If you stick to the theory that labor made a man out of a monkey, then the first step in this long and difficult path belongs to the shoulder joint. It was its unique structure that made it possible for the underlying segments of the upper limb to acquire functional features unusual for other mammals.
In turn, having significantly expanded their functions from a banal support when moving, human hands have become one of the most injured parts of the body. In this regard, injuries of the shoulder girdle, which often accompanies rupture of the ligaments of the shoulder joint, are in the area of special attention of clinicians. And the root cause of this is the possible loss of ability to work and, what is worse, the disability of a person with an injury treated incorrectly or not on time.
Brief Anatomical Reference
The uniqueness of the shoulder joint is expressed in the ratio of its true articular surfaces. In the formation of this element of the skeleton, directtwo bones involved: scapula and humerus. The articular surface of the humerus is represented by a spherical head. As for the concave surface of the oval shape of the articular cavity of the scapula, it is approximately four times smaller in area than the area of the adjacent ball.
The missing contact from the side of the scapula is compensated by a cartilaginous ring - a dense connective tissue structure called the articular lip. It is this fibrous element, together with the capsule surrounding the joint, that allows it to be in the correct anatomical ratio and at the same time perform that incredible amount of movement that is possible in the most mobile of all the other joints.
The ligaments that hold the joint and move the muscles
Helps the thin synovial membrane of the joint capsule to maintain its anatomical structure with a powerful coraco-brachial ligament. Together with it, the joint is held by the tendon capsules of the biceps brachii (biceps) and subscapularis muscles passing in extra-articular torsions. It is these three connective tissue strands that suffer if the ligaments of the shoulder joint are torn.
Subscapularis, deltoid, supra- and subosseous, teres major and minor, as well as pectoralis major and latissimus dorsi muscles give the joint a wide range of motion around all three axes. The biceps muscle of the shoulder does not participate in the movements of the shoulder joint.
Shoulder injuries and causes of injury
Among the most common injuries of the shoulder joint, there arebruises. Sprains of the ligaments of the joint with partial or complete rupture or without it are possible. Joint dislocations, intra-articular or avulsion fractures of extra-articular fragments (at the attachment site of the joint ligaments) are among the most severe injuries.
The main causes of damage to the shoulder joint is a direct or indirect mechanical impact on its structures. It can be a direct blow and a fall on an outstretched hand. A sharp excessive tension of the muscles that move the joint, or a sharp movement of a large volume, can cause both sprains and dislocation in the joint. As a rule, the accompanying rupture of the ligaments of the shoulder joint (the photo is presented below) requires not only the treatment of the injury itself, but also the restoration of the integrity of the ligamentous apparatus.
Signs of broken ligaments
Injury can occur when a fall occurs on an outstretched arm or outstretched arm. It is also possible to tear the ligaments as a result of a sharp movement in the maximum allowable volume or hanging on the arm, for example, when falling from a height.
The symptoms accompanying damage to the capsule and rupture of the ligaments of the shoulder joint are characterized by sharp pain at the time of injury and, which is especially indicative of a rupture, during movements that repeat the mechanism of injury. Further, edema of the damaged area develops, which changes the external configuration of the joint. In addition to edema, in the process of formation of swelling may be involved poured out from damaged vessels near the tendons ormuscle blood.
Additional methods for assessing injury severity
Among the clinical research methods that allow the traumatologist to determine whether there is a partial rupture of the ligaments of the shoulder joint or their complete damage, ultrasound diagnostics and magnetic resonance imaging stand out. Both methods do not carry radiation load, but have a very high resolution. In particular, MRI allows you to determine the diagnosis and the choice of treatment tactics with maximum certainty.
X-ray or computed tomography is performed to exclude bone damage: fractures (including avulsion), dislocations associated with a fracture, and dislocations in the shoulder joint. Joint puncture is often used. Arthroscopy is performed if there is a suspicion of degenerative changes in the connective tissue structures of the joint or damage to the capsule. In some cases, arthrography is used.
Injury severity
The classic division into simple, moderate and severe degrees of injury, also applicable to ligament rupture. To mild injuries of the shoulder joint, relative to the ligamentous apparatus, include sprain with partial damage to the fibers of the ligaments, while maintaining the integrity of blood vessels, nerves and muscles. The average degree is characterized by a partial tear of the tendon fibers, the muscles surrounding the injured area are involved in the process, the joint capsule may be damaged. The first degree refers to a sprain, the second to a sprain with a partial tear.
