The human hand is one of the most functional elements of the body. It is difficult to imagine a full life without hands. The brush performs dynamic, touch and static functions. Despite its small size, it has a rather complex specific structure and consists of a bone frame, tendons, ligaments, blood vessels, nerve fibers, etc. The ligaments of the hand are strong, elastic and dense formations of connective tissue that allow them to be fixed and held in a certain position. position of the joints, while providing them with the necessary mobility within the physiological norm. Ligaments also connect bones to muscles. The ligamentous apparatus of the hand provides elasticity and flexibility of the limb. Ligaments can withstand quite serious loads, but in cases of increased physical impact, various injuries are possible.
Types of damage
Ligament injuries in the hand occur in both adults and children. The reasons can be very diverse. These include household injuries (falling on an outstretched arm, which can be combined with dislocations and subluxations of the joints); sports injuries resulting from improper exercise or excessive stress on the hand. For children, ligament damage is common in cases where adults, without calculating their strength, lift or sharply jerk the child, holding him by the hands.
The most typical injuries to the ligaments of the hands can be considered:
- Sprains of the hand are injuries to nerve fibers and blood vessels at the microscopic level
- Rupture of the ligaments of the hand is a partial or complete violation of the integrity of the fibers. Less common is a complete separation of the ligament from the bone or with a fragment of part of the bone (then the ligamentous rupture is complicated by an avulsion fracture)
- Inflammatory processes occurring in the hands. These are the following diseases: peritendinitis (inflammation of ligaments and tendons), carpal tunnel syndrome, arthritis, etc.
Surgical intervention
Surgical treatment of thumb ligament rupture in Germany is carried out in a minimally invasive way - using arthroscopy.
Indications for surgical treatment are:
- complete rupture of the ligament;
- old damage;
- ligament injury with separation of bone fragments;
- ineffectiveness of conservative therapy within 10-14 days.
During arthroscopic treatment, the specialist makes 2 incisions several millimeters long in the projection of the affected joint. This determines minimal trauma to healthy tissue, which means the absence of postoperative complications and relatively short rehabilitation.
A skier's toe in Germany is repaired by suturing the damaged ligament and restoring the integrity of the joint capsule. In addition, plastic surgery of bone structures is performed (if necessary) by applying fixing screws, plates and wires. Resorbable systems are often used, which are absorbed and excreted from the body over time.
Symptoms and location of pain
When sprains of the carpal ligaments, the following symptoms are observed:
- The occurrence of pain of varying intensity
- The appearance of puffiness and swelling of the hand
- The mobility of this part of the arm is limited
- When moving the hand, the pain increases
- A hematoma may appear on the injured area of the arm as a result of rupture of blood vessels
- With ruptures, the pain syndrome intensifies, a clicking sound is characteristic, and movements in the joint acquire an unusually large amplitude.
Symptoms of hand ligament injuries may vary depending on the location of the source of pain. For example, damage to the ligaments of the wrist, damage to the ligaments of the fingers and separately to the ligaments of the thumb are possible.
Rehabilitation and return to physical activity
After minimally invasive intervention, the patient remains in the clinic for 24 hours. On the morning of the next day after surgery, a specialist examines the wound and can discharge the patient. It is quite possible to remove sutures in a domestic clinic, so the patient does not need to stay in Germany for a long time. Our team will always help the patient regarding treatment control. You contact a DeutscheMedizinischeUnion consultant, provide the latest X-ray data, and we send the result to your attending physician abroad. After reviewing the image, the specialist gives further recommendations for your rehabilitation.
In addition, rehabilitation can be carried out in specialized orthopedic centers in Germany, which our team will also help you choose. However, rehabilitation begins 2-4 weeks after surgery. During this entire time, an orthopedic splint is placed on the thumb joint, keeping it stationary. The wrist joint remains mobile, so the patient’s activity is somewhat preserved.
Note that after surgery, full weight-bearing on the arm is possible only after 1-2 months, but conservative treatment, depending on the degree of the rupture, can take up to 4 months. In any case, in a foreign clinic you will be offered the optimal method of therapy, which will allow you to quickly eliminate the damage and return to your normal life. Leave a request on our website and we will help you get treatment from the best orthopedists abroad.
Diagnosis of ligament injuries
Diagnosis of sprains and ligament tears includes:
- initial examination by a doctor with a complete medical history of the patient
- x-ray examination
- ultrasonography
- magnetic resonance imaging.
Diagnostics in Germany
Diagnosing a pathology such as a skier's finger, that is, an acute rupture of a ligament, is not difficult. Based on the medical history, the doctor makes an assumption about the type of pathology and confirms the diagnosis by ordering an x-ray examination. In addition to ligament rupture, the x-ray will determine the presence or absence of damage to bone structures.
