Ligament injury - complete or partial violation of the integrity of the ligaments due to traumatic impact. Such pathologies are widespread. Their cause in most cases is a sports or domestic injury. The most commonly affected ligaments are the knee, ankle, and shoulder joints. Ligament injury, as a rule, is manifested by pain, increased swelling, limitation of movement and support. Often, a pronounced hematoma forms in the injured area on the 2-3rd day. The diagnosis is made on the basis of a visual examination, if necessary, radiography, ultrasound and MRI are prescribed. Therapy is mostly conservative.
Basic concepts
A ligament injury is an injury in which a ligament or its individual fibers are torn. Along with bruises, it is one of the most common traumatic injuries and can occur at any age. The upper extremities are most commonly affectedlower. There is also some seasonality, for example, the number of ankle ligament injuries increases dramatically in winter, especially during icy conditions.
Reasons
The main cause of such injuries is strong pressure or range of motion that exceeds the elasticity of the ligament tissue. The most common traumatic mechanisms in case of damage to the knee ligaments or any other are twisting of the leg, twisting of the arm (for example, when practicing contact sports or an unsuccessful fall). The degree of damage can vary greatly - from a minor sprain, the symptoms of which disappear on their own within 2-3 weeks, to a complete rupture of the ligament, in which the patient requires surgical treatment.
Views
Ligament injuries are classified according to only one feature - the area of injury localization. Thus, damage can relate to the following joints:
- ankle;
- knee;
- shoulder;
- hip.
Degrees
Regardless of the location of this injury, there are three degrees of ligament damage in traumatology:
- 1st degree (stretching) - is a rupture of part of the fibers while maintaining the mechanical integrity and continuity of the ligament. In everyday life, this damage is usually called a sprain, but it is known that they do not have elasticity, therefore they are not able to stretch. This stage is accompanied by moderate painexpressiveness. There is no hemorrhage, but there is a slight swelling. Unsharp limitation of movement and support may also occur with partial damage to the ligaments.
- 2nd degree (tear) - a condition in which there is a rupture of the main part of the fibers of a particular ligament. This injury is accompanied by swelling and bruising. Minor instability of the joint may be detected. The patient's movements are limited and some pain is felt.
- 3rd degree - rupture of the ligament. With such traumatization, a person experiences severe pain, a large bruise is formed, the injured area of the body swells strongly, and joint instability is observed.
Signs and symptoms
Injury to ligaments is manifested by pain in the damaged joint, which increases significantly with movement. There is swelling of the damaged area. The severity of these symptoms directly depends on the severity of the injury. On palpation, the doctor notes pain localized in one area. Bruising may appear 2-3 days after the violation of the integrity of the ligamentous apparatus.
If there is a complete rupture of the ligamentous tissues, the symptoms will be quite painful. In such situations, the victim needs urgent medical attention. The movement of the injured limb is difficult, and without timely therapy, hemarthrosis may develop.
How long does the pain last?
Pathological signs of sprain or tear disappear after about 1-2 weeks,however, if a rupture of the ligament is detected, soreness will accompany the patient for up to a month or more. The main signs of a ligament injury are:
- puffiness;
- pain in injured joint;
- circulatory failure;
- functional disorders;
- impaired lymph outflow;
- presence of hemorrhages.
Diagnosis
The diagnosis of "ligament injury" is established taking into account the mechanism of the injury that occurred and the data of visual examination. In general, the more pronounced the clinical signs, the more ligament fibers were damaged during the injury. At the same time, it must be taken into account that hemorrhage and swelling increase over time, therefore, with fresh complete ruptures of the ligaments, the symptoms may be less pronounced than with tears more than 2-3 days ago. To assess the degree of violation of the integrity of the ligamentous structures, ultrasound or MRI of a particular joint is prescribed.
Differential Diagnosis
Ligament injuries must be differentiated from dislocations and fractures. With a dislocation, a pronounced displacement of the bones is noted, the joint is significantly deformed, the correct anatomical relationships between the structures are violated, limb movements are impossible, and when passive movements are attempted, spring resistance is observed. During damage to the ligaments, the external shape of the joint is changed only due to swelling, the anatomical relationships are not violated, limb movements are possible, but significantly limited due topain syndrome, spring resistance is not observed.
At a fracture, as a rule, there is crepitus, deformity and pathological mobility of the joint. However, these signs of a violation are optional, in some cases (for example, with fractures of the outer malleolus), they may be absent. Other symptoms of a fracture (swelling, limitation of movement, loss of support and pain) are similar to the clinical symptoms of ligament injury, therefore, an X-ray examination is necessary for the final diagnosis. If necessary, MRI or ultrasound diagnostics are prescribed.