Severe damage is accompanied by a complete violation of the integrity of the structure of the tendon (ligament) - rupture of the ligaments of the shoulder joint, damage to local vessels, involvement of nerves and defects in the joint capsule. With this degree, intra-articular and avulsion fractures, hemorrhages into the joint (hemarthrosis) are possible.
Choosing treatment tactics
Depending on the severity of the damage to the ligamentous apparatus of the shoulder joint, conservative or surgical treatment can be used. If there is an incomplete rupture of the ligaments of the shoulder joint, treatment is limited to conservative methods. Anesthesia and immobilization (immobilization) are applied. It is possible to apply a bandage or plaster cast, depending on the severity, nature of the injury and the volume of the affected structures. Bandage or plaster immobilization can be replaced by orthoses (bandages) of the shoulder joint of medium or rigid fixation.
With a complete rupture, especially with damage to the muscles and joint capsule, surgical treatment is used. The victim needs hospitalization in a traumatology hospital and further long-term rehabilitation after discharge from the hospital.
Operational Defect Recovery Manual
The sooner the operation correcting the torn ligaments of the shoulder joint is applied, the greater the chances of a complete restoration of joint functions and the lower the percentage of injury complications. Surgical repair of a damaged ligament (tendon),adjacent muscles, damaged vessels and the elimination of the defect of the capsule is reduced to their stitching together.
Under general anesthesia (narcosis) with direct access over the damaged locus, layer-by-layer dissection and separation of tissues is performed. The detected defects are sutured. The wound is closed in layers. In the early postoperative period, immobilization with a plaster cast with a window for postoperative suture is used.
The terms of plaster immobilization and inpatient treatment are determined by the volume of the affected structures. An important factor for the number of bed-days is the age of the patient, the nature of his work activity and concomitant diseases.
Elbow ligament injury
Very rare in the home, this injury is more common in professional athletes when an active and sharp swing of the arm bent at the elbow is used. The risk group includes, first of all, tennis players, golfers, handball, baseball, water and horse polo.
The most commonly injured is the annular ligament of the radius, the collateral ulnar or radial ligament. A sign of injury is pain that increases with movement. Edema, hemorrhages in the surrounding tissues are characteristic. Possible hemarthrosis. If there is a complete rupture of the ligaments, there may be a slight displacement of the bones of the forearm in the joint.
X-ray will differentiate a fracture from a dislocation. An MRI will show where the elbow ligament tear is located. Treatment for partial and incomplete rupture is conservative. Immobilization is applied for several weeks. With a complete rupture, surgical repair of damaged ligaments is performed.
Brief anatomy of the wrist
Complex in its structure, the joint is formed by the articular surface of the radius and cartilaginous plate of the ulna from the side of the forearm and the scaphoid, lunate and trihedral from the side of the hand. The pisiform bone is located in the thickness of the tendon and does not take a direct part in the formation of the joint.
The joint is strengthened by five ligaments. From the side of the palm, these are the ulnar and radiocarpal ligaments, from the back surface, the dorsal ligament of the hand. On the sides are the lateral palmar (from the side of the thumb) and ulnar (from the side of the little finger) ligaments.
Wear ligament injuries are much less common than shoulder ligament ruptures. But more often than elbow ligaments.
Rupture of ligaments of the wrist joint
The mechanism of injury is associated with a fall on an outstretched hand or a blow to a bent or unbent hand. The position of the hand at the time of injury is of direct importance in determining which of the ligaments may have been damaged. The connective tissue structure opposite to the bend of the hand is most injured.
Leading signs of ligament damage: pain, swelling, dysfunction of the joint and soft tissue hematoma. If there is pain when moving in the fingers of the hand or it increases sharply when turning injoint, it is possible to suspect a rupture of the ligaments of the wrist joint. Symptoms are supplemented in the diagnosis by hardware studies: radiography - to exclude bone fractures, ultrasound and / or MRI. They are needed to determine the nature of damage to the ligaments and other soft tissues surrounding the joint.
As in any other case, if there is a torn ligament in the wrist, the treatment will depend on the severity of the injury. With mild and moderate severity, conservative tactics are used, with severe - operational tactics.
Regardless of what kind of damage has occurred, what is the nature of the violation of the integrity of the structures of the joint, which joint is injured, the wrist, elbow, or there is a partial or complete rupture of the ligaments of the shoulder joint, treatment should always be prescribed by a specialist doctor. A consultation is obligatory in the specialized department (trauma center, traumatologist in the clinic or in the emergency department of the trauma hospital). This is especially true for childhood trauma, since young patients have a number of age-related features that can mask a severe injury. And untimely appeal for competent medical care can lead to negative long-term consequences.
