Rupture of sheaves – violation of integrity of a sheaf as a result of a trauma. Can be full or partial. Results from application of force, the sheaf exceeding durability. Injuries at sports activities and performance of hard physical activity become the reason usually. Ruptures of ligaments of the lower extremities are quite often formed at a leg podvorachivaniye during walking. Damage is shown by sharp pain, hypostasis, restriction of a support and movements. At complete separations excessive mobility of a joint is observed. The diagnosis is exposed on the basis of the symptoms given to a X-ray analysis, MPT and KT. Treatment can be both conservative, and quick.
Rupture of sheaves
Rupture of sheaves – one of the most widespread damages of the musculoskeletal device. It can be caused by a sports, professional or home accident. Meets at people of any age, however young, physically active patients more often suffer. Incomplete ruptures of sheaves (anguishes and stretchings) in absolute majority of cases are treated conservatively. At complete separations, especially with a divergence of the ends of the injured sheaf, operation usually is required.
Falling, jump, blow or not physiologic bend of an extremity during sports activities can become the reason of a rupture of a sheaf. Especially often such injuries come to light at athletes, hockey players, football players, basketball players, gymnasts and mountain skiers. The rupture of sheaves at a sports and home accident, as a rule, happens isolated. Occasionally ruptures of sheaves arise at car accidents, in such cases the combination to changes of a basin and bones of extremities, injury of a thorax, a stupid injury of a stomach, ChMT and other damages is possible.
Sheaves – the dense educations consisting of connecting fabric and connecting among themselves separate bones and bodies. Usually have an appearance of tyazhy, is more rare – flat plates. Depending on places of an attachment can strengthen a joint, direct or limit the movements in a joint. Perform the holding function, provide congruence of articulate surfaces. Depending on the main function can be braking, directing or supporting.
Ligaments of large joints of the lower extremities (talocrural and knee) are exposed to especially big loading therefore they, even at very high durability, a thicket are subject to gaps. However injuries of ligaments can be observed also in other joints: coxofemoral, humeral, luchezapyastny etc. The complete separation (violation of integrity of all fibers) and an incomplete gap (violation of integrity of a part of fibers), a rupture of tissue of ligament at the different level or its separation from the place of an attachment to a bone is possible. In the latter case together with a sheaf the small bone fragment quite often comes off.
The contributing factors increasing probability of a rupture of sheaves are cicatricial changes owing to the previous injuries, the repeated microgaps caused by excessive loading and degenerate and dystrophic diseases of joints (arthroses) at which pathological changes arise in all elements of a joint, including sheaves. Taking into account this aspect, all ruptures of sheaves divide on traumatic (caused by a trauma) and degenerate (arisen owing to wear or the previous damage and scarring).
The patient complains of pain. The field of damage is edematous, contours of a joint are maleficiated. At a partial gap hypostasis insignificant or moderate, at full – considerable, it is frequent with distribution on the next anatomic segments. Except weight of damage, degree of hypostasis depends on prescription of a trauma therefore stale (prescription over days and more) stretchings or anguishes can be followed by more expressed swelling in comparison with fresh complete separations. At complete separations on skin bruises practically always come to light.
Extent of restriction of a support and movements also depends on weight of damage – from insignificant difficulty at stretchings to impossibility to lean on a leg at complete separations. The palpation of a sheaf is sharply painful. Krepitation is absent. At considerable anguishes and gaps pathological mobility in a joint is defined (for example, the lateral motions which are absent normal or excessive mobility in a knee of a kpereda and kzada).
Ruptures of sheaves in the clinical manifestations are often very similar to circumarticular or intra articulate changes therefore in all similar cases the X-ray analysis for an exception of injury of a bone is appointed. At sheaf separations in the field of an attachment on roentgenograms freely lying thin bone plate – the fragment which came off together with a sheaf sometimes is found. To exclude insignificant damages of dense structures of a joint, appoint joint KT, for assessment of a damage rate of sheaves – joint MRT. In certain cases for diagnostics and treatment use an arthroscopy.
