Rupture of ligaments of the shoulder joint: symptoms and treatment

If you adhere to the theory that labor was made from a human monkey, then the first step in this long and complex path belongs to the shoulder joint. It was his unique structure that made it possible for the lower extremities of the upper limb to acquire functional features unusual for the rest of the mammal.

In turn, greatly expanding its functions from the banal support during the movement, the hands of a man have become one of the most injured parts of the body. In this regard, injuries of the shoulder girdle, which often accompanies the rupture of the ligaments of the shoulder joint, are in the zone of special attention of clinicians. And the root cause of this is the possible loss of ability to work and, worse, the disability of a person with a wrong or wrong cured injury.

Brief anatomical help

The uniqueness of the shoulder joint is expressed in the ratio of its true articular surfaces. In the formation of this element of the skeleton, two bones directly participate: the scapula and the humerus. The articular surface of the humerus is represented by a ball-shaped head. As for the concave surface of the oval shape of the articular cavity of the scapula, it is about four times smaller than the area of the adjacent ball.

The missing contact from the shoulder is compensated by the cartilaginous ring - a dense connective tissue structure called the joint lip. It is this fibrous element, together with the capsule surrounding the joint, that allows it to be in the right anatomical ratio and at the same time to carry out that unthinkable amount of movements that is possible in the most mobile of all the other joints.

Bracing joints and ligaments

It helps the thin synovial membrane of the joint capsule to preserve its anatomical structure with a powerful beak-brachial ligament. Together with her joint, the capsules of the biceps tendons of the biceps muscle and the subscapular muscle pass through the extraarticular cuffs. It is these three connective tissue strands that suffer if there is a rupture of the ligaments of the shoulder joint.

The subscapular, deltoid, supra- and subacute, large and small round, as well as the large thoracic and broadest back muscles give a wide range of movements around all three axes in the joint. The biceps brachii muscle does not take part in the movements of the shoulder joint.

Injuries to the shoulder joint and the causes of injury

Among the most common injuries of the shoulder joint, bruises are distinguished. It is possible to stretch the ligaments of the joint with partial or complete rupture or without it. Joint dislocation, intra-articular or detachment fractures of extra-articulate fragments (in the place of attachment of the joint ligaments), refer to the most severe injuries.

The main causes of damage to the shoulder joint is a direct or indirect mechanical effect on its structure. This can be a direct blow and a fall on the arm that is extended forward. The sharp excessive tension of the muscles that move the joint, or the sudden movement of a large volume, can cause both sprains and dislocations in the joint. As a rule, accompanying their rupture of the ligaments of the shoulder joint (photo is presented below), requires not only the treatment of the injury itself, but also the restoration of the integrity of the ligament apparatus.

Signs of rupture of ligaments

Trauma can occur when a fall occurs on an elongated forward or sideways arm. Also, the ligament rupture is possible as a result of sudden movement in the maximum permissible volume or hang on the arm, for example, when falling from a height.

Accompanying damage to the capsule and rupture of the ligaments of the shoulder joint symptoms are characterized by sharp pain at the time of injury and, which is especially indicative of rupture, with movements that repeat the mechanism of injury. Further, the edema of the area of damage develops, which changes the external configuration of the joint. In addition to edema, in the process of forming a swelling, the blood poured out from the damaged vessels near the tendons or muscles can take part.

Additional methods for assessing the severity of injury

Among the clinical methods of investigation that allow a traumatologist to determine if there is a partial rupture of the ligaments of the shoulder joint or their complete damage, ultrasound diagnosis and magnetic resonance imaging are distinguished. Both methods do not carry a radiation load, but have a very high resolving power. In particular, MRI allows you to determine with the greatest certainty the diagnosis and choice of treatment tactics.

Radiography or computed tomography is performed in order to exclude bone lesions: fractures (including detachment), dislocations associated with a fracture, and dislocations in the shoulder joint. Often, joint puncture is used. Arthroscopy is performed if there is a suspicion of degenerative changes in connective tissue structures of the joint or damage to the capsule. In some cases, arthrography is used.

Degrees of severity of damage

Classical division into a simple, medium and severe degree of trauma, with respect to rupture of ligaments. To slight injuries of