Raiyyan Tahsan

Raiyyan Tahsan
Hello I'm Raiyyan Tahsan
Brand Model and Executive

TC(1002).(05).Orthopedics Case No 80:- Ligament Sprain

Ligament Sprain — Bangla Clinical Note

গুরুত্বপূর্ণ নোট: নিচের dose গুলো adult general dose। Pregnancy, CKD, peptic ulcer, liver disease, asthma/NSAID allergy, anticoagulant use, uncontrolled HTN/CVD থাকলে dose/medicine বদলাতে হবে। Bangladesh brand list MedEx-এ পাওয়া common representative brands; বাজারে availability পরিবর্তন হতে পারে।

1) Definition / Core meaning

Ligament sprain হলো joint-এর ligament অতিরিক্ত stretch হওয়া, partial tear হওয়া অথবা complete tear হওয়া। সবচেয়ে common হলো ankle sprain, বিশেষ করে inversion injury-তে lateral ligament—ATFL, CFL, PTFL—injured হয়। Ankle awkwardly roll/twist করলে ligament stretch/tear হয়ে pain, swelling, bruising ও instability হয়।

2) Etiology / Cause — কারণগুলো

A. Mechanical cause

  1. Twisting injury / পা মচকে যাওয়া
    পা হঠাৎ inward বা outward ঘুরে গেলে ligament stretch বা tear হয়।
  2. Fall বা awkward landing
    Jump করার পর ভুলভাবে landing করলে ankle/knee/wrist ligament injured হতে পারে।
  3. Uneven surface-এ হাঁটা/দৌড়ানো
    গর্ত, ঢালু রাস্তা, খেলাধুলার মাঠে ankle roll হয়ে sprain হয়।
  4. Sports injury
    Football, basketball, badminton, volleyball—এ sudden stop, pivot, jump, collision থেকে sprain common।
  5. Direct trauma
    Joint-এর পাশে আঘাত লাগলে ligament damage হতে পারে।

B. Risk factors

  1. Previous sprain — আগের injury থাকলে proprioception কমে recurrent sprain হয়।
  2. Weak muscle / poor balance — ankle stabilizer muscle দুর্বল হলে ligament বেশি strain নেয়।
  3. Improper footwear — loose shoe, high heel, poor grip shoe risk বাড়ায়।
  4. No warm-up — cold muscle ও stiff joint injury-prone।
  5. Obesity / high body weight — joint load বাড়ে।
  6. Ligament laxity / hypermobility — ligament naturally loose হলে sprain বেশি হয়।

Mayo Clinic ankle sprain-এর cause হিসেবে twisting, fall, awkward landing, uneven surface, sports contact এবং risk factor হিসেবে sports, previous injury, poor physical condition ও poor footwear উল্লেখ করেছে।

3) Pathophysiology — কীভাবে রোগ হয়

  1. Ligament অতিরিক্ত stretch হয়।
  2. Micro-tear বা partial/complete tear হয়।
  3. Local bleeding ও inflammation শুরু হয়।
  4. Swelling, pain, heat, tenderness তৈরি হয়।
  5. Ligament mechanoreceptor damage হলে proprioception কমে, ফলে joint unstable লাগে।
  6. Proper rehab না হলে chronic instability ও recurrent sprain হতে পারে।

4) Classification / Grade

Gradeকী হয়Clinical meaning
Grade IMild stretch, microscopic tearMild pain, minimal swelling, no instability
Grade IIPartial tearModerate pain/swelling, bruising, painful weight bearing, mild laxity
Grade IIIComplete tearSevere swelling, instability, unable to bear weight, possible “pop” sound

5) Symptoms — লক্ষণগুলো

  1. Pain
    Injured ligament-এর ওপর localized pain; হাঁটলে বা weight দিলে বাড়ে।
  2. Swelling
    Injury-এর কয়েক ঘণ্টার মধ্যে ফুলে যায়।
  3. Tenderness
    Ligament-এর জায়গায় চাপ দিলে ব্যথা।
  4. Bruising / Ecchymosis
    24–48 ঘণ্টার মধ্যে কালচে দাগ দেখা দিতে পারে।
  5. Restricted movement
    Joint stiff লাগে, movement কমে যায়।
  6. Instability / giving way
    মনে হয় joint ভেঙে পড়বে বা ধরে রাখতে পারছে না।
  7. Pop বা snap feeling
    Injury moment-এ “পট” শব্দ/অনুভূতি হতে পারে।
  8. Unable to bear weight
    Severe sprain বা fracture suspicion হলে রোগী দাঁড়াতে পারে না।