Treatment of ligament injury
Incomplete injuries are treated in the emergency room. Patients are prescribed rest, physiotherapy and elevated position of the injured limb. On the first day, it is recommended to apply cold to the damage zone (for example, a heating pad with ice), later - dry heat. When walking, a tight bandage is applied to support the joint and protect the ligamentous structures from further injury. The bandage is removed at rest. In no case should an elastic bandage be left overnight - this often causes a violation of the blood supply to the limb and can provoke increased swelling. With a strong pain syndrome, patients are advised to take painkillers. The period of active therapy is usually 2-4 weeks, complete recovery of the ligamentous structures occurs after about 10 weeks. More about the treatment of knee ligament injury below.
Hospitalization
With a complete rupture, the patient is hospitalized in a hospital, in the trauma department, where immobilization is carried out, the limb is given an elevated position, analgesics and physiotherapy are prescribed. Subsequently, depending on the location of the injury, both conservative and surgical treatment can be indicated. Basically, the operation to restore the integrity of the ligament is carried out in a planned manner. Nevertheless, in some cases, the intervention can be carried out immediately upon admission of the patient to the hospital. In the future, rehabilitation measures are mandatory.
Ankle injury
This injury is the most common. Often it occurs when the foot is turned inward. Most often, ligaments that are localized between the talus and fibula or calcaneus and fibula suffer from this. With injuries of the 1st degree (sprain), the patient complains of mild pain when walking, slight or moderate swelling of the joint. The walking function is not impaired.
2nd degree (tear), as a rule, is accompanied by severe swelling, extending to the front and outer surface of the foot. There is a significant limitation of movement, walking may be difficult, lameness occurs.
When a ligament is completely ruptured (3rd degree), intense pain, swelling and hemorrhage appear, which spread to the entire foot, including its plantar surface. The patient is unable to walk. MRI of the joint shows completeor partial rupture of ligamentous fibers. On the radiograph of the ankle joint (1-2nd degree of damage), there are no violations. At grade 3, a small bone fragment may be visible, detached from the bone in the area of attachment of the ligament.
Ankle sprain therapy on the first day includes tight bandaging and cold. From the 2-3rd day, physiotherapy is prescribed: alternating magnetic fields, UHF, later - ozokerite or paraffin. Recovery occurs after 2-3 weeks.
When a ligament is torn, a plaster splint is applied to a limb for 10 days or more. Otherwise, the therapy is the same as for stretching, the rehabilitation period is several weeks. With a complete rupture, a splint is first applied to the ankle joint, and after the swelling subsides, the plaster is kept for another 2 weeks. Next, the bandage is modified so that the patient can remove it during massage, exercise therapy and physiotherapy. The plaster is kept for up to 1 month, then for 2 months it is recommended to wear an elastic bandage or a special ankle to prevent re-injury. Surgical therapy is not usually done.
Injury to the knee joint
As for damage to the knee ligaments, it occurs when the lateral forced deviation of the lower leg. If they deviate outward, injury to the internal ligament is possible, if inward, the external ligament is damaged. The internal ligament in such injuries suffers much more often, but usually it does not break, but a partial tear occurs, in some situations a complete tear occurs. outdoorthe ligament is injured less frequently, but more often there are complete ruptures, detachment of the ligament from the epicondyle of the femur or from the head of the fibula with its fragment.
A patient with damage to the ligaments of the knee joint complains of difficulty walking and movements, pain. The joint is edematous, hemarthrosis may appear. Palpation is quite painful. With a complete rupture or significant tear, excessive lateral mobility of the lower leg is observed. With a partial rupture, a plaster splint is applied, UHF is prescribed. With a complete rupture of the internal ligament, conservative therapy is performed, which includes immobilization, physiotherapy and exercise therapy. Treatment of a knee ligament injury is usually short.
Cruciate ligaments, which are located in the knee joint, can be damaged during transcendental movements. The anterior ligament is damaged by a blow to the back of the knee, the posterior ligament is damaged by a blow to the front of the lower leg or sharp knee extension.
Shoulder injury
Injury to the shoulder ligaments in most cases occurs with a fall or a blow to the shoulder. This injury can also be caused by an outward rotation of the arm or a strong jerking motion.
Injury to the shoulder ligaments is diagnosed by the following symptoms: pain on palpation, swelling in the shoulder area, fever in the damaged area, bruising and redness of the skin of the shoulder, limited motor activity, sharp pain. It is important to differentiate a torn ligament from a shoulder dislocation.
Based on the number and extent of tears, as well as the presence or absence of an inflammatory process, the doctor prescribes a treatment that includes several parallel events. First of all, anesthesia is carried out with the help of medications containing diclofenac or ibuprofen. These medicines will relieve soreness and swelling. Shoulder sprain requires recovery and therapy for a month.