Rupture of ligaments of shoulder joint
Shoulder joint – extremely active joint with a wide amplitude of various movements. In this joint a large number of sheaves is attached. Taking into account localization allocate injuries of an akromialny ligament (AKS), injury of a grudino-clavicular ligament, injury of sinews of a short and long head of a biceps and damage of the rotating cuff of a shoulder formed by sinews of a nadostny, podostny, subscapular and small round muscle.
Rotation of a hand of a knaruzha, falling arm-distance, blow to the area of a clavicle or sharp extension of a hand during a throw can become the reason of a rupture of ligaments of shoulder joint. The joint is edematous, deformed, its contours are maleficiated. Bruises can come to light. The movements are limited. At ruptures of sinews of a biceps shortening of a biceps of a shoulder in attempt to bend a hand is observed. Injury of ligaments of shoulder joint can be both full, and incomplete, at complete separations symptomatology brighter.
The diagnosis is exposed on the basis of a clinical picture and data of a X-ray analysis of a shoulder joint confirming lack of bone damages. At suspicion appoint MRT of a shoulder joint to injury of an articulate lip and complete separations of other sheaves. In certain cases use an artrografiya and an ultrasonografiya. If by means of the listed researches it is not possible to establish localization and volume of damages, the patient is directed to an arthroscopy of a shoulder joint which can be used in quality of both a diagnostic, and medical method (for a defect ushivaniye).
Treatment is more often conservative. To young patients impose plaster for 3 weeks, carry out by the elderly patient an immobilization with use of a wide kosynochny bandage within 2 weeks. All patients are directed to physical therapy (in the absence of contraindications). After the termination of an immobilization recommend to carry out special exercises for development of a joint. At the same time within 1,5 months it is necessary to avoid the forced movements, especially – repeating at which there was a gap.
Surgeries are shown at complete, heavy and repeated separations. Operation can be performed as a classical method, with use of open access, and through a small section, with use of the arthroscopic equipment. The sheaf is sewed, in the postoperative period carry out an immobilization, appoint physical therapy, massage and LFK. Outcome of a rupture of ligaments of shoulder joint usually favorable.
Rupture of ligaments of elbow joint
A little widespread trauma, usually comes to light at athletes (golfers, tennis players, baseball players) very seldom occurs in life. Injury of a ring-shaped ligament of beam bone, and also elbow and beam collateral sheaves can be observed. There are incomplete ruptures of sheaves (stretchings and anguishes) more often. Signs of damage are hemorrhages in soft fabrics, , hypostasis and the pain amplifying at the movements. At complete separations perhaps some shift of a forearm.
For an exception of a change and dislocation the X-ray analysis of an elbow joint is carried out. Localization and a damage rate of sheaves are specified by means of MRT of an elbow joint. Treatment usually conservative – an immobilization of 2-3 weeks, sublime position of an extremity, analgetics and anti-inflammatory medicines. After the termination of an immobilization appoint LFK. Physiotreatment is used with care and not in all cases. At complete separations perform surgery – sewing together or plasticity of a sheaf with use auto-or an allotransplantata.
Rupture of ligaments of luchezapyastny joint and ligaments of a finger
Are observed less than injuries of ligaments of shoulder, but more often than ruptures of ligaments of elbow joint. The sharp movements or falling on a hand as a result of a sports or home accident become the reason of damage. Hypostasis, , hemorrhages and the pain amplifying at the movements is observed. In hard cases instability of a joint is possible. Clinical manifestations of injury of ligaments are similar to fractures of bones of a wrist therefore they for an exception of a change carry out a X-ray analysis of a luchezapyastny joint, and for assessment of a damage rate of sheaves – MRT of a luchezapyastny joint. Treatment – cold, an immobilization during 2-3 weeks, the anti-inflammatory and anesthetizing medicines, then physical therapy and LFK.