Mayo Clinic pain on weight-bearing, tenderness, swelling, bruising, limited ROM, instability এবং popping sensation/sound উল্লেখ করেছে।

6) Clinical Diagnosis — Specific clinical approach

A. History

  1. Injury mechanism: inversion/eversion/twist/fall/contact injury
  2. Time of swelling: immediate swelling = severe ligament tear/fracture suspicion
  3. Pop sound ছিল কি না
  4. Weight bear করতে পারছে কি না
  5. Previous sprain history
  6. Sports/occupation demand
  7. Red flags: deformity, numbness, cold foot, open wound, severe pain

B. Physical examination

  1. Inspection — swelling, bruising, deformity
  2. Palpation — ATFL/CFL/PTFL, medial malleolus, lateral malleolus, base of 5th metatarsal, navicular
  3. Range of movement — dorsiflexion, plantarflexion, inversion, eversion
  4. Weight-bearing test — 4 steps হাঁটতে পারে কি না
  5. Neurovascular exam — pulse, capillary refill, sensation
  6. Special tests
    • Anterior drawer test — ATFL injury
    • Talar tilt test — CFL injury
    • Squeeze test / external rotation test — syndesmotic/high ankle sprain
    • Thompson test — Achilles tendon rupture exclude

C. Ottawa Ankle Rules — X-ray লাগবে কখন?

Ankle trauma-তে X-ray consider করবেন যদি:

  1. Malleolar zone pain + medial/lateral malleolus posterior edge/tip tenderness
  2. Midfoot pain + navicular বা base of 5th metatarsal tenderness
  3. Injury-এর পর বা clinic-এ 4 steps হাঁটতে না পারে

7) Investigations — Specific

1. X-ray

Indication: Ottawa ankle rule positive, severe pain, deformity, inability to bear weight, fracture suspicion।
Purpose: fracture/dislocation exclude করা।

2. MRI

Indication:

  • Grade III sprain suspicion
  • Syndesmotic injury
  • Persistent pain/swelling > 4–6 weeks
  • Osteochondral lesion suspicion
  • Athlete/surgery planning
    Purpose: ligament tear, cartilage injury, occult fracture দেখা।

3. Ultrasound

Purpose: dynamic ligament/tendon assessment, hematoma, tendon injury।

4. CT scan

Indication: complex fracture বা occult fracture suspicion।

5. Lab test

Uncomplicated sprain-এ routine blood test লাগে না। Fever, hot swollen joint, gout/septic arthritis suspicion হলে CBC, ESR/CRP, uric acid, joint aspiration লাগতে পারে।

Mayo Clinic diagnosis অংশে physical exam-এর পাশাপাশি X-ray, MRI, CT ও ultrasound-এর ভূমিকা উল্লেখ করেছে।

8) Differential Diagnosis

  1. Fracture — malleolus, talus, navicular, base of 5th metatarsal
  2. Achilles tendon rupture
  3. Peroneal tendon injury/subluxation
  4. Syndesmotic/high ankle sprain
  5. Osteochondral lesion of talus
  6. Joint dislocation
  7. Gout / septic arthritis
  8. Cellulitis
  9. DVT — calf swelling/pain থাকলে
  10. Lisfranc injury — midfoot pain/swelling

