Sprains, tendons and muscles | Makarov S.A., Sergienko S.A.

A sprain is a common injury characterized by micro-tears of fibers or individual parts of the ligament. It often occurs in standard everyday situations, for example, when twisting a leg. Most often observed in athletes and people leading an active lifestyle.

Symptoms of a sprain depend on the stage of the pathological condition. In any case, at the moment of injury, sharp pain occurs. It intensifies when trying to use the affected limb and subsides a little during the period of repose. Sometimes, when stretched, a characteristic pop is heard - this indicates the rupture of most of the fibers. At the first stage of the pathology, slight swelling forms, movements are somewhat limited, and pain is moderate. In the second, bruising appears, swelling is greater, movements are painful and limited, and support on the injured leg is difficult. The third stage is characterized by significant swelling, multiple bruises, instability of the joint, severe limitation of movement and the inability to lean on the leg.

Diagnosis and treatment of sprains

Diagnosis of sprains takes place in the traumatologist's office. He examines the injured joint, asks about bothersome symptoms, and asks additional questions. To determine sprains, he prescribes x-rays or other diagnostic methods. They will help to accurately determine the location of the damage and prescribe adequate treatment.

Treatment for sprains is most often outpatient. The patient is advised to keep the injured limb at rest and in an elevated position. During the first day, cold compresses are applied to the damaged area, after the third day - dry heat.

To relieve pain syndromes, gels and ointments with analgesic and anti-edematous effects are prescribed. In severe cases, painkillers may be prescribed.

An elastic bandage is placed on the joint to fix it in the correct position. For a moderate sprain, a splint may be prescribed that will securely fix the joint and prevent the risk of re-sprain. To restore motor activity, doctors prescribe physical therapy and physiotherapeutic treatment.

Main symptoms and diagnosis

An elbow sprain is considered an injury and is quite common in athletes who perform activities that are not typical for the normal functioning of the elbow joint.
A sprain occurs when the physical load on a joint is many times greater than the physical capabilities of the joint. Having received such an injury, a person experiences severe pain, in addition, swelling forms and an enlargement of the elbow is observed, which, in turn, leads to impaired motor function. Also, similar injuries occur as a result of falling on the hand or as a result of blows to the elbow. The specialists of our clinic have developed a number of procedures for identifying sprained elbow ligaments, which, in principle, are based on those generally accepted in medicine, namely:

• visual examination by a doctor of the injury site. It also includes palpation with determination of temperature in the joint area and swelling;

• radiography;

• diagnostics using ultrasound;

• magnetic resonance imaging, which is a highly accurate diagnostic method with an information content of up to 99%.

Treatment

The basic principles of treatment are:

minimizing pain;
eliminating inflammation, swelling or hematoma;
assistance in proper fusion;
replenishment of lost range of motion;
prevention of complications.

Depending on the severity, the traumatologist may prescribe adherence to a certain lifestyle, drug therapy, immobilization and surgical treatment.

Immediately after an injury, rest is needed; it is better not to move the injured arm unnecessarily. A cool compress (locally, for 10-15 minutes) will help relieve swelling or hematoma. It is better to place the injured arm above the healthy one (to reduce blood flow). Exercise therapy classes are carried out at the direction of a specialist during the rehabilitation period.

NSAIDs (non-steroidal anti-inflammatory drugs) will help relieve inflammation. They are applied locally, in the form of a warming ointment or cream. The doctor may also prescribe oral administration of the drug after assessing the general condition. Analgesics in the form of ointments, injection ampoules or tablets are prescribed to relieve severe pain.

The joint is fixed with a plaster cast in case of severe damage. With medium, for better fixation, a bandage with metal ribs is used.

There are three options for operations for moderate and severe severity:

Reconstruction of the collateral ligament - in case of frequent (chronic) trauma, it is replaced with a tendon to maintain strength and mobility.
The introduction of a frame is the fixation of torn areas using metal structures for optimal tissue fusion.
Arthroscopic surgery is a minimally invasive method that allows you to most accurately compare the areas of rupture and eliminate long-term recovery in the postoperative period.

Only a doctor can tell you which method is best to choose. A correctly collected medical history, tests and diagnostic results will help him choose the optimal path to recovery. There are risk factors due to which even a microscopic tear needs to be operated on (for example, abnormalities in the development of the joint).

physiotherapy

NSAIDs;
analgesics;
multivitamin preparations;
chondroitin sulfate;

Non-drug measures are prescribed, mainly physiotherapy (electromagnetic fields, mud, ultraphonophoresis with non-steroidal analgesics).

The nature of the injury and its location influence how long a knee sprain takes to heal. Typically, the average duration of conservative therapy is about a month. If a severe knee sprain has been diagnosed, treatment includes surgery. The operation is performed with an open approach or using arthroscopy.

How to treat a sprained elbow joint?

Before treating a sprained elbow, it is important to ensure that there is no accumulation of blood or inflammatory exudate within the joint capsule or bursa. Signs of these processes are that swelling and redness form around the elbow, and fluctuation (squelching sounds) is heard on palpation. if this is not the case, you can begin rehabilitation treatment 5-7 days after the injury.

