Importantly

Arrange immediate referral to an Emergency Department if suspected

• Fracture

• Dislocation.

• Damage to nerves or circulation.

• Tendon rupture.

• Wound penetrating the joint.

• Known bleeding disorder.

• Signs of septic arthritis (for example fever, joint swollen and warm to the touch) or haemarthrosis (very painful and tender joint swelling immediately after injury).

• A large intramuscular haematoma.

• A complete tear, or tear of more than half the muscle belly.

To manage their injury using the PRICE measures:

• Protection — protect from further injury (for example by using a support or high-top, lace-up shoes).

• Rest — avoid activity for the first 48–72 hours following injury.

• Ice — apply ice wrapped in a damp towel for 15–20 minutes every 2–3 hours during the day for the first 48–72 hours following the injury. This should not be left on whilst the person is asleep. 

• Compression — with a simple elastic bandage or elasticated tubular bandage, which should be snug but not tight, to help control swelling and support the injury. This should be removed before going to sleep.

• Elevation — keep the injured area elevated and supported on a pillow until the swelling is controlled. If the leg is injured, prolonged periods with the leg not elevated should be avoided.

• To avoid HARM in the first 72 hours after the injury:

  Heat — for example hot baths, saunas, and heat packs.

  Alcohol — increases bleeding and swelling and decreases healing.

  Running — or any other form of exercise which may cause further damage.

  Massage — may increase bleeding and swelling.

Consider the need for immobilization.

• For sprains:

  • If severe, a short period of immobilization can result in quicker recovery.

  • For less severe sprains, it is advisable not to immobilize the joint. Begin flexibility (range of motion) exercises as soon as they can be tolerated without excessive pain.

• For strains:

  • Immobilize the injured muscle for the first few days after the injury. Consider the use of crutches in severe injuries.

  • Start active mobilization after a few days if the person has pain-free use of the muscle in basic movements and the injured muscle can stretch as much as the healthy contralateral muscle.

The Ottawa rules recommend an X-ray in the following cases:

Following an ankle injury, if there is pain in the malleolar zone, and one of the following:

• Inability to bear weight (walk four steps) immediately after the injury and when examined.

• Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus.

• Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus.
  

Following a foot injury, if there is pain in the midfoot zone, and one of the following:

• Inability to bear weight (walk four steps) immediately after the injury and when examined.

• Bone tenderness at the base of the fifth metatarsal.

• Bone tenderness of the navicular bone.

Following a knee injury, if there is one or more of the following:

• Inability to bear weight (walk four steps) at the time of injury and when examined.

• The person is aged 55 years or more.

• Tenderness at the head of the fibula.

• Isolated tenderness of the patella.

• Inability to flex the knee to 90 degrees.

An X-ray is also recommended:

• Following a wrist injury, if there is pain or tenderness over the scaphoid bone (palpate at the base of the anatomical snuff box).

Use clinical judgement when considering an X-ray:

For people who:

• Are younger than 18 years of age.

• Are intoxicated.

• Have multiple painful injuries, head injury, or diminished sensation in the lower extremities (for example due to neurological deficit).

• Have an altered mental status.

• Are pregnant.

• If gross swelling makes palpation of the area impossible.

• If there is a language barrier.