9) Complications — বাংলায় ব্যাখ্যা

  1. Chronic ankle instability
    Ligament ঠিকমতো heal না করলে joint বারবার মচকে যায়।
  2. Recurrent sprain
    Proprioception ও muscle strength না ফিরলে একই জায়গায় বারবার injury হয়।
  3. Persistent pain and swelling
    Cartilage injury, occult fracture বা incomplete rehab থাকলে pain দীর্ঘস্থায়ী হয়।
  4. Joint stiffness
    অতিরিক্ত immobilization করলে movement কমে যায়।
  5. Osteochondral lesion
    Talus cartilage/bone injury হলে chronic deep ankle pain হয়।
  6. Post-traumatic osteoarthritis
    repeated instability ও cartilage damage থেকে পরে arthritis হতে পারে।
  7. Complex regional pain syndrome
    Rare, কিন্তু disproportionate pain, color change, sweating, stiffness হতে পারে।

Mayo Clinic recurrent sprain, chronic ankle pain, chronic instability and arthritis as complications উল্লেখ করেছে।

10) Treatment / Management

A. Non-pharmacological management — মূল চিকিৎসা

First 48–72 hours: PRICE / RICE

  1. Protection — খেলাধুলা বন্ধ, brace/ankle support
  2. Rest — painful activity avoid
  3. Ice — 15–20 মিনিট করে দিনে 3–5 বার
  4. Compression — elastic bandage/ankle wrap
  5. Elevation — heart level-এর ওপরে পা রাখা

AAOS ও Mayo RICE/ice/compression/elevation-based early care recommend করে।

Functional treatment

  1. Early protected weight-bearing — pain tolerate করলে
  2. Ankle brace/taping — 4–6 weeks useful
  3. Crutch — হাঁটতে না পারলে short-term
  4. Walking boot — Grade II–III বা severe pain হলে short period
  5. Physiotherapy — ROM, strengthening, balance, proprioception
  6. Avoid prolonged cast — বেশিরভাগ sprain-এ long immobilization avoid

Functional brace/taping 4–6 weeks এবং early rehab prolonged immobilization-এর চেয়ে ভালো outcome দিতে পারে।

11) Pharmacological treatment — Bangladesh prescription style

Important prescribing rule

  • একসাথে দুইটা oral NSAID দেবেন না — যেমন ibuprofen + diclofenac একসাথে নয়।
  • NSAID সবসময় after meal।
  • NSAID high-risk patient-এ PPI consider।
  • Antibiotic, steroid injection, calcium/vitamin—uncomplicated ligament sprain-এ routine নয়।

11.1 Paracetamol

  1. Generic name: Paracetamol / Acetaminophen
  2. Therapeutic category: Non-opioid analgesic, antipyretic
  3. Pharmacological class: Para-aminophenol derivative; central COX inhibition
  4. Bangladesh available brand name:
    • Napa 500 mg tablet, Napa Extend 665 mg, Napa One 1000 mg
    • Ace 500 mg tablet, Ace XR 665 mg, Ace Plus formulations
  5. Dose: 500–1000 mg orally every 6–8 hours PRN
    • Max: usually 3–4 g/day; liver disease/alcohol use হলে কম
  6. Duration: 3–5 days PRN
  7. Why used: pain relief; inflammation কমায় না, কিন্তু mild sprain pain control ভালো।
  8. Side effects: nausea, rash, rare blood dyscrasia, overdose hepatotoxicity
  9. Interaction: alcohol, warfarin with prolonged high dose, enzyme inducers—phenytoin, carbamazepine, rifampicin
  10. Avoid/caution: severe liver disease, chronic alcohol use

MedEx-এ Ace ও Napa 500 mg সহ ER/1000 mg forms, adult dose, side effects ও interactions উল্লেখ আছে।

11.2 Topical Diclofenac gel — mild/moderate localized pain

  1. Generic name: Diclofenac Sodium topical gel
  2. Therapeutic category: Topical analgesic, anti-inflammatory
  3. Pharmacological class: Topical NSAID, COX inhibitor
  4. Bangladesh available brand name:
    • Diclofen Gel 1% w/w
    • DicloGel 1% w/w
  5. Dose: 2–4 g affected area-তে দিনে 3–4 বার apply
  6. Duration: 5–7 days
  7. Why used: local pain, swelling, inflammation কমাতে; systemic NSAID side effect তুলনামূলক কম।
  8. Side effects: local burning, redness, rash, itching
  9. Interaction: oral NSAID/anticoagulant use করলে systemic risk সামান্য বাড়তে পারে
  10. Avoid: open wound, infected skin, eye/mucosa, occlusive dressing