Ruptures of side (collateral) ligaments of finger arise at excessive sharp deviations of a finger in the beam or elbow party. Pain, a swelling, bruises and side instability of a joint results. The movements are painful. The change is excluded by means of a finger X-ray analysis. Treatment conservative – plaster steak or taping of a finger (imposing of a special leykoplastyrny bandage), UVCh. If instability of a joint remains upon termination of the recovery period, surgery is shown.
Rupture of ligaments of coxofemoral joint
Meets rather seldom, heavy gaps are usually combined with other injuries of a joint. Falling from height, road accident or a sports injury (pole vaults, obstacle race, mountain skiing) can become the reason. It is shown by the pain, hypostasis, hemorrhages in a joint extending to a hip and inguinal area. The movements are limited, there can be pain or unpleasant feelings in attempt to reject a trunk aside.
The diagnosis is exposed on the basis of a X-ray analysis of a coxofemoral joint and MRT of a coxofemoral joint. Treatment usually conservative – analgetics, resolvents, an immobilization with use of a special breys within 1 month. During this period to the patient recommend to use crutches, moving at first without support, and then – with a partial support on a sore extremity. The physical therapy is appointed from 2-3 days after a trauma, apply UVCh, an electrophoresis, laser therapy and magnetotherapy. After reduction of pains begin LFK occupations.
Rupture of ligaments of knee joint
Widespread damage, meets at the professional athletes and young people leading active lifestyle more often. Arises at strong direct stroke to a knee or sharp turn of a trunk at the fixed shin. Gaps external side (tibial), internal side (low-tibial), back crosswise and forward crosswise sheaves are possible. Allocate three degrees of a gap: 1 degree – stretching, the 2nd degree – an anguish, the 3rd degree – a complete separation.
At the time of a trauma there is sharp pain, sometimes there is a feeling of "dislocation" of a shin aside, kpered or kzad. The knee joint is edematous, is defined . Bruises are possible. The movements are limited. At a rupture of side sheaves at slightly bent joint pathological mobility in the side direction is defined. At a rupture of a forward crucial ligament the symptom of forward "drawer" comes to light, at a rupture of a back crucial ligament – a symptom of back "drawer".
Apply a X-ray analysis of a knee joint to an exception of changes. For assessment of weight of damages use MRT and an arthroscopy of a knee joint. Treatment of gaps 1 and 2 degrees usually conservative – rest, an immobilization, anti-inflammatory and anesthetics. In several days after a trauma appoint thermal procedures. During rehabilitation of the patient direct to massage and LFK. At fresh complete separations and instability of a joint after treatment concerning incomplete damages surgical intervention – sewing together or plasticity of a sheaf is shown.
Rupture of ligaments of ankle joint
Stretchings, anguishes and ruptures of ligaments of ankle joint – the damages of the copular device, most widespread in traumatology. Unlike ruptures of linking of other localizations, this trauma often has household character though can occur also at athletes. Is the main reason podvorachivany legs at run or walking. The number of injuries of ligaments an ankle sharply increases during a winter season, especially in the period of ice.
It is shown by pain, hypostasis, bruises, restriction of a support and movements. At incomplete gaps symptoms are expressed poorly or moderately, the support on a leg is kept. At complete separations considerable hypostasis with transition to a plantar surface of foot, big bruises and sharp restriction of movements is observed. The support on an extremity is impossible. For an exception of a fracture of anklebones carry out a X-ray analysis of an ankle joint. For assessment of degree of a rupture of sheaves if necessary appoint MRT of an ankle joint.
Treatment in most cases conservative. In the first days use cold, with the day before yesterday – dry heat. Recommend sublime position of an extremity. At complete separations and considerable anguishes impose plaster, at small damages for the period of walking fix a joint elastic bandage. If necessary apply NPVS in tablets, ointments and creams. Appoint UVCh, paraffin applications and diadynamic currents. In the recovery period give LFK classes. Operations are required in exceptional cases – at heavy complete separations of one or several sheaves.