Treatment.—Slight sprains need little attention; a stimulating liniment well rubbed in and the application of a band age to give support are all that need be done. In sprains at all severe more act ive treatment is necessary, the nature of which will depend upon the condition of the joint when first seen. Two indica tions must he met: perfect rest must he assured and inflammatory action pre vented or subdued. If the case is seen immediately after the accident, and be fore any great swelling is present, the joint may be strapped very firmly with long strips of plaster, over which an im movable dressing (starch, silicate-of-soda, or plaster-of-Paris bandage) may be ap plied, by which rest, immobility, and compression of the joint are secured. The application of an immovable dress ing will allow the patient to go about and attend to business, crutches being used if the knee or ankle is involved, or the arm being placed in a sling if the joints of the upper extremity arc af fected. if preferred, the joints may be wrapped with cotton, and a plaster-of Paris bandage applied over it. In either case, if much blood has been effused into the joint, it should be removed by as piration, the needle being first made aseptic.
Should inflammation with much swell ing be present, this may be subdued by the usual means (cold water, evaporating lotions, leeches, etc.); when the swelling has somewhat subsided, the care of the joint should follow the course already outlined to secure the necessary rest: immobilization and the compression of the joint. Later, when pain and stiff ness alone are left, douches of cold water used twice daily, followed by massage with soap liniment, will usually restore strength and mobility to the joint.
For several years massage has been personally employed on sprains.
The old practice of immobilization of sprains is now generally conceded to lie improper, for more than a few days. Per sonal routine practice, even in those cases in which there is considerable laceration. is to first use the hot and cold alternat ing douche for ten minutes to allay pain, then to gently rub and knead about the injured joint for some fifteen minutes, and to apply a flannel bandage. Perfect rest for twenty-four hours is enjoined. On the second day more thorough knead ing and stroking is done and a little passive motion is employed; and this followed up daily.
In the ease of a "sprained ankle" in which there is much extra vasation of blood, tcndo-synovitis, and escape of synovial fluid, the immobilizing treat ment is most objectionable. By its use adhesions are apt to form, impairment of function with pain results, and where there is a tubercular taint proper condi tions for a localized tuberculosis are es.
tablished. The same is true of the wrist, knee, shoulder, and other joints.
The use of a skillfully-applied flannel bandage is a very important adjunct to properly-applied massage. The bandage should be broad, cut on the bias, and should cover with firm and evenly dis tributed elastic pressure all the parts as far as the adjacent joints on either side, with an extra pad over the injured joint itself.
After the first day the patient should go about on crutches, in the case of a sprained ankle; and, after the third day, he should be encouraged to begin bearing a little weight on the foot. Two to three weeks often suffice to put such a sprained joint in a condition for careful use. J. G. Mumford (Boston Med. and Surg. Jour., June 17, '97).
A plan of treatment that seems to be well suited to sprains of all degrees of severity, and which can be used with or without fixed dressings and bandages, ac cording to the indications, is massage properly applied. Massage should not be begun over a recently-in jured joint; neither should passive nor active motion be encouraged in spite of pain caused thereby.
A snug bandage is usually sufficient to afford rest and support, and to press the swelling out in the intervals between the massages. But if the bandage does not give sufficient support, then an easily re movable splint or plaster may be applied. Joints tender and swollen, that do not admit of massage being applied directly upon them, can be approached by com mencing on the healthy tissues some dis tance above them and nearer to the trunk, by gentle stroking in the direction of the returning currents of lymph and blood, and gradually proceeding ward. The healthy tissues beyond the seat of the injury should also be similarly treated.
The returning currents are then pushed along more rapidly, making room for ex udations to be carried off. For this pur pose each hand should make alternate strokes, using the greatest possible ex tent of the pahuar surface while the limb is in a comfortable position.
After working a few minutes in this manner, deep manipulation, or massage properly so called, may be brought into play, beginning, as before, above the painful joint by adapting the greatest possible extent of hand and fingers, one hand contracting and making the great est push upward as the other relaxes while gradually approaching the object ive point. The parts beyond the sprain should be treated likewise. By alter nately stroking and kneading in this manner one can soon make gentle, firm pressure over the but recently painful and swollen joint. If sufficient tact be used this pressure may not. hurt, and very soon it can have motion added to it. When a light touch is disagreeable, firm pressure often affords relief, so that the whole hand is better than the finger-tips.