MedEx topical diclofenac gel-এর sprain/bruises/dislocation indication, dose এবং topical side effects উল্লেখ করেছে।

11.3 Ibuprofen — common oral NSAID

  1. Generic name: Ibuprofen
  2. Therapeutic category: NSAID analgesic, anti-inflammatory
  3. Pharmacological class: Propionic acid derivative; non-selective COX inhibitor
  4. Bangladesh available brand name:
    • Advel 200/400 mg
    • Flamex 200/400 mg
    • Profen 400 mg
    • Reumafen 200/400 mg
    • Serviprofen 400 mg
  5. Dose: 200–400 mg orally every 6–8 hours after meal
    • Max OTC: 1200 mg/day
  6. Duration: 3–5 days
  7. Why used: pain + swelling + inflammation কমায়।
  8. Side effects: dyspepsia, gastritis, GI bleeding, renal impairment, BP rise, bronchospasm, rash
  9. Interaction: anticoagulant/antiplatelet, steroid, SSRI, ACEI/ARB + diuretic, lithium, methotrexate
  10. Avoid: active peptic ulcer, CKD, NSAID allergy/asthma, severe heart disease, late pregnancy

MedEx ibuprofen page indications, pharmacology, adult dose, interactions, side effects, contraindications, therapeutic class ও Bangladesh brands list দিয়েছে।

11.4 Naproxen — longer acting NSAID

  1. Generic name: Naproxen / Naproxen Sodium
  2. Therapeutic category: NSAID analgesic, anti-inflammatory
  3. Pharmacological class: Propionic acid derivative; non-selective COX inhibitor
  4. Bangladesh available brand name:
    • Naprosyn 250/500 mg
    • Napro-A 250/500 mg
    • Diproxen 250/500 mg
    • Anaflex 250/500 mg
    • Ecless 500 mg
  5. Dose: 500 mg stat, then 250 mg every 6–8 hours PRN
    • Alternative: 250–500 mg twice daily after meal
  6. Duration: 3–5 days
  7. Why used: moderate pain/swelling; longer duration of action।
  8. Side effects: gastric pain, ulcer/bleeding, dizziness, renal impairment, edema, BP rise
  9. Interaction: anticoagulant, antiplatelet, steroid, SSRI, ACEI/ARB, diuretic, lithium, methotrexate
  10. Avoid: PUD, CKD, NSAID hypersensitivity, high bleeding risk

MedEx naproxen page musculoskeletal disorder dosing, interaction, side effects, therapeutic class ও Bangladesh brands উল্লেখ করেছে।

11.5 Diclofenac potassium — acute pain/swelling

  1. Generic name: Diclofenac Potassium
  2. Therapeutic category: NSAID analgesic, anti-inflammatory
  3. Pharmacological class: Phenylacetic/acetic acid derivative; COX inhibitor
  4. Bangladesh available brand name:
    • Diclofen K 50 mg
    • A-Fenac K 50 mg
    • Intafenac K 50 mg
    • Nopain 25/50 mg
  5. Dose: 50 mg stat, then 25–50 mg every 8 hours PRN after meal
    • Max: 150 mg/day
  6. Duration: 2–5 days
  7. Why used: post-traumatic pain, inflammation, swelling—sprain pain দ্রুত কমাতে।
  8. Side effects: dyspepsia, peptic ulcer, GI bleeding, renal impairment, edema, BP rise, liver enzyme rise
  9. Interaction: anticoagulant, steroid, SSRI, ACEI/ARB, diuretic, lithium, methotrexate
  10. Avoid/caution: CVD, uncontrolled HTN, CKD, active ulcer, NSAID allergy

MedEx diclofenac potassium page sprain-related post-traumatic pain/inflammation/swelling indication, dose, interactions, contraindication, side effects ও brands দিয়েছে।

