Rupture of ligaments, muscles, tendons: general information

Possible ruptures of ligaments, muscles and tendons. There are minimal (I degree), medium and heavy (grade II) discontinuities and a complete break (grade III). The third degree of damage to the ligaments can lead to instability of the joint, it is differentiated from the II degree by means of stress tests. A full rupture of the tendon turns off the muscle function. Treatment of all gaps includes analgesics, immobilization and, for some cases, grade III damage to ligaments and tendons, surgical treatment.

Ligament injuries are often found in the acromioclavicular joint, PMPS, knee and ankle joints; tendon ruptures are characteristic of extensors of the knee joint and calcaneal tendon. Often there are also ruptures of some muscles. Torn ligaments, muscles and tendons cause pain, tenderness in palpation and, usually, swelling. At ruptures of II degree the pain is especially strong at reduction. A complete rupture of ligaments often leads to instability of the joint. If the tendon is completely ruptured, the muscle is not able to drive the segment of the limb, as there is virtually no attachment to the bone. Defect of the tendon can be palpable.

Bedside stress testing consists in the passive retraction of the joint in the direction opposite to the natural (stress), to detect its instability; this makes it possible to differentiate the second degree of discontinuity from III. Since muscle spasm in the process of sharply painful damage can mask instability, it is necessary to wait for the maximum relaxation of muscles and repeat the test, each time slightly increasing the load. The results of the examination are compared with the opposite, normal limb. At breaks of II degree the trial is painful and the opening of the joint is limited. At grade III, the pain in testing is weaker, since the ligaments are completely ruptured and not stretched, and the opening of the joint is less limited. With severe muscle strain, the test should be performed after injection of a local anesthetic, systemic analgesia or sedation, or a few days after resolution of the spasm.

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Treatment of ruptures of ligaments, muscles, tendons

Treatment of all gaps includes rest, cold, compression and elevated limb position and, if necessary, analgesics. At the first degree, treatment with early activation is most effective. At moderate ruptures of II degree often immobilization by a kerchief or a bandage for some days is often applied. With severe damage of the II degree and some tears of the third degree, the immobilization is maintained up to several weeks, sometimes with a plaster bandage. At the majority of ruptures of III degree surgical treatment is shown.

Damage to the acromioclavicular joint. A typical mechanism is a fall supported by a shoulder or an arm. With severe ruptures of the coracoid-clavicular ligament, the clavicle is displaced anteriorly from the acromial process. Treatment - immobilization (for example, a sling dressing) and early activation. With some severe ruptures, surgical treatment is indicated.

Damage to the ulnar collateral ligament ("finger of the huntsman"). A typical mechanism is the lateral retraction of the thumb. Stress test involves the removal of the finger in the radial direction, local anesthesia is needed. Treatment - immobilization of the thumb with a longus. If the maximum possible diversion is more than 20 °, compared with the thumb of the healthy side, then surgical treatment is indicated.

Damage to the ligaments of the ankle joint. For joint stability, the most important are the powerful deltoid ligament (medial), the anterior and posterior portions of the talon-peroneal ligament, the heel-peroneal ligament (lateral). Damage occurs very often, usually occurs when the foot is turned inward (inversion) and is accompanied by rupture of the lateral ligaments, usually beginning with the anterior talon-peroneal ligament. Severe damage of grade II and III often leads to chronic joint distortion and instability, which predisposes to additional ruptures. Damage to the ligaments of the ankle joint causes pain and swelling, the maximum on the anterolateral surface. A grade III rupture often causes a more diffuse edema and soreness (sometimes this zone acquires an egg-like shape).

Radiography is performed to exclude significant fractures in the following cases:

• age> 55 years;
• the inability to carry the weight of the body right after the injury plus the inability to take 4 steps during the first examination;
• tenderness of the bone at the posterior margin and at the apex of both ankles.

The "front drawer" test for the ankle allows assessing the stability of the anterior talon-peroneal ligament, which helps to differentiate the II degree of lateral rupture from III. The patient sits or lies on his back with slightly bent knees. With one hand, the doctor prevents the lower leg from moving forward, and the second hand covers the heel from behind and pulls it forward. Treatment of injuries of the 1st degree includes rest, cold, pressing bandage, elevated position and early load on the limb. With lesions of the II degree, immobilization of the ankle joint in the neutral position by the posterior longus is added to this treatment, with activation in a few days at moderate ruptures and later with severe ruptures. At grade III, surgical treatment may be required. If the II degree is not differentiated from III (for example, because of muscle spasm or pain), it is possible to perform MRI or try immobilization for several days, then repeat the examination.

In rare cases, with the turn of the foot, a delta-shaped ligament rupture is possible, often in combination with a fracture of the fibular head.

Injuries to the calcaneal tendon. A typical mechanism is the dorsiflexion of the foot, especially if the Achilles tendon is stretched. When squeezing the eggs of the patient lying on the abdomen, the passive plantar flexion of the foot is weakened. Partial ruptures are often not diagnosed. Treatment of complete ruptures is usually surgical. Treatment of partial injuries and some complete ruptures is the immobilization of the ankle by the posterior end of the lumbar sole plantar flexion for 4 weeks.