For treatment, it is important to use techniques that accelerate tissue regeneration processes and prevent scar formation. To do this, it is necessary to enhance capillary microcirculation in soft tissues and create conditions to improve their trophism.

The second most important direction of rehabilitation is to prevent the formation of contracture, in which the usual range of motion in the elbow joint is limited. Prevention of ligamentosis begins immediately after the pain syndrome is eliminated. To do this, you need to use a special system of exercises aimed at improving the condition of the ligamentous and tendon apparatus.

In the first three days, to treat a sprained elbow joint, it is important to use medications that reduce pain. The limb should be immobilized and no physical exertion should be allowed. A pressure bandage based on an elastic bandage is applied to the elbow joint itself. Fixation and compression lead to the fact that internal bleeding stops and subsequently there is no long recovery period.

In the first days, you can use anti-inflammatory non-steroidal ointments that relieve pain and accelerate the process of breakdown of blood accumulated in the cavities. They relieve inflammation and improve overall well-being. They do not have any effect on restoring tissue integrity. Therefore, they need to be used in the minimum possible dosages.

Sprain or rupture of ligaments: how to determine?

Joint ligaments are a kind of association of individual connective tissue fibers. They are designed to connect the bone elements of a particular joint, strengthen it and restrain the range of motion in the joint.

Among ligament injuries, the most common are their rupture and sprain. How does a ligament tear or sprain manifest? How can you tell if a ligament rupture or sprain occurs after a joint injury?

Ligament sprain is a pathological condition that is characterized by tearing of its individual fibers, but while maintaining the continuity of the organ in anatomical terms. The reasons for this condition may be different. It occurs with sudden and strong movements that are not characteristic of a particular joint.

Ligament rupture is a traumatic condition that occurs as a result of a complete violation of its integrity due to transverse separation of connective tissue fibers. The causes of ligament rupture are the same as for sprains, but the force that acts on the joint is much greater.

At first glance, it is impossible to understand the difference between a ligament rupture and a sprain. There is no clear difference between these pathological conditions. In both cases, the integrity of the fibers is damaged. There is one exception: in case of stretching it is partial, and in case of rupture it is complete.

How to treat an elbow injury?

More often, therapy comes down to the practice of providing first aid to the joint, ligaments and subsequent restorative practice. As part of the first point of the therapeutic plan, you need to:

limit the mobility of the joint (remove the load, fix the structure of the elbow “hinge” with a compression bandage);
apply cold (for 15–20 minutes);
place the arm in an elevated position (it is not necessary to keep the elbow joint suspended all the time - the ligaments need blood supply, but periodically raising the arm to avoid swelling characteristic of a sprain is advisable).

From the 2nd day after the sprain, the cold should be replaced with heat (heating pad, compresses, ointments). In this case, the elbow is fixed closer to the body in a sling. Separately, compression “pinches” (but does not squeeze) the ligaments. The sling should be worn for up to a week, compression – up to 2 weeks.

The entire process of restoring ligaments after a sprain takes up to 1.5 months. If you allow adjacent inflammation (myositis), the recovery period will be delayed. Physiotherapy and aquatherapy methods will help speed up therapy and prevent the so-called effect of habitual sprains (associated with weak ligaments).

What you will need for first aid

To properly provide first aid in the event of a sprain, you must have in your first aid kit regular and compression bandages, painkillers, as well as a cooling pack, which can be replaced with the following available means:

cold accumulator for thermal bag;
pieces of ice from the freezer, tied in a bag;
finely chopped frozen vegetables;
bag of snow;
a heating pad filled with cold water.

It is desirable that the cooling agent can easily take any shape for better fit to the injured area. An elastic and simple bandage, as well as a cooling pack, should always be in your home, office, or car first aid kit in order to be able to provide first aid for a sprain as soon as the need arises. In case of open wounds, you need to have sterile dressing material. Also, to immobilize the injured limb, splints may be needed, which can be replaced with any oblong-shaped objects at hand.

knee ligaments - symptoms

Painful sensations in the area of trauma, the severity and localization of which depend on how severe the sprain of the knee joint is and how many structures were involved in the pathological process.
Swelling of tissues and hyperemia of the skin resulting from the development of an inflammatory reaction.
Limitation of joint movements or, conversely, the appearance of instability.

Signs of knee sprain also depend on the severity of the violation of the anatomical integrity of the connective tissue fibers and the involvement of other structures (bone base, menisci). Severe sprain of the knee joint may be accompanied by the appearance of pathological mobility in it.

Stages of assistance

Before considering what the sequence of providing pre-medical first aid for a sprain is, we note what absolutely cannot be done. After a blow, the first reflex movement is to rub the bruised area. It is better to refrain from this, since rubbing activates blood circulation, and if the vessels are damaged, then hemorrhage into the surrounding tissue will increase, which will lead to the growth of a hematoma.

The same applies to heating the damaged area. In the first two days, it is forbidden to apply warm heating pads to the injury site, take a hot bath or shower, or make warming compresses. This can be done only after 48 hours, when the threat of hemorrhage from damaged vessels has passed.