11.6 Aceclofenac — commonly used NSAID in Bangladesh

  1. Generic name: Aceclofenac
  2. Therapeutic category: NSAID analgesic, anti-inflammatory
  3. Pharmacological class: Phenylacetic acid derivative; COX inhibitor
  4. Bangladesh available brand name:
    • Flexi 100 mg / SR 200 mg
    • Movex 100 mg / SR 200 mg
    • Avenac 100 mg
    • Reservix 100 mg
    • Mervan 100 mg / SR 200 mg
  5. Dose: 100 mg twice daily after meal
    • SR: 200 mg once daily
  6. Duration: 3–5 days
  7. Why used: musculoskeletal pain/inflammation control; Bangladesh prescription practice-এ common।
  8. Side effects: dyspepsia, abdominal pain, nausea, diarrhea, GI bleeding, renal impairment
  9. Interaction: other NSAID, anticoagulant, steroid, SSRI, ACEI/ARB, diuretic, lithium, methotrexate
  10. Avoid: peptic ulcer, CKD, NSAID allergy, severe liver/cardiac disease

MedEx aceclofenac page dose, pharmacology, interactions, contraindications ও therapeutic class দিয়েছে; MedEx search results multiple Bangladesh brands/strengths দেখায়।

11.7 Etoricoxib — COX-2 selective NSAID, selected cases

  1. Generic name: Etoricoxib
  2. Therapeutic category: NSAID analgesic, anti-inflammatory
  3. Pharmacological class: Selective COX-2 inhibitor
  4. Bangladesh available brand name:
    • Oricox 60/90/120 mg
    • Recox 60/90/120 mg
    • Etorix 60/90/120 mg
    • Setorib 60/90/120 mg
    • Ribox 60/90/120 mg
  5. Dose: 60 mg once daily; severe acute pain হলে selected patient-এ 90 mg once daily
  6. Duration: shortest possible, usually 3–5 days
  7. Why used: NSAID দরকার কিন্তু gastric intolerance risk বেশি—তবে CV risk বিবেচনা জরুরি।
  8. Side effects: edema, BP rise, dyspepsia, headache, dizziness, renal impairment, cardiovascular risk
  9. Interaction: warfarin/anticoagulant, ACEI/ARB, diuretic, lithium, methotrexate
  10. Avoid: ischemic heart disease, stroke history, uncontrolled hypertension, CKD, pregnancy, active ulcer/bleeding

MedEx etoricoxib page COX-2 pharmacology, dosing, interaction, contraindications, side effects ও Bangladesh brands/strengths দেখায়।

11.8 Omeprazole — NSAID gastric protection

  1. Generic name: Omeprazole
  2. Therapeutic category: Anti-ulcerant
  3. Pharmacological class: Proton Pump Inhibitor, PPI
  4. Bangladesh available brand name:
    • Seclo-MUPS 20/40 mg
    • Cosec-MUPS 20/40 mg
    • Losectil MUPS 20/40 mg
    • Ometid MUPS 20/40 mg
  5. Dose: 20 mg once daily before breakfast
  6. Duration: NSAID যতদিন, usually 3–5 days; ulcer treatment হলে 4–8 weeks
  7. Why used: NSAID-induced gastritis/ulcer risk কমাতে high-risk patient-এ।
  8. Side effects: headache, nausea, abdominal discomfort; long-term হলে hypomagnesemia, B12 deficiency, infection risk
  9. Interaction: clopidogrel effect কমাতে পারে; warfarin/phenytoin monitoring দরকার
  10. Avoid unnecessary long-term use

MedEx omeprazole page NSAID-induced ulceration dose, interaction, therapeutic class ও Bangladesh brands দিয়েছে।

11.9 Muscle relaxant — only if painful muscle spasm থাকে

Option A: Tizanidine

  1. Generic name: Tizanidine
  2. Therapeutic category: Skeletal muscle relaxant
  3. Pharmacological class: Central α2-adrenergic agonist
  4. Bangladesh available brand name:
    • Sirdalud 2 mg
    • Relentus 2 mg
    • Tizadin 2 mg
    • Tizalex 2 mg
    • Tizalud 2 mg
  5. Dose: 2 mg at night or 2 mg 2–3 times daily if spasm significant
  6. Duration: 2–3 days, short course
  7. Why used: ligament sprain-এর সাথে reflex muscle spasm থাকলে pain কমাতে।
  8. Side effects: sedation, dizziness, dry mouth, hypotension, weakness
  9. Interaction: alcohol, benzodiazepine, sedative, ciprofloxacin/fluvoxamine with major risk
  10. Avoid: driving, hypotension, severe liver disease

