Ligament damage - complete or partial violation of the integrity of the ligaments due to traumatic effects. Similar pathologies are widespread. Their cause in most cases is a sports or domestic injury. Most often, ligaments of the knee, ankle and shoulder joints suffer. Damage to the ligaments, as a rule, is manifested by pain, aggravated swelling, restriction of movement and support. Often in the injured area on the 2-3rd day, a pronounced hematoma is formed. 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
Damage to the ligaments is an injury in which rupture of the ligament or its individual fibers occurs. Along with bruises, it is one of the most frequent traumatic injuries and can be observed at any age. More often than the upper limbs, the lower ones suffer. There is also some seasonality, for example, the amount of damage to the ankle ligaments increases sharply in the winter, especially during icy conditions.
Causes
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 for damage to the knee ligaments or any other are tucking the legs, twisting the arms (for example, when practicing contact sports or an unsuccessful fall). The degree of damage can vary significantly - 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.
Kinds
Ligament injuries are classified according to only one feature — the injury localization site. Thus, damage can relate to such joints:
- ankle;
- the knee;
- shoulder;
- the hip.
Degrees
Regardless of the location of this injury, in traumatology there are three degrees of ligament damage:
- 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. A similar stage is accompanied by moderate pain. There is no hemorrhage, but slight swelling is observed. An unsharp restriction of movements and support may also occur with partial damage to the ligaments.
- 2nd degree (tear) - a condition in which a rupture of the main part of the fibers of a particular ligament occurs. This trauma is accompanied by swelling and bruising. Minor joint instability can be detected. Patient's movements are limited, with some pain is felt.
- 3rd degree - ligament rupture. With such traumatization, a person experiences severe pain, a large bruise forms, the injured area of the body strongly swells, and joint instability is also observed.
Signs and Symptoms
Damage to the ligaments is manifested by pain in the damaged joint, which is significantly amplified by movement. There is a swelling of the damage zone. The severity of such symptoms directly depends on the severity of the injury. The doctor on palpation notes soreness, localized in one area. Bruising can appear 2-3 days after a 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, without timely therapy, hemarthrosis may develop.
How long does the pain last?
Pathological signs of a sprain or tear disappear after about 1-2 weeks, but if a ligament rupture is detected, pain will accompany the patient for up to a month or more. The main signs of ligament damage are:
- swelling;
- pain in a damaged joint;
- blood supply disturbance;
- functional impairment;
- violation of the outflow of lymph;
- the presence of hemorrhages.
Diagnostics
The diagnosis of “ligament damage” is established taking into account the mechanism of the injury and visual inspection data. In general, the brighter the clinical signs appear, the greater the number of ligament fibers was damaged during the injury. However, it must be borne in mind that hemorrhage and swelling increase over time, therefore, with fresh, complete ruptures of the ligaments, the symptomatology 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 are prescribed.
Differential diagnosis
Damage to the ligaments must be differentiated with dislocations and fractures. With dislocation, a marked displacement of the bones is noted, the joint is significantly deformed, the correct anatomical relations between the structures are broken, movements with the limb are impossible, and when trying to passive movements, 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 broken, limb movements are possible, however, they are significantly limited due to the pain syndrome, spring resistance is not observed.
With a fracture, crepitus, deformation and pathological joint mobility are usually observed. However, these signs of violation are optional, in some cases (for example, with fractures of the external ankle) they may be absent. Other fracture symptoms (swelling, limitation of movement, impaired support and pain) are similar to the clinical symptoms of ligament damage, therefore, when making a final diagnosis, an X-ray examination is necessary. If necessary, MRI or ultrasound diagnostics are prescribed.