In case of old damage, when doubts arise about the diagnosis, an MRI of the affected hand is prescribed. In addition to instrumental studies, mandatory general clinical tests are carried out. Also, if surgery is necessary, examinations are prescribed to determine the general condition, such as chest radiography and ECG.
Treatment options for hand ligament tears
For minor sprains and bruises, conservative treatment is prescribed. This is a set of measures that involves: drug treatment (taking painkillers and anti-inflammatory drugs, using chondroprotectors, ointments, taking vitamins); physiotherapeutic treatment (electrophoresis, laser treatment, magnetic therapy, wave therapy and other methods as prescribed by the doctor); appointment of massage treatments; applying a bandage that limits the mobility of the injured arm, etc.
In more serious cases (tears and ruptures of ligaments), the patient undergoes surgery in the hospital. The surgeon determines the optimal surgical option in each specific case, based on the patient’s diagnostic data. It consists of stitching torn ligaments, or removing inflamed parts of the ligaments, fixing tendons and bones. After surgery, the patient needs rehabilitation measures. To fully restore the functional ability of the hand, physiotherapy, therapeutic massage, exercise therapy, etc. are prescribed.
If you receive such injuries, you should not self-medicate and delay contacting a doctor. The sooner the correct diagnosis is made and the necessary treatment is prescribed, the more favorable the prognosis for the complete restoration of mobility and performance of the hand. Specialists from the Department of Hand Microsurgery of the Medical Center of the Central Clinical Hospital of the Russian Academy of Sciences are always ready to provide you with qualified assistance.
Conservative treatment methods
For patients diagnosed with skier's toe, treatment is prescribed on the day of diagnosis, which determines the best prognosis for recovery. Local anti-inflammatory drugs (creams, ointments) are usually prescribed; in case of severe pain, anesthetics are injected into the lesion. Other medications include vitamin therapy, restorative treatment, and for severe pain, oral painkillers.
Also a mandatory stage of conservative therapy is wearing orthopedic structures and using an elastic bandage. In the acute period, treatment for a rupture of the thumb ligament abroad includes fixation of the structure and complete immobilization. The injured thumb should remain immobilized for four weeks. Afterwards, comprehensive orthopedic rehabilitation is prescribed using therapeutic exercises and special exercises that restore hand mobility.
Orthopedic rehabilitation, among other things, allows you to strengthen the ligaments of the hand, which will prevent their repeated stretching and rupture. And if the patient returns to the type of activity that led to the injury, the rehabilitation specialist gives certain instructions for preventing subsequent injuries.
Symptoms
- Pain and tenderness on the inside of the elbow, especially when trying to throw a ball
- Clicking or cracking tear or discomfort during injury
- Swelling and hematomas (after 24 hours) at the site of injury on the inside of the forearm in the elbow area and above if a rupture has occurred.
- Inability to throw with full force, loss of ball control
- Stiffness in the elbow, inability to straighten the elbow
- Numbness or tingling in the fingers
- Impaired hand functions such as grasping and performing small movements.
Possible complications
If you do not consult a doctor in time or self-medicate, then even mild damage to the elbow ligaments can lead to:
- arthrosis – damage to articular cartilage;
- damage to the nerves in the forearm or shoulder;
- permanent limitation of mobility, etc.
Any complications will make it difficult to treat the underlying damage, and the consequences of the above diseases will remain for a long time. Therefore, it is strongly recommended to consult a doctor at the first symptoms indicating damage to the ligaments of the elbow joint.
Diagnostics
Pain over the medial aspect of the elbow, tenderness directly over the ulnar collateral ligament, and specific functional tests that simulate stress on the ligament may be helpful in diagnosing injury to this ligament. Specific physical tests include a valgus stress test, in which force is applied to the elbow and range of motion is tested. This may be the most sensitive functional test. MRI is the best method for imaging the soft tissues of the elbow joint. Small tears on the lower (deep part) of the ligament are especially well visualized when using contrast (injected into the elbow) as such damage cannot be seen without contrast.
Causes of damage
If you injure your finger with a sharp object, you can easily damage the extensor tendon, which is located on the back surface of the finger.
However, closed, subcutaneous injuries are also often encountered: when the skin remains intact, but the tendon is torn. This can happen with a blow to the finger or under rather curious circumstances, for example, when the patient puts on a sock and hears a slight cracking sound. Trying to understand the cause of this sound, the person notices that the nail phalanx does not straighten, although there was no injury. Thus, as a result of a rupture of the extensor tendon, the nail phalanx of the finger ceases to actively extend, but is still capable of bending. The flexor tendon, while maintaining traction, gives the nail phalanx a bent position. (Fig. 1). Fig.1. Subcutaneous injury to the extensor tendon of the 5th finger of the right hand at the level of the distal interphalangeal joint.
Nikitin Alexander Vladimirovich
Traumatologist-orthopedist "SM-Clinic"
“For different types of injuries, different treatment tactics are used. Open injuries require urgent surgery to repair the tendon rupture.”