Option B: Tolperisone

  1. Generic name: Tolperisone
  2. Therapeutic category: Skeletal muscle relaxant
  3. Pharmacological class: Centrally acting muscle relaxant
  4. Bangladesh available brand name:
    • Myolax 50/100 mg
    • Mydocalm 50 mg
    • Myoson 50/100 mg
    • Tolmus 50 mg
    • Tolson 50/100 mg
  5. Dose: 50 mg 2–3 times daily after meal
  6. Duration: 3–5 days
  7. Why used: associated muscle spasm/guarding কমাতে।
  8. Side effects: dizziness, weakness, GI upset, hypersensitivity
  9. Interaction: sedatives/other muscle relaxants additive effect
  10. Avoid: allergy, severe weakness, cautious in driving

MedEx tizanidine/tolperisone pages painful muscle spasm indication, dose এবং Bangladesh brand examples দেখায়।

11.10 Tramadol — severe pain rescue only, routine নয়

  1. Generic name: Tramadol
  2. Therapeutic category: Opioid analgesic
  3. Pharmacological class: Weak μ-opioid agonist + monoamine reuptake inhibitor
  4. Bangladesh available brand name:
    • Anadol 50 mg / SR 100 mg
    • Lucidol 50 mg / injection
    • Dolonil 50 mg
    • Winpain 50 mg
  5. Dose: 50 mg every 6–8 hours PRN severe pain
    • Max: 400 mg/day
  6. Duration: ≤2–3 days only
  7. Why used: severe pain যেখানে paracetamol/NSAID insufficient বা NSAID contraindicated।
  8. Side effects: nausea, vomiting, dizziness, sedation, constipation, respiratory depression, seizure risk, dependence
  9. Interaction: alcohol, benzodiazepine, sleeping pill, SSRI/SNRI/MAOI, antipsychotic—serotonin syndrome/seizure/sedation risk
  10. Avoid: epilepsy uncontrolled, substance misuse risk, respiratory depression, driving

MedEx tramadol pharmacology ও Bangladesh brands/strengths উল্লেখ করে।

12) Bangladesh doctors commonly prescribe — practical list

Uncomplicated ligament sprain-এ Bangladesh practice-এ সাধারণত এই pattern দেখা যায়:

  1. Paracetamol 500 mg
    • Mild pain control
    • Example: Napa/Ace 500 mg
  2. Topical diclofenac gel 1%
    • Local pain/swelling
    • Mild to moderate sprain-এ useful
  3. One oral NSAID only
    • Ibuprofen 400 mg অথবা Naproxen 250/500 mg অথবা Diclofenac K 50 mg অথবা Aceclofenac 100 mg
    • Pain + inflammation কমাতে
    • Gastric/renal/CV risk দেখে choose করা হয়
  4. PPI: Omeprazole 20 mg
    • NSAID gastric protection
    • Especially gastritis/PUD risk থাকলে
  5. Muscle relaxant
    • Tizanidine 2 mg বা Tolperisone 50 mg
    • শুধুমাত্র spasm থাকলে
  6. Tramadol 50 mg
    • Severe pain rescue
    • Routine sprain prescription নয়
  7. Brace/ankle support + physiotherapy
    • Drug-এর চেয়ে বেশি important for long-term recovery

13) Example prescription pattern — adult, uncomplicated ankle sprain

Mild Grade I

  1. Paracetamol 500 mg — 1 tab 6–8 hourly PRN, 3 days
  2. Diclofenac gel 1% — local apply 3 times daily, 5 days
  3. Elastic crepe bandage/ankle brace
  4. RICE + ankle ROM exercise after pain reduces

