Etiology
Damage to the articular disc can occur for the following reasons:
- Avulsion of the styloid process of the ulna.
When the styloid process of the ulna is avulsed (for example: with a fracture of the distal radius), the articular disc is separated from the ulnar attachment zone.
- Fractures of the distal radius.
The articular surface of the radius often becomes abruptly displaced relative to the ulna, resulting in damage to the articular disc.
Shortening of the radius, which often occurs with these fractures, leads to a relative lengthening of the ulna compared to the radius (positive ulnar cleft). In this case, the head of the ulna puts constant pressure on the disc, which is under constant tension, especially with ulnar deviation.
- Rheumatoid arthritis.
Chronic synovitis can lead to disc damage.
- Degenerative changes.
They can develop due to chronic trauma in combination with deterioration of diffusion properties, which leads to disturbances in the nutrition of the articular disc.
- Direct compression damage to the disc.
As the length of the ulna increases, regardless of the cause, the disc is constantly compressed between the head of the ulna and the lunate.
- Congenital perforation.
Cases of congenital disc perforation have been described.
- Excessive flexion (less common).
A fall on a bent hand leads to damage to the dorsal capsule and posterior disc separation. This compresses the palmar parts of the disc.
- Excessive extension (more often).
At the moment of contact with a hard surface, the hand extended forward during a fall is in a position of extension and slight ulnar deviation. In this case, the articular disc comes under strong axial compression, which is also transmitted through the capitate bone to the scapholunate ligament.
Clinical picture
As a rule, the pain is localized on the elbow side, but can spread to the entire hand. Clicking and cracking sounds may occur periodically or with certain movements. Decreased handgrip strength has also been described.
Diagnostics
Local pain is detected in the dorsal-ulnar quadrant of the hand. In case of acute or recent injury, deviation of the hand to the ulnar side causes pain on the same side of the hand. This pain also occurs during the “hammer test”, when the patient is asked to hold the hammer handle relaxed and deflected to the elbow.
If this test is painful, disc damage should be suspected. Maximum deviation of the hand to the ulnar side increases the pain.
Another test is based on disc load during ulnar deviation of the hand and axial compression. The patient's relaxed arm, bent at the elbow, is placed on the table, fixing the distal forearm. In the ulnar abduction position, alternate flexion and extension of the hand are performed.
Pain and audible or palpable clicking sounds indicate disc damage. Sometimes crepitus can increase with pronation and supination.
With increased extensibility of the ligaments, even in the absence of morphological changes in the disc, clicks are often detected in the ulnar parts of the hand. In patients over 30 years of age with chronic pain in the ulnar parts of the hand, degenerative changes in the disc should be considered.
Articular cartilage is visible on radiographs only if it is calcified. Relative elongation of the ulna is an indirect sign of pathological changes in the disc, which is confirmed by functional radiography in the anteroposterior projection performed with ulnar abduction.
MRI does not detect small disc injuries, but large tears can be visualized. Therefore, MRI should be used in a very limited number of cases when disc injury is suspected.
Anatomy of an olecranon fracture
A fracture of the olecranon process occurs mainly when falling on the elbow from one’s own height. There are cases when this fracture is characterized by a displacement variant. Most often it occurs at the level of the apex of the process, but sometimes it causes extra-articular damage. It is to this area that the tendon of the triceps brachii muscle (triceps) is attached, which “pulls” the broken elements proximally (towards the shoulder), thereby creating a diastasis between the fragments, which is a serious obstacle to fracture healing.
Arthroscopic findings
The articular disc has a yellowish-white surface resembling the cartilage of the radius. Often, a feeler gauge must be used to determine the location of the radial attachment of the disk. The ulnar and dorsal attachments of the disc are homogeneous. As a result of complex disc avulsion in the dorsal-ulnar region, the small prestyloid volvulus on the ulnar side of the disc may expand.
The consistency and elasticity of the disc, as well as its dorsal and radial attachments, are assessed by palpation with a probe.
The degree of damage to the disc varies from local compaction and superficial fibering to flap-like ruptures of various sizes. With widespread degenerative changes and relative elongation of the ulna, complex injuries are revealed during arthroscopy, in which only the palmar and dorsal thickenings of the disc remain intact.
If the disc appears intact, it should still be instrumented to look for hypermobility due to an old rupture. Peripheral dorsal-ulnar tears are quickly covered by synovial tissue and functional tests are necessary to detect avulsion.
Classification
Several classifications of disk damage have been proposed. A more practical classification is Ostermann (1990), which distinguishes three types of disc damage:
- Type 1 – Traumatic radial tear .
- Type 2 – Central degenerative perforation .
- Type 3 – Traumatic peripheral rupture .
Unfortunately, this classification does not take into account structural changes in the disc. Careful palpation is required to identify disc damage. In many cases, the tear is not noticeable because the edges touch or overlap. This is common in central degenerative lesions that become symptomatic after trauma or normal movement. In contrast, identification of central perforation is usually not difficult.
To confirm or exclude rupture of an apparently unchanged disc, the following sequence of instrumental palpation has been proven effective:
- Elimination of the central gap.
- Rule out peripheral rupture or hypermobility.
- Assessment of disc tissue (softening, hardening, surface fibering).
- Exclusion of impingement syndrome caused by the head of the ulna.
Rehabilitation after plaster removal
If everything goes according to plan, then after 5 weeks the immobilization is canceled. If an open fracture has occurred, the doctor may apply a zinc-gelatin bandage, which will have to be worn for 1-4 weeks.
