Sprains and strains: Signs and symptoms

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Recognising sprains and strains

Sprains and strains can be managed relatively simply, so it helps to know how to identify this common type of injury.1

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Signs and symptoms

Both sprains and strains cause pain, inflammation and swelling.

  • Symptoms of a sprain occur around the affected joint and can also include bruising, loss of function, and mechanical instability if severe2
  • Symptoms of a strain affect the injured muscle and can include spasm, weakness and cramping2

Symptom severity depends on both the severity of the injury and the time since the injury took place – it can take up to 24 hours for bruising and swelling to become apparent.2

  • NICE guidelines recommend to ask about:2

    • How and when the injury occurred
    • The symptoms experienced, including the severity and duration
    1. Symptoms of a sprain typically include pain around the affected joint, tenderness, swelling, bruising, functional loss (e.g. pain on weight-bearing), and mechanical instability (if the sprain is severe)
    2. Symptoms of a strain typically include muscle pain, spasm, weakness, inflammation and/or cramping. Large haematomas can occur as a result of tearing of the intramuscular blood vessels. There may be obvious swelling, although small haematomas or those deep within the muscle are more difficult to diagnose clinically
    3. Severity of symptoms will depend on severity of the injury as well as time since the injury e.g. it may take up to 24 hours for full extend of bruising to be apparent
    4. Symptom duration of more than a few days can suggest a more severe injury
    • Any predisposing or risk factors such as a medical condition or previous sprain or strain
    • Any complicating factors such as medication that may affect the injury e.g. anticoagulants or a complicating illness e.g. neuropathy, bleeding disorder or history of deep vein thrombosis.

  • The patient should be immediately referred to an emergency department if any of the following is suspected:3

    • Fracture
    • Dislocation
    • Damage to nerves or circulation
    • Tendon rupture
    • Wound penetrating the joint
    • Known bleeding disorder
    • Signs of septic arthritis (e.g. fever, joint swollen and warm to touch) or haemarthrosis (joint is very painful and swollen immediately after injury)
    • A large intramuscular haematoma
    • A complete tear, or a tear of more than half of the muscle belly

Understanding sprains and strains

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Causes

Find out about the causes of sprains and strains.

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Management

Learn how sprains and strains should be managed.

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Overview of joint pain

Find out more about joint pain and meet two patients with joint pain.

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Patient care resources

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