114 228 Definition Stretching of the supportive structures of a joint, resulting in a complete or incomplete tear of a ligament or joint capsule. Sprain can vary in intensity from a partial tear of a single liga- ment to complete rupture of the ligaments supporting a joint. Characteristics With minor sprain, mild pain and minimal swelling without ecchymoses loss of function and point tenderness are evident. Major sprain usually is accompanied by severe pain, his- tory of a “pop” or a “snap” (i.e., ligament tear), immediate swelling, tissue hemorrhage, point tenderness at the site of the tear, loss of function, crepitus, and joint instability. Policy Evaluate employee in the occupational health unit to determine the degree of injury. If in doubt as to whether the injury is a fracture, treat as a fracture. Objectives Clinical Assessments and Interventions Referral for Medical Action Sprain: Acute ● Severe sprain. ● Injury with possible fracture. Follow-up Actions ● Conduct worksite assessment to identify risk factors for sprain and prevention strategies. ● Reassess minor sprain in 1 to 3 days. ● Collaborate with personal health care provider regarding treatment plan for major sprain and rehabili- tation. ● Provide employee with appropri- ate brace support or information for obtaining such. ● Consider limited duty until in- jured part is functional. Determine extent and location of injury. Reduce pain and swelling. ● Assess status of employee and injury site and try to determine whether the sprain is minor or severe. Provide immobilization. ● Initiate RICE treatment: – Rest injured part until pain is minimal or completely resolved. – Ice affected part for 15 minutes 4 times daily for first 48 hours. – Compress injury with dressing (e.g., ace wrap, ankle stirrup) to control swelling. Consider a Jones dressing (multiple layers of cast padding covered by an ace ban- dage, often applied in successive layers). A Jones dressing will provide significant immobilization and control of swelling if applied appropriately. – Elevate affected part to minimize edema. ● Administer NSAIDs (e.g., ibuprofen) per standing order, if not contraindicated. Guideline continues on next page