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Musculoskeletal sprains and strains

Última revisão: 11 Jun 2025
Última atualização: 28 Jan 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • acute onset of symptoms
  • mechanism of injury
  • severe pain
  • swelling
  • bruising
  • palpable gap in normal position for Achilles tendon (Achilles tendon rupture)
  • positive calf squeeze test (Achilles tendon rupture)
  • positive Matles test (Achilles tendon rupture)
  • positive biceps squeeze test (biceps tendon rupture)
  • positive Hook test (biceps tendon rupture)
  • pop sound
  • deformity
Detalhes completos

Outros fatores diagnósticos

  • previous injury
  • symptom duration more than a few days
  • limited range of motion (ROM)
  • weakness
Detalhes completos

Fatores de risco

  • type of sports (basketball, ice skating, soccer, contact sports)
  • anatomic variation
  • eccentric exercise
  • pennate muscle architecture and type II muscle fibers (fast twitch)
  • muscle-tendon units that span 2 joints
  • previous history of ankle sprain
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • x-rays
  • MRI
  • ultrasound for nonligament injuries
Detalhes completos

Investigações a serem consideradas

  • diagnostic arthroscopy
Detalhes completos

Algoritmo de tratamento

AGUDA

presenting within the first 24 to 48 hours: incomplete rupture (grade 1 or 2) suspected

presenting within the first 24 to 48 hours: confirmed complete rupture (grade 3)

CONTÍNUA

with worse pain and/or without functional improvement at 1-week review

Colaboradores

Autores

Senthil N. Sambandam, MBBS, MS, MRCS(Edn)

Staff Orthopaedic Surgeon

Department of Orthopaedics

VA Medical Center

Cheyenne

WY

Declarações

SNS declares that he has no competing interests.

Varatharaj Mounasamy, MD, FRCS

Assistant Professor

Department of Orthopaedic Surgery

Virginia Commonwealth University

Richmond

VA

Declarações

VM is an editorial board member, European Journal of Orthopaedic Surgery & Traumatology.

Sakthivel Rajaram Manoharan, MD, MS

Spinal Clinical Research Fellow

Queens Medical Centre

Nottingham

UK

Declarações

SRM declares that he has no competing interests.

Agradecimentos

Dr Senthil N. Sambandam, Dr Varatharaj Mounasamy, and Dr Sakthivel Rajaram Manoharan would like to gratefully acknowledge Dr Issada Thongtrangan, a previous contributor to this topic. IT declares that he has no competing interests.

Revisores

Quanjun Cui, MD

Assistant Professor

Department of Orthopaedics

University of Virginia

Charlottesville

VA

Declarações

QC declares that he has no competing interests.

Nicola Maffulli, MD, MS, PhD, FRCS(Orth)

Professor of Trauma and Orthopaedic Surgery

University Hospital of North Staffordshire

Keele University School of Medicine

Stoke on Trent

UK

Declarações

NM is an author of a study referenced in this topic.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Bahr R. Can we prevent ankle sprains? In: MacAuley D, Best TM, eds. Evidence-based sports medicine, 14th ed. London: BMJ, 2002:470.

Fong DT, Hong Y, Chan LK, et al. A systematic review on ankle injury and ankle sprain in sports. Sports Med. 2007;37:73-94. Resumo

Noonan TJ, Garrett WE Jr. Muscle strain injury: diagnosis and treatment. J Am Acad Orthop Surg. 1999;7:262-269. Resumo

Speer KP, Lohnes J, Garett WE Jr. Radiographic imaging of muscle strain injury. Am J Sports Med. 1993;21:89-95. Resumo

Boutin RD, Fritz RC, Steinbach LS. Imaging of sports-related muscle injuries. Radiol Clin North Am. 2002;40:333-362. Resumo

Wexler RK. The injured ankle. Am Fam Physician. 1998;57:474-480.Texto completo  Resumo

Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018 Aug;52(15):956.Texto completo  Resumo

Hertel J. The role of nonsteroidal anti-inflammatory drugs in the treatment of acute soft tissue injuries. J Athl Train. 1997;32:350-358.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Diagnósticos diferenciais

    • Fracture
    • Cartilage injury
    Mais Diagnósticos diferenciais
  • Diretrizes

    • ACR Appropriateness Criteria Acute Trauma to the Ankle
    • Nonpharmacologic and pharmacologic management of acute pain from non–low back, musculoskeletal injuries in adults: a clinical guideline from the American College of Physicians and American Academy of Family Physicians
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Ankle sprain

    Mais Folhetos informativos para os pacientes
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