Moderate Grade II

  1. Paracetamol 500 mg — 1 tab 6–8 hourly PRN, 3–5 days
  2. Ibuprofen 400 mg after meal — BD/TDS, 3 days
    or Naproxen 250 mg BD, 3–5 days
  3. Omeprazole 20 mg before breakfast, NSAID course চলাকালীন
  4. Ankle brace 2–4 weeks
  5. Physiotherapy: ROM + strengthening + balance training

Severe Grade III / unable to bear weight

  1. X-ray first if Ottawa positive
  2. Immobilization boot/brace + crutch
  3. Analgesic ± short NSAID if safe
  4. Orthopedic referral
  5. MRI if instability, syndesmosis, persistent pain, athlete case

14) Prevention — কীভাবে প্রতিরোধ করবেন

  1. Exercise/sports-এর আগে warm-up করবেন।
  2. Proper shoe ব্যবহার করবেন; high heel কমাবেন।
  3. Uneven surface-এ সতর্ক থাকবেন।
  4. Previous sprain থাকলে ankle brace/tape ব্যবহার করবেন।
  5. Balance training করবেন: single-leg stand, wobble board।
  6. Calf, peroneal, tibialis muscle strengthening করবেন।
  7. Sudden return to sports করবেন না।
  8. Pain-free full ROM, strength ও balance না ফিরলে খেলায় ফিরবেন না।
  9. Recurrent sprain হলে physiotherapist/orthopedics evaluation করবেন।

Mayo Clinic prevention হিসেবে balance exercise, warm-up, brace/tape, proper shoe, uneven surface caution ও strength/flexibility conditioning উল্লেখ করেছে।

15) Overview / Summary

Ligament sprain হলো joint ligament-এর stretch, partial tear বা complete tear। Most common ankle sprain inversion injury-তে হয়। Diagnosis প্রধানত clinical—history, swelling/tenderness pattern, weight-bearing ability, special tests এবং Ottawa Ankle Rules। Investigation সবসময় লাগে না; X-ray fracture exclude করতে, MRI severe/persistent/syndesmotic injury-তে। Treatment-এর মূল হলো RICE/PRICE, functional brace, early rehab, proprioception training। Medicine শুধু pain/swelling control করে; cure করে না।

16) Actionable Plan / Steps

  1. First 48–72 hours: Rest, ice, compression, elevation।
  2. Pain control: Paracetamol ± topical diclofenac।
  3. Moderate swelling/pain: one oral NSAID short course, after meal; high-risk হলে PPI।
  4. Support: ankle brace/tape, crutch if painful walking।
  5. Rehab: ROM → strengthening → balance/proprioception → return to sport।
  6. Urgent referral: deformity, neurovascular sign, open injury, unable to bear weight, Ottawa positive, severe instability, persistent pain >4–6 weeks।
  7. Avoid: multiple NSAIDs together, prolonged immobilization without indication, early return to sports।

17) Reference List

Textbook

  1. Baxter’s The Foot and Ankle in Sport, 3rd edition, 2021 — ankle sprain clinical management reference cited by Mayo Clinic.
  2. Apley & Solomon’s System of Orthopaedics and Trauma, latest edition — soft tissue injury, ligament sprain, musculoskeletal trauma principles.
  3. Bailey & Love’s Short Practice of Surgery, latest edition — trauma and soft-tissue injury principles.

Guidelines / Clinical Resources

  1. NICE CKS — Sprains and strains, management includes paracetamol/topical NSAID options.
  2. AAOS OrthoInfo — Sprained Ankle, RICE and staged treatment.
  3. Mayo Clinic — Sprained ankle diagnosis and treatment, physical exam, imaging, RICE, drugs, therapy and surgery indications.

Peer-reviewed journals with DOI

  1. Vuurberg G, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine. 2018;52:956. DOI: 10.1136/bjsports-2017-098106.
  2. Martin RL, et al. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021;51(4):CPG1–CPG80. DOI: 10.2519/jospt.2021.0302.
  3. Gaddi D, et al. Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews. Frontiers in Medicine. 2022;9:868474. DOI: 10.3389/fmed.2022.868474.

Md.Rafiqul Islam Lipu,Date:-14-06-2026 Sunday,Time:-12-20-12 Pm

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top