If we adhere to the theory that labor was made from a human monkey, 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 its functions from banal support during movement, human hands became one of the most injured parts of the body. In this regard, injuries of the shoulder girdle, which is often accompanied by a rupture of the ligaments of the shoulder joint, are in the area of special attention of clinicians. And the root cause of this is a possible disability and, worse, disability of a person with incorrect or untimely cured damage.
Brief anatomical reference
The uniqueness of the shoulder joint is expressed in the ratio of its true articular surfaces. Two bones are directly involved in the formation of this skeleton element: the scapular and the 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 adjacent ball.
The missing contact from the shoulder blade is compensated by the 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 to fulfill the incredible range of movements that is possible in the most mobile of all the other joints.
Joints holding joints and muscles giving movement
Helps the thin synovial membrane of the joint capsule maintain its anatomical structure, the powerful coraco-brachial ligament. Together with it, the joint is held in the extraarticular inversions of the tendon capsule of the biceps of the shoulder muscle (biceps) and the subscapularis muscle. It is these three connective tissue strands that suffer if a rupture of the ligaments of the shoulder joint occurs.
The subscapular, deltoid, supraspinatus, and hypodermic, large and small round, as well as the pectoralis major and latissimus dorsi muscles give a wide range of movements around all three axes in the joint. The biceps 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, bruises are distinguished. Joint sprains with or without partial or total rupture are possible. Dislocations of the joint, intraarticular or tear fractures of extra-articular fragments (at the site of attachment of the ligaments of the joint), are among the most serious injuries.
The main causes of damage to the shoulder joint is a direct or indirect mechanical effect on its structure. It can be a direct hit and fall on an arm extended forward. A sharp excessive tension of the muscles moving 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 (photo below) requires not only treatment of the injury itself, but also restoration of the integrity of the ligamentous apparatus.
Signs of a ligament rupture
Injury can occur when a fall occurs on an arm extended forward or laid back to the side. It is also possible rupture of ligaments as a result of a sharp movement in the maximum permissible volume or hanging on the arm, for example, when falling from a height.
Symptoms accompanying capsule damage and rupture of the ligaments of the shoulder joint are characterized by sharp pain at the time of the injury and, which is especially indicative of rupture, during movements that repeat the mechanism of injury. Further, edema of the damage area develops, which changes the external configuration of the joint. In addition to edema, blood poured from damaged vessels near the tendons or muscles can take part in the formation of swelling.
Additional methods for assessing the severity of an injury
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 are highlighted. Both methods do not carry a radiation load, but have a very large resolution. In particular, MRI allows you to determine the diagnosis and the choice of treatment tactics with maximum reliability.
Radiography or computed tomography is performed to exclude bone injuries: fractures (including tear-offs), dislocations associated with a fracture, and dislocations in the shoulder joint. Often used joint puncture. 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.
Severity of damage
The classic division into simple, moderate and severe degrees of injury, as applied to ligament rupture. Mild injuries of the shoulder joint relative to the ligamentous apparatus include stretching with partial damage to the ligament fibers, while maintaining the integrity of the 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 relates to sprain, the second to stretching with partial rupture.
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 tear-off fractures, joint hemorrhages (hemarthrosis) are possible.
The choice of treatment tactics
Depending on the severity of 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 used. A bandage or plaster cast can be applied, 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 hard fixation.
With a complete break, especially with damage to the muscles and capsules of the joint, surgical treatment is used. The victim needs to be hospitalized in a trauma hospital and further long-term rehabilitation after discharge from the hospital.
Defect Repair Operational Aid
The earlier the corrective rupture of the ligaments of the shoulder joint is applied, the greater the chances of a complete restoration of joint functions and the less the percentage of injury complications. Surgical restoration of a damaged ligament (tendon), adjacent muscles, damaged vessels and elimination of a capsule defect reduces to suturing them.
Under general anesthesia (anesthesia), direct access above the damaged locus is a layer-by-layer dissection and separation of tissues. Detected defects are sutured. The wound closes in layers. In the early postoperative period, plaster cast immobilization with a window for a postoperative suture is used.
The terms of gypsum immobilization and inpatient treatment are determined by the volume of affected structures. An important factor for the number of bed days is the patient's age, the nature of his work and associated diseases.
Elbow ligament damage
Very rare in the domestic environment, this injury is more characteristic of professional athletes when an active and sharp wave 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.
Most often, the annular ligament of the radial bone, collateral ulnar or radial ligament is injured. A sign of damage is pain that increases with movement. Edema, hemorrhages in the surrounding tissue are characteristic. Hemarthrosis is possible. If there is a complete rupture of the ligaments, there may be a slight displacement of the bones of the forearm in the joint.
Radiography will differentiate the fracture from dislocation. MRI will show where the rupture of the ligaments of the elbow joint is localized . Partial and incomplete rupture treatment is conservative. Immobilization is applied for several weeks. With a complete break, surgical repair of damaged ligaments is performed.
Brief anatomy of the wrist joint
The joint, complex in structure, is formed by the articular surface of the radial 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 directly participate in the formation of the joint.
Five ligaments strengthen the joint. On the palm side, this is the ulnar and wrist ligaments, on the back surface - the back ligament of the hand. Lateral palmar (from the thumb) and ulnar (from the little finger) ligaments pass along the sides.
Damage to the wrist ligaments is much less common than rupture of the ligaments of the shoulder joint. But more often than the ligaments of the elbow.
Wrist ligament rupture
The mechanism of occurrence of injury is associated with a fall on a forward arm or a blow to a bent or bent brush. The position of the hand at the time of the injury is of direct importance in determining which of the ligaments may be damaged. The connective tissue structure opposite to the fold of the brush is most injured.
The leading signs of ligament damage: pain, swelling, impaired joint function and soft tissue hematoma. If there is pain when moving in the fingers of the hand or it increases dramatically when turning in the joint, then a wrist ligament rupture may be suspected. Symptoms are supplemented in diagnostics by hardware studies: radiography - to exclude bone fracture, ultrasound and / or MRI. They are necessary 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 rupture of the ligaments of the wrist joint, the treatment will depend on the severity of the damage. For mild to moderate severity, conservative tactics are used, and for severe ones, operational tactics are used.
Regardless of what kind of damage has occurred, what is the nature of the violation of the integrity of the joint structures, which joint is injured, 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. Mandatory consultation in the relevant department (emergency room, with a traumatologist in a clinic or in the admission department of a hospital with a trauma profile). This is especially true for childhood trauma, as young patients have a number of age-related features that can veil severe trauma. And untimely seeking competent medical help can lead to negative long-term consequences.