First aid steps for a sprain include resting the injured joint, cooling, and compression. Painkillers are also used if necessary. We briefly covered the stages of first aid for a sprained ligament victim, and now we will look at each of them in detail.

Peace

The first step in helping with muscle and tendon sprains is to keep the injured joint immobile. This allows you to achieve two goals - to stop the development of pathological processes caused by injury and to reduce pain.

The victim must be laid down, placing the joint in a position in which pain is minimal. In this case, it is desirable that the injured area is above the level of the heart. This reduces blood supply to the injured area. If there is a suspicion of a fracture or ligament rupture, it is recommended to immobilize the limb using splints. But this must be done after the stages of bandaging with an elastic bandage and cooling.

Splints are applied on both sides of the injured area, extending beyond it, and attached to the limb using bandages. It is necessary to place a soft cloth under the splints to avoid damaging the skin.

Compression

The next stage of first aid for an injured person with sprained muscles and ligaments is the application of a tight bandage, which, on the one hand, provides fixation of the joint, and on the other hand, slightly compresses the damaged vessels and reduces internal hemorrhage. It is best to use a compression bandage for this purpose, but if this is not available, you can make a tight bandage with a regular bandage or strips of clean fabric. If there are wounds on the skin, they must be covered with several layers of sterile dressing material before applying a tight bandage. The bandage should be tight, but in moderation, it should not interfere with blood circulation in the limb, because when a ligament is sprained, providing first aid, everything should be done to improve, and not worsen, the condition of the injured person. If, some time after applying a tight bandage, the skin of the limb turns blue or, conversely, becomes too pale, the bandage must be loosened.

Cooling

First aid for a sprain also includes applying cold to the injured area. This helps stop internal bleeding. Immediately after the injury, cold exposure should be 25–30 minutes, and then for two days, cold should be applied for ten minutes every two hours, excluding sleep time. When using cooling agents, wrap them in a cloth and make sure the dressing does not get wet, especially if there are wounds on the skin.

Symptoms - how to recognize a sprain

The following complaints are typical when sprained:

Pain
Edema
Bruising (bruise)
Limitation of range of motion

If these symptoms appear, you should consult a doctor to rule out serious damage to the structures of the musculoskeletal system.

Risk factors

People with weak ligaments
are prone to sprains.
Also, this type of injury occurs more often with a hollow foot, slower muscle reaction time
and
muscle weakness
.

Stretching is typical for sudden movements. Very often, sprains occur while playing basketball, football and running on uneven surfaces. Thumb ligaments are damaged when playing handball, volleyball and skiing.

Prevention of sports injuries

If a joint is unstable, the likelihood of it spraining increases many times over.

Bandages and other orthopedic devices will help stabilize the joint. For example, the following products are used to stabilize the ankle joint, and the Manumed family of products can be used to stabilize the wrist joint.

Helpful advice.

When playing sports, always wear appropriate, good quality shoes. This advice also applies to everyday activities.

Sprained collateral ligament of the knee joint - signs

A sprain of the collateral ligament of the knee usually occurs when a mechanical force is applied, resulting in abnormal flexion in the frontal plane. It is accompanied by severe pain sensations developing in the area of the internal or external surface.

Sprains of the medial collateral ligament of the knee develop somewhat less frequently, but can lead to pathological mobility. Sometimes damage to the lateral connective tissue cords and sprain of the cruciate ligaments of the knee can be combined. In this case, the symptoms are more pronounced, and the pain becomes more intense.

Tasks of a traumatologist-diagnostician

Recognizing a sprain is not difficult. Although diagnostic manipulations with the elbow (affected joint) can be repeated in order to monitor and adjust ligament therapy.

The key task of the diagnostician is to distinguish sprains from pathologies with related symptoms. The latter include inflammation in the joint, neuralgia in the elbow, mechanical damage not to the ligaments, but to the bones.

To verify lesions, the following is usually carried out:

examination of the elbow with palpation of the joint;
percussion of the damaged ligament;
a conversation to clarify the circumstances that could lead to the sprain;
Ultrasound of ligaments;
X-ray examination of the elbow joint.

In some cases, if a rupture or major tear of the ligaments is suspected, MRI/CT may be recommended. These types of sprains are treated promptly, but they are rare in the elbow.

Complications of treatment

Possible complications of conservative treatment include:

Inability to return to previous level of sports activities
Frequent recurrence of symptoms such as inability to throw with full force or distance, pain when throwing, and loss of ball control, especially if sporting activity resumes soon after the injury
Injury to other structures of the elbow, including the cartilage of the outer part of the elbow; decreased range of motion in the arm, ulnar nerve damage, medial epicondylitis, and sprained wrist flexor tendons.
Damage to articular cartilage, resulting in the development of elbow arthritis
Elbow stiffness (decreased range of motion)
Symptoms of ulnar nerve neuropathy

Possible complications of surgical treatment include:

Surgical complications not specifically related to this operation, such as pain, bleeding (rare), infections (

Complications characteristic of surgical treatment of this disease:

Inability to restore normal stability
Inability to return to previous activity level
Ulnar nerve injuries
Irritation of skin areas associated with palmaris tendon graft harvest