstretching of the joints during sports activities and accidents such as falls or collisions. It may be due to fatigue or not warming up before an activity.

Symptoms of Sprains and Strains

Symptoms of sprains include:

  • Pain 
  • Swelling 
  • Tenderness 
  • Bruising 
  • Joint stiffness 

Symptoms of strains include:

  • Muscle spasm and weakness 
  • Pain in the affected area
  • swelling 
  • Redness 
  • Bruising

What is Bruising?

A bruise or muscle contusion is an injury that occurs during vigorous activities such as sports. Contusions can be minor or severe. Minor contusions can be managed with little loss of functional ability. Severe contusions however can cause deep tissue damage and may take up to a month to heal and prevent participation in certain activities such as sports. Muscle contusions can occur as a result of a direct blow to the body or from a fall against a hard surface.

What are the Symptoms associated with Bruising?

Symptoms include swelling and pain at the injury site, inability to fully move a nearby joint, muscle weakness, and stiffness, skin discoloration, and formation of a lump. Severe bruising may be present with broken bones, joint dislocation, torn muscles and sprains, and shock due to swelling and bleeding under the skin. Abdominal contusions may result in internal organ damage.

Immediate Care for Sprains, Strains and Bruises 

Immediately following an injury and before being evaluated by your doctor, the P.R.I.C.E. method of treatment is recommended to control symptoms.

  • Protection: Protect the injured area with the help of support.
  • Rest: Rest the affected area as more damage could result from putting pressure on the injury.
  • Ice: Ice should be applied over a towel to the affected area for 15-20 minutes every two to three hours during the day.  Never place ice directly over the skin.
  • Compression: Wrapping with an elastic bandage or an elasticated tubular bandage can help to minimize the swelling and provide support to the injured area.
  • Elevation: Elevating the injured area above heart level will also help with swelling and pain. 

Diagnosis of Sprains, Strains and Bruises

Diagnosis involves a thorough physical examination. The ER physician will inspect the area of injury and see how well you move the muscle or joint. X-rays or other tests may be ordered to rule out fractures or other problems.

Treatment of Sprains, Strains and Bruising

The ER physician may prescribe nonsteroidal anti-inflammatory drugs to reduce the pain and inflammation. A period of bracing may be necessary. Physical therapy may be recommended for moderate to severe injuries. Surgery is rarely needed but may be suggested for torn ligaments and tendons.

Most sprains and strains show significant improvement in about 2 weeks. Severe injuries sometimes take months to heal. Strenuous activity should be avoided for at least 8 weeks to allow proper healing.

Fracture Care

A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high-force impact or stress, bone fractures can also occur because of certain medical conditions that weaken the bones, such as osteoporosis.

A fracture may be complete or partial and is commonly caused by trauma due to a fall, motor vehicle accident or sports injury. Thinning of the bone due to osteoporosis in the elderly can also cause bones to break easily. Overuse injuries are a common cause of stress fractures in athletes.

Types of fractures

  • Simple fracture: The fractured pieces of bone are well aligned and stable
  • Unstable fracture- the fragments of the broken bone are misaligned and displaced
  • Open (compound) fracture: A severe fracture in which the broken bones protrude through the skin. This type of fracture is more prone to infection and requires immediate medical attention.
  • Greenstick fracture: A fracture unique to children, where one side of the bone is broken while the other is bent

Fracture Healing

Our body reacts to a fracture by protecting the injured area with a blood clot and callus or fibrous tissue. Bone cells begin forming on either side of the fracture line. These cells grow towards each other and eventually close the fracture.

Medical Therapy

The objective of early fracture management is to control bleeding, prevent ischemic injury (bone death) and to remove sources of infection such as foreign bodies and dead tissues. The next step is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after the fracture heals. To achieve this, fracture reduction and immobilization are achieved by either a non-operative or surgical method.

Non-operative (closed) therapy uses casting and traction (skin and skeletal traction).


This is done for any fracture that is displaced, shortened, or angulated. Splints and casts are made of fiberglass or Plaster of Paris (POP) and are used to immobilize the limb.


This method is used for fractures and dislocations that cannot be treated by casting. There are two methods of traction: skin traction and skeletal traction.

Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture.

In skeletal traction, a pin is inserted through the bone and attached to ropes. Weights are applied, and the patient is placed in a traction apparatus. This method is commonly used for fractures of long bones.

Surgical Therapy

Open Reduction and Internal Fixation (ORIF)

This is a surgical procedure in which the fracture site is exposed while a reduction of the fracture is done. Internal fixation is done with wires, plates, screws, and nails.

External fixation

This is a procedure in which the fracture stabilization is done outside the body using rods screwed into the bone above and below the fracture that exit the body and are attached to a stabilizer device that may be adjusted.  It helps to maintain bone length and alignment without casting.

External fixation is performed in the following conditions:

  • Open fractures with soft-tissue involvement
  • Burns and soft tissue injuries
  • Pelvic fractures
  • Comminuted (shattered) and unstable fractures
  • Fractures having bony deficits
  • Limb-lengthening procedures
  • Fractures with infection or non-union (fails to heal)


Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of the cast or brace so the bone becomes solid enough to bear stress. Rehabilitation programs involve exercises and a gradual increase in activity levels until the process of healing is complete.