A closed fracture of the styloid process does not require such a procedure, but as an “insurance”, it is recommended to wear a high compression wristband. It will not cause the development of joint stiffness, and further development of the broken limb can be done both with it and without it.
Elastic wristband does not interfere with the development of the wrist joint
Physiotherapy
In the first 7-10 days, it will be enough to perform the active movements shown in the photo above. By the way, after 10-14 days, people with light physical labor can go to work. Over the next 2-3 months, it is forbidden to carry heavy objects, and gradually add movements to the above exercises that increase the load on the joint.
You should do the following every day and several times:
- a large number of repetitions (50 times or more) of clenching and unclenching your fist, raising your hand up;
- exercises with various manual expanders, dumbbells and weights;
- push-ups first from the wall, table, and then from the floor;
- movements in support on the table, on all fours and lying down;
- half-hangs and hangs.
Exercises in the pool, where you need to swim in doses, including with special fins for your hands, will also not be superfluous.
Physiotherapy
UHF procedure
Since fractures in the area of the wrist joint finally heal over quite a long time, in addition to a course of therapeutic massage from a specialist and daily self-massage, it is recommended to do:
- at home - paraffin and contrast baths, mud applications;
- in the outpatient clinic - UV irradiation, UHF, electrophoresis.
Sports training is permitted by a doctor on an individual basis, depending on the condition of the callus, the type and severity of the expected load on the joint. The time for gradual entry into the training and competitive process for weightlifters, kettlebell lifters, boxers, wrestlers, volleyball players, gymnasts or pole vaulters can last up to 8-12 months.
And in conclusion, we suggest watching another video that was filmed specifically for women. After all, it is they who, as was mentioned at the beginning of the article, most often fall in such a way that they receive, as a complication of Colles’ injury, an avulsion fracture of the styloid process located on the ulna.
Treatment
The articular disc is of exceptional importance for stabilizing the distal radioulnar and elbow joints. Total resection of the disc leads to disintegration in the distal radioulnar joint, as well as with avulsion of the styloid process of the ulna. Therefore, in acute peripheral tears and hypermobility associated with an old tear, an attempt at disc suturing is necessary. Due to the relatively poor blood supply to these areas, suturing for central ruptures of the disc and its separation from the radius is not indicated.
There are five approaches to treatment for articular disc injuries: non-intervention, debridement of disc irregularities, resection of unstable fragments, suturing, and a combination of resection and suturing.
In most cases, partial synovectomy is also required to identify peripheral tears. For central tears in combination with relative lengthening of the ulna, arthroscopic intervention is indicated to shorten the head of the ulna.
Conservative treatment of a radius fracture in a typical location (plaster cast)
For non-displaced fractures, conservative treatment can be offered - in a plaster cast. The average stay in a cast is 6-8 weeks. This rarely goes away without a trace for a limb - after conservative treatment, the joint requires the development of movements and rehabilitation. When treating a fracture with even a slight displacement in the cast, secondary displacement of the fragments can occur.
Diagnosis of olecranon fractures with and without displacement
In the case of a fracture of the olecranon without displacement or with acceptable displacement, deformation of the elbow joint is not determined. Movements are limited only by pain, that is, the function of the hand does not suffer. Therefore, it is impossible to say with certainty that there is no fracture with normal function.
To determine the fracture, an x-ray of the elbow joint is performed in two projections. This research is sufficient in most cases. For a more detailed study of the nature of the fracture, computed tomography (CT) is performed. With its help, you can determine how much the process is destroyed and decide on treatment tactics. Whether to perform the operation and using what metal structure. All these nuances are very important for better fixation and the best treatment outcome.
Recovery time and whether there may be complications
The average time for complete recovery is from 3 to 6 months (from the moment you start wearing the cast until you develop full functionality). They depend on the complexity of the injury and the individual characteristics of the victim (age, chronic diseases, bad habits, etc.).
Possible complications after injury are:
- Development of infection in case of open damage. In particular, osteomyelitis.
- Dystrophic changes in the joint and subsequent problems with its functionality.
- Nerve conduction disorder, manifested by intermittent pain in the forearm, shoulder, and wrist.
First aid
First aid to the victim is characterized by the need to reduce discomfort, as well as ensure complete rest. To do this you need:
- Ensure limb immobilization.
- Treat open wounds, if any, with available antiseptics to prevent the development of infection in soft and bone tissues.
- Give a pain reliever. Fast-acting products like Ketorol, Baralgin, etc. are perfect for this.
- Apply cold to the injury site to remove excess swelling. However, applying ice to exposed skin can cause frostbite. Therefore, before ensuring the contact of the damaged area with the cold, it is necessary to apply a soft cloth between them.
What you should never do:
- Specially move the hand in order to restore the correct position of the fragments.
- Apply warm compresses. They increase bleeding and provoke the activity of pathogenic flora.
Attention! Do not bandage the injured area, as this will further spread the fragments and worsen the situation.
Symptoms of an olecranon fracture
When visiting a doctor, the patient complains of pain and dysfunction of the elbow joint.
Upon examination and physical examination, the following signs of an olecranon fracture exist:
- Deformation and swelling of the elbow joint;
- Limitation of extension and flexion of the forearm (when displaced, extension is limited, since the triceps muscle pulls only the broken fragment);
- Hemarthrosis (bleeding into the joint);
- Pain on palpation of the appendage;
- When the olecranon is fractured with displacement, a retraction of the skin is determined instead of the usual bony elevation.