Contusions, strains, and sprains are soft tissue injuries caused by blunt force, overuse, or twisting motions. Contusions involve bleeding into the injured tissue from ruptured blood vessels. Strains are microscopic muscle tears, while sprains damage ligaments around a joint. Symptoms include pain, swelling, bruising, and limited range of motion. Treatment focuses on RICE - rest, ice, compression, and elevation to reduce swelling along with analgesics and immobilization if severe. Patients are educated on proper care, gradual return to activity, and avoiding reinjury.

1. Kinna P. Siarro, RN
Contusions, Strains, Sprains

2. OVERVIEW

3. • Contusion
– an injury to the soft tissue produced
by a blunt force
– blow, kick, or fall
• Strain
– a microscopic tearing of the muscle
caused by excessive force,
stretching, or overuse

4. • Sprain
– An injury to ligamentous structures
surrounding a joint
– Usually caused by a wrench or twist
resulting in a decrease in joint
stability

5. CLINICAL MANIFESTATIONS

6. Contusion
• Hemorrhage into injured part
(ecchymosis)—from rupture of small
blood vessels; also associated with
fractures.
• Pain, swelling, and ecchymosis.
• Hyperkalemia may be present with
extensive contusions, resulting in
destruction of body tissue and loss of
blood

7. Strain
• Hemorrhage into the muscle.
• Swelling.
• Tenderness.
• Pain with isometric contraction.
• May be associated spasm.

8. Sprain
• Rapid swelling—due to extravasation of
blood within tissues.
• Pain on passive movement of joint.
• Increasing pain during first few hours
due to continued swelling.

9. MANAGEMENT

10. • X-ray may be done to rule out fracture.
• Immobilize in splint, elastic wrap, or
compression dressing to support
painful structures and control swelling.
• Apply ice while swelling is present.
• Analgesics usually include nonsteroidal
anti-inflammatory drugs (NSAIDs).
• Severe sprains may require surgical
repair or cast immobilization.

11. NURSING INTERVENTIONS
AND PATIENT EDUCATION

12. • Elevate the affected part to reduce
swelling
• Maintain splint or immobilization as
prescribed.
• Apply cold compresses for the first
several days (15-20 min at a time every
few hours)—to produce
vasoconstriction, decrease edema, and
reduce discomfort
• Do not apply ice directly to skin

13. • Ice may be needed for up to a week to
control acute swelling
• Assess neurovascular status of
contused extremity every 1 to 4 hours
as patient's condition indicates
• Instruct patient on use of pain
medication as prescribed
• Ensure correct use of crutches or other
mobility aid with or without weight
bearing, as prescribed.

14. • Educate on need to rest injured part for
about a month to allow for healing.
• Teach patient to resume activities
gradually.
• Teach patient to avoid excessive
exercise of injured part.
• Teach patient to avoid reinjury by
“warming up” before exercise and
stretching tendons and muscles before
and after exercise.

15. • Complementary methods, such as
acupuncture, biofeedback, and
imagery, may contribute to healing by
reducing anxiety and pain.

16. NURSING ALERT
Teach patients to use PRICE at home for minor injuries:
 Protection—of the affected part from injury
 Rest—to promote healing
 Ice—to control swelling (do not use heat until acute
swelling is relieved)
 Compression—with an elastic wrap or splint to control
swelling and prevent stiffness, can be removed at
night
 Elevation —above the level of the heart to reduce
swelling