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What is the definitional distinction between grade I, II and III sprains

What is the definitional distinction between grade I, II and III sprains? How would these various grades of injury present distinctly on examination? 

 


A grade I sprain results from mild stretching of a ligament with microscopic tearing only. Patients have mild swelling and tenderness. There is no objective joint instability on examination.

It is often a clinical (subjectively applied) diagnosis: if a patients says "I twisted my ankle and it hurts" and nothing is seen objectively, the diagnosis often applied would be "grade I" sprain. Many such patients have nothing wrong with them, giving rise to the incorrect notion that grade I sprain (when it truly occurs) is completely inconsequential injury.

Signal change in the MCL indicates an injury (compare to ITB laterally (which is darker)), but the gross course of the ligament is unchanged


A grade II sprain is a more severe injury involving an incomplete tear/macroscopic stretching of a ligament.

Patients can have moderate pain, swelling, tenderness, and ecchymosis.

 

There is mild to moderate joint instability on exam with some restriction of the range of motion and loss of function. If a grade II sprain is found in the leg, weight bearing and ambulation are painful. Here is there is tearing within the ligament, but some fibers are in continuity

think pulled taffy:

 


A grade III sprain involves a complete tear of a ligament.

This is often the result of higher energy mechanisms, such as the valgus blow to the knee shown below (likely to injure the MCL)

 

 

There is significant laxity perceived by the examiner. Patients might be unable to bear weight or ambulate. Paradoxically, perhaps, this may hurt less than a grade 2, as once the ligament is torn, it no longer is provoked with every step.
Here is there is disruption the ligament. Why is there bone edema near the red asterisk ?

 

 

Note that a complete tear is the same as a grade III sprain

 

 

Here is a RUPTURED anterior cruciate. It is medically correct to call this a grade III sprain – though nobody does....

 

OTHER POINTS:


There are proprioceptive nerves are within the ligament (informing the brain just how bent the joint is you might say) and therefore even a grade I sprain can cause proprioceptive disruption.

Also, there can be a chondral injury from impaction even with a grade I sprain (that's the edema seen near the red asterisk, above). In all, Grade I injuries may be less benign than they might seem.

 

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