Sprain, Strain or Break: When an Injury Needs Imaging

Call 911 for an obvious deformity with loss of circulation — a limb that is
cold, grey or blue beyond the injury — for a bone through the skin, or for an
injury after a significant fall or crash.

Come in now if: you cannot put weight on it at all, the joint looks the
wrong shape, there is numbness or tingling past the injury, the skin is broken
over it, or the pain is getting worse rather than settling over the first few
hours.

And the most useful thing on this page: how much it hurts does not tell you
whether it is broken. A bad sprain can hurt more than a clean fracture. That
is why imaging exists.

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The pattern that is an emergency and does not look like one

Pain out of all proportion to the injury, in a limb that feels tight and
swollen, with numbness, pins and needles, or pain that gets much worse when
someone gently moves your fingers or toes.

That combination is an emergency. Come in now, not tomorrow. Pressure can
build inside a muscle compartment after a fracture or a crush injury, and the
window for relieving it is short. It is uncommon, it is easy to mistake for "a
bad break," and escalating pain in a tight limb is the signal.

If the pain is worse an hour after you got comfortable, come in.

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When imaging is worth having

Come in for an X-ray if any of these are true:

• You cannot bear weight on it — four steps is the usual rough test
• Pressing on a specific spot of bone produces sharp, localised pain,
  as opposed to general soreness over soft tissue
• There is a deformity, or the limb looks different from the other side
• The joint will not move, or it locks
• Numbness, tingling or weakness past the injury
• The injury involves significant force — a fall from height, a crash, a
  sporting collision
• It is not improving after two or three days, or swelling is increasing
  rather than settling

Come in regardless of the above if: you are over 65, you have osteoporosis,
you take steroids or a blood thinner, or you have had a fragility fracture
before. In those situations a fracture can happen with very little force,
and the usual rules of thumb are unreliable.

Two things that catch people out

An older adult can walk on a broken hip. Pain in the groin or thigh after a
fall, even with the ability to stand and take a few steps, is worth an X-ray.
Being able to walk is not evidence of no fracture.

A child who will not use a limb has an injury, even with nothing to see.
Children's growing bones injure in ways that do not always show obvious
swelling, and a child who stops using an arm or refuses to weight-bear is
telling you something more reliable than the appearance of the limb.

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When home care is reasonable

Ordinary twists and pulls: swelling that is settling, pain that eases with rest,
weight-bearing that is uncomfortable but possible, no deformity, no numbness,
no red flags above.

What to do: rest it for a day or two, use something cold on it for short
periods with a layer between the cold and the skin, keep it elevated when you
can, and use a snug — not tight — support if it helps.

What to watch for, and this is the part worth reading:

• Pain increasing after the first day rather than decreasing
• Swelling that is still growing after 48 hours
• New numbness or pins and needles
• Still unable to weight-bear after two or three days
• Any fever, spreading redness, or heat around it

Any of those means come in. Setting a limit now — "if I still can't stand on
this on Thursday, I go in" — works better than reassessing each morning while
the injury dictates your judgement.

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What happens when you arrive here

• A physician sees you — board-certified, every visit, at every hour.
• X-ray on site. This is the whole point of coming here for an injury: you
  find out during the visit rather than being sent somewhere for the picture and
  then somewhere else for the answer.
• CT on site, and ultrasound called in from a mobile service, for the injuries
  where a plain film is not enough.
• Pain treated while you are here.
• Splinting or immobilisation as needed, and clear instructions on what to
  do next.
• A critical care room here for the presentations that need one.

If you need surgery, a specialist, or admission, we stabilise you and arrange
the transfer to a hospital. We are an emergency room, not a hospital. Most
fractures do not need surgery, and most people go home the same day with the
injury supported and a plan.

An urgent care without an X-ray cannot answer the question you came with —
which is the honest reason to choose an emergency room for a possible fracture,
rather than anything about how we treat you when you get here.
ER or urgent care

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What not to do

• Do not "test it" by walking on it. If you are wondering whether it is
  broken, walking on it is not a diagnostic and can make a small fracture a
  bigger one.
• Do not try to put a dislocated joint back.
• Do not apply heat in the first day or two, and do not put ice directly
  against skin.
• Do not wrap it tightly. Swelling will continue and a tight wrap becomes a
  tourniquet.
• Do not sleep on "pain out of proportion." See the section above — that is
  the one pattern here that cannot wait until morning.

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El Mirage ER — open 24 hours a day, 7 days a week, 365 days a year.
12000 N El Mirage Rd, El Mirage, AZ 85335 · (480) 237-4922
Walk in. No appointment, no referral.
If this is a medical emergency, call 911.

This article explains when to seek emergency care. It is not medical advice and
cannot account for your history, your medications, or what is happening to you
now. If you are unsure, call us or call 911.

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Sources

The guidance in this article about when to seek emergency care is drawn
from these public sources. Each one is linked so you can read it yourself.

• OrthoInfo, American Academy of Orthopaedic Surgeons — Sprains, Strains and Other Soft-Tissue Injuries — https://www.orthoinfo.org/en/diseases–conditions/sprains-strains-and-other-soft-tissue-injuries/
• MedlinePlus (National Library of Medicine) — Fractures — https://medlineplus.gov/fractures.html
• OrthoInfo, American Academy of Orthopaedic Surgeons — Compartment Syndrome — https://www.orthoinfo.org/en/diseases–conditions/compartment-syndrome/

This article is general information, not a diagnosis, and it cannot account
for your history or medications. If you are unsure, call us on (480) 237-4922
or come in. If it might be an emergency, treat it as one and call 911.

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