Opinion ID: 1773140
Heading Depth: 1
Heading Rank: 3

Heading: sprain

Text: First, then, what does a sprain mean to a physician? Dorland's Medical Dictionary defines a sprain as a joint injury in which some of the fibers of a supporting ligament are ruptured but the continuity of the ligaments remain intact. Stedman's Medical Dictionary defines a sprain as an injury to a joint, with possible rupture of some of the ligaments or tendons, but without dislocation or fracture. The joints of the human anatomy permitting free movement are synovial joints. Such a joint (as Thompson's thumb joint) is enclosed in a fibrous capsule and contains fluid for lubrication. Attached to the bones at the joint are ligaments. Ligaments, unlike muscles, cannot move the adjoining bones at the joint. Instead, they protect the joint by permitting movement in the way nature has designed the bones to move at the joint, and preventing an unnatural movement. Thus, the ligaments in the knee prevent its being bent but one way. Ligaments give a joint stability, without which problems develop. A blow forcing a joint in an unnatural direction stretches the ligament. While a ligament has considerable strength, it has limited elasticity. It does not return to its original size following any significant stretching. Such problems can become serious and quite painful as well as disabling. Obviously, if the blow has been severe enough to knock the bones at the joint out of alignment, and there has been a dislocation, or subluxation, the supporting ligaments have been substantially stretched and most likely torn, along with a rupture of the capsule enclosing the joint. In the softball game Thompson sustained a severe stretching and tearing of one or more ligaments in his thumb. This was evident to Dr. Boyd for two reasons: he could tell by looking at it, but especially; he was told in the history of the injury that Thompson gave him that the thumb had been knocked out of place, and a teammate had pulled it back into place. Dr. Boyd could further have determined the severity of the sprain by making certain simple movements of the thumb known to any orthopedist. He did not perform any of these routine tests. Dr. Boyd sent Thompson to the hospital for x-rays of the thumb to see if there were any broken or fractured bones, and whether there was any dislocation at the joint. He did not need x-rays to tell him that his patient had a substantial sprain.