Ligament Damage Treatment
Therapy of incomplete injuries is carried out in the emergency room. Patients are prescribed rest, physiotherapeutic procedures and the 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), followed by dry heat. When walking, a tight bandage is applied to support the joint and protect the ligamentous structures from further trauma. The bandage is removed at rest. In no case should you leave the elastic bandage overnight - this often causes a violation of the blood supply to the limb and can trigger increased swelling. With severe pain, patients are advised to take pain medication. The period of active therapy is usually 2-4 weeks, complete restoration of the ligamentous structures occurs after about 10 weeks. We will discuss the treatment of damage to the ligaments of the knee in more detail below.
Hospitalization
With a complete break in the patient, they are hospitalized in a hospital, in the department of traumatologists, where immobilization is carried out, the limbs are 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 performed immediately upon admission of the patient to the hospital. In the future, rehabilitation measures are mandatory.
Damage to the ankle joint
Such an injury is the most common. Often it occurs when the foot is turned inside. Most often, ligaments localized between the talus and fibula or the calcaneus and fibula suffer from this. In case of injuries of the 1st degree (sprain), the patient complains of non-intense pain when walking, minor or moderate swelling of the joint. The walking function is not impaired.
2nd degree (tear), as a rule, is accompanied by severe swelling that extends to the front and outer surface of the foot. A significant restriction of movements is observed, walking may be difficult, lameness occurs.
With a complete rupture of the ligament (3rd degree), intense pain, swelling and hemorrhage appear, which extend to the entire foot, including its plantar surface. The patient cannot walk. On MRI of the joint, complete or partial rupture of ligamentous fibers is determined. On the roentgenogram of the ankle joint (1-2 degree of damage) there are no violations. At the 3rd degree, a small bone fragment can be seen, torn from the bone in the area of attachment of the ligament.
The first day ankle sprain therapy includes tight bandaging and cold. From the 2-3rd day, physiotherapy is prescribed: alternating magnetic fields, UHF, in the future - ozokerite or paraffin. Recovery occurs after 2-3 weeks.
If the ligament is torn to the limb for 10 days or more, a plaster cast is applied. The rest of the therapy is the same as with 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 gypsum remains for another 2 weeks. Next, the dressing is modified so that the patient can remove it during massage, exercise therapy and physiotherapy. Gypsum lasts up to 1 month, then for 2 months it is recommended to wear an elastic bandage or a special ankle to prevent repeated damage. Surgical therapy is usually not performed.
Damage to the knee
As for damage to the knee ligaments, it occurs with lateral forced deflection of the lower leg. If they deviate outward, injury to the inner ligament is possible, if inward, the outer ligament is damaged. The internal ligament with such injuries suffers much more often, but usually it does not break, but it is partially torn, in some situations there is a complete gap. The external ligament is less likely to be injured, but moreover, complete tears, separation of the ligament from the epicondyle of the thigh or from the head of the fibula with its fragment are more often observed.
The patient with damage to the ligaments of the knee joint complains of difficulty walking and movement, pain. The joint is swollen, hemarthrosis may occur. Palpation is quite painful. With a complete tear or a significant tear, excessive lateral mobility of the lower leg is observed. With a partial rupture, a plaster cast is applied, UHF is prescribed. With a complete rupture of the internal ligament, conservative therapy is carried out, which includes immobilization, physiotherapy and exercise therapy. Treatment of damage to the knee ligament, as a rule, does not take much time.
The cruciate ligaments, which are located in the knee joint, can be damaged by transcendental movements. The anterior ligament is damaged when it hits the back of the knee, the back - when it hits the front of the leg or a sharp extension of the knee.
Shoulder damage
Injury of the brachial ligaments in most cases occurs when falling or hitting the shoulder. The cause of this injury may also be a rotation of the arm outward or a strong jerk.
Damage to the brachial 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, severe pain. It is important to differentiate ligament rupture from shoulder dislocation.
Based on the number and extent of tears, as well as on the presence or absence of the inflammatory process, the doctor prescribes treatment, which includes several parallel events. First of all, anesthesia is performed using medications containing diclofenac or ibuprofen. These drugs will relieve soreness and swelling. Shoulder sprain requires recovery and therapy for a month.