A suture is placed on tendons and ligaments in case of damage or rupture. This is a very delicate procedure that requires a highly qualified doctor. If everything is done correctly, the functions of the ligaments are fully restored.
The hands have tendons that flex and extend the fingers and wrist. They are easy to injure because they are close to the surface of the skin. However, if an injury occurs, it is extremely important to seek help as quickly as possible and stitch the tendons and ligaments in the first few days. If this is delayed, irreversible changes will appear in the membranes and ligaments. And in this case, much more serious work by the surgeon and a two-stage operation will be required.
Causes of tendon damage
The most common causes of ligament and tendon damage are:
- deep cuts in everyday life or at work: with a knife, glass, electrical appliances, etc.;
- excessive load on the hand when lifting weights, leading to rupture;
- sports loads when performing any exercises or working with weights;
- diseases of the joints and tissues that weaken ligaments (for example, rheumatoid arthritis).
There are also cases when there is no visible or tangible reason for a tendon rupture or ligament damage: the patient may complain of the inability to bend or straighten the finger, but not know when and for what reason this happened.
Diagnosis of tendon rupture
A final diagnosis can only be made after a thorough diagnosis:
- examination of the patient by a doctor;
- tests for flexion and extension of fingers and hands (separately for each phalanx);
- palpation to exclude damage to the artery and nerves;
- finger sensitivity test to rule out nerve damage;
- radiography to exclude bone tissue injury;
- MRI in the absence of an open wound to determine the location and extent of damage.
After the doctor has received enough information about the nature of the injury, surgery is prescribed.
Suture of tendons and ligaments (stitching)
A damaged ligament can be repaired by applying a surgical suture. If necessary, the operation can be postponed until favorable conditions for its implementation occur (for example, if more than 24 hours have passed since the injury and in other cases).
This is a very delicate work, the result of which determines the normal function of the patient’s hand and fingers. The surgeon performing this operation must master several techniques for suturing ligaments, which are used for different types and locations of injury.
The stitching method is selected individually in each case. To access the tendon, an incision is made at the site of the procedure, no more than 1 cm long. In case of an open wound, it is first thoroughly treated, and then the ligaments and tissues of the hand are sutured layer by layer.
For different types and locations of ligament damage, the surgical procedure is individual. There are cases when it is necessary to stitch the tendons on several fingers at once. And each operation is performed according to its own methodology.
The injury, often referred to as “gamekeeper's toe” or “skier's toe,” is associated with a tear of the collateral ligament of the thumb.
What is the difference between these names?
The first term is typical for injuries that are chronic, and the second for acute injuries. Gamekeeper's finger was first described in 1955. This chronic injury is typical of Scottish gamekeepers, who killed wounded rabbits by pinching their necks between the base of their index finger and thumb.
A typical injury for alpine skiers is a rupture of the collateral ligament of the metacarpophalangeal joint. Sometimes such injuries occur in athletes involved in contact sports, for example, boxing, as well as sports in which the athlete can fall and lean on his hands. The injury, common among skiers, was first described in 1939. It is the second most common injury among downhill skiers (about 10% of cases) and among upper extremity injuries (37% of cases).
The ligament is damaged when the athlete falls on the snow. At this moment, the thumb is maximally straightened and abducted as the hand holds the ski pole. To avoid serious consequences of a fall, the skier instinctively extends his arms forward, but the stick remains in his hand. This greatly increases the vulnerability of the thumb.
To avoid injury, skiers began to be advised to use ski poles that do not have a belt. It was the latter that did not allow him to free his hand from the stick in time when falling. Some manufacturers have designed a new type of “grip” for sticks, but even in this way the problem could not be completely solved.
Thumb injuries sometimes occur in other sports as well. Hockey players most often suffer if, at the time of the collision with any hard object of the stick, the thumb was strongly moved to the side. A similar situation happens in football and other sports where you need to catch the ball.
Features of the structure of the metacarpophalangeal joint of the thumb
This joint is unique both in functional biomechanics and anatomical structure. Its stability is necessary to create leverage and create a powerful grip. Its mobility varies from person to person: some are unable to extend it more than usual, others are able to do this to the fullest. The flexion angle ranges from five to one hundred and fifteen degrees, the radial deviation in some cases reaches 30 degrees in a straightened position and up to 15 degrees in full compression.
There are several degrees of damage to the collateral ligament:
- The first degree, which occurs among skiers in almost 35% of cases. This degree is characterized by a slight rupture of the ligament, with no loss of integrity.
- The second degree is determined by a slight rupture of the fibers and their elongation, but without loss of integrity. Occurs in 47% of cases.
- Third degree, which is characterized by complete rupture of the ligament. It is formed at the distal end in close proximity to the place where it enters the proximal phalanx. Third degree damage occurs in 18.2% of cases.
A fairly common occurrence accompanying ligament rupture is a fracture - 23.3% of cases.
Timely and correct treatment of the victim is possible only after a thorough examination. If you neglect the problem, a complication may arise in the form of chronic impairment of the functionality of the finger.
