Ligaments, which connect bone to bone, stabilize joints by restricting the range and direction of the bones’ movement. A sprain is an injury to a ligament caused by a force that exceeds the ligament’s tensile strength. Children differ from adults in that their ligaments are stronger relative to their bones; so the clinician diagnosing a sprain in a growing child must be confident that there is no underlying fracture.

When faced with trauma to an extremity, the clinician must inquire about the mechanism of injury to help focus the examination, which should include inspection for swelling and ecchymosis, palpation along bones and ligaments, assessment for effusion, evaluation of range of motion and neurovascular status, and comparison of the injured with the uninjured side. Ambulation must be evaluated in injuries to a lower extremity.

Sprains can be classified by the severity of injury. A grade 1 sprain involves stretching of a...

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