Diagnostics
Most often, the patient experiences pain around the elbow of the metacarpophalangeal joint with swelling. If the doctor suspects a ligament rupture, an x-ray will be ordered to detect an avulsion fracture, if there really is one. If an open type fracture is found, surgical intervention is necessary; a closed type will require immobilization. If no bone damage is found, a clinical examination is performed to assess the stability of the joint. To check, a load is applied in the radial direction in a straightened and bent state. Test results from the other limb are used to determine discrepancies. Loss of integrity of the accessory collateral ligament with the palmar plate can be detected in the absence of stability in the straightened state. A rupture of the collateral ligament itself manifests itself in a violation of stability during flexion.
In some cases, symptoms may coincide with another injury - Stener's injury. To determine the true cause, an x-ray of the joint is taken.
Treatment
The injured person should immediately apply ice to the joint, with the thumb in an elevated position. For a first-degree injury, a splint is placed on the hand or forearm. If there is a second degree of damage, the athlete will have to wear a cast for 3-4 weeks. For a grade 3 injury, a plaster cast is placed for a period of four to six weeks. If the instability of the joint is severe, surgical intervention will be required. The operation is performed in the first weeks after the injury, and its essence consists of placing a wire suture at the site of the tear, which will subsequently be removed.
Training sessions may be resumed during treatment. If a splint or protective plaster cast has been applied. The splint or plaster is applied in such a way that deflection forces in the radial direction act on the proximal phalanx. Such forces should also cause deflection of the first metacarpal through the action of the first dorsal interosseous muscle. This, and thumb opposition, which should be avoided, may contribute to abduction of the metacarpophalangeal joint. The position of the metacarpophalangeal joint should be flexed. The angle is 30 degrees. The interphalangeal joint should be in a flexed position at an angle of 20 degrees.
If a fiberglass cast has been installed, it must have sufficient rigidity to allow the athlete to return to training. The tire is not able to provide sufficient mobility and protection. It should be secured using an elastic material and used after the cast is removed to protect the area of stress injury. Protective equipment that is used after healing of grade 2 and 3 injuries should be worn for 2-3 months.
Subject to complete healing, the athlete can return to training after four to six weeks, but before this, a course of rehabilitative physical education will be required. Ultimate health can only be diagnosed by a doctor.
If the victim refuses treatment for a collateral ligament injury, periodic or continuous instability of the joint and weakening of grip strength may occur. In some cases, injury leads to arthrosis of the joint. Even when treating the most serious problems, surgery allows you to get decent results.
Injury Prevention
Often the cause of joint damage is a ski pole. This conclusion is based on observational and subjective data, which undoubtedly indicate that among athletes who held ski poles without securing them with special straps on the palm, injuries were detected in only 5% of cases. Based on this information, we can say with confidence: ski poles should not be secured with straps to avoid joint injury. It is recommended to either remove the straps themselves or place them on the outside of the ski pole. Some manufacturers produce poles without straps. Skiers should remove their poles when falling.
To protect the thumb, a special device can be added to the glove so that it does not interfere with the normal movement of the thumb and relieves stress on the elbow. Preliminary studies were conducted which showed that when skiing with a pre-installed protective mechanism in the glove, the number of injuries was significantly reduced.
Rehabilitation after suturing the ligament
The recovery process after this procedure is quite long and complex. In different cases it lasts from 3 to 6 weeks, depending on the complexity of the damage. During this entire period, the patient is under the supervision of a doctor. It is also extremely important to adhere to the recommendations of the operating surgeon.
The further mobility of the hand and fingers largely depends on how accurately the patient follows the recommendations.
If you have questions about suturing ligaments and tendons, you can ask them by phone +7 or by message using the feedback form in the Contacts .
3. Treatment for muscle ruptures of varying degrees
Depending on the severity of the injury, the patient requires different amounts of medical care. The recovery period is also very individual. Muscle tears are classified according to two criteria:
- open or closed gap;
- full or partial.
First aid for muscle fiber injury is provided on the spot and includes:
- fixing the affected area in a position that ensures maximum approximation of the separated parts of the muscle;
- applying ice to stop bleeding;
- in case of an open rupture, it is necessary to treat the edges of the wound with antiseptic agents.
First aid measures may be sufficient for a partial rupture. In this case, further fusion of damaged tissue occurs under the condition of complete rest.
However, it is difficult for a non-specialist to assess the severity of the injury.
It is recommended to take the victim to the nearest emergency room for diagnosis and obtain qualified advice. The treatment plan based on the results of the examination may include:
- applying ice to the injury area according to a specific pattern;
- subsequent heat treatment;
- painkillers and anti-inflammatory drugs;
- first rest, and then physiotherapy aimed at development and recovery.
Muscle tears require 4 to 12 weeks to heal and recover. This injury is dangerous because the muscles can heal incorrectly and form a lifelong defect. If there is any suspicion that the rehabilitation process is being delayed or is not producing the desired result, you should contact a traumatologist.
The doctor will conduct intermediate studies and make adjustments to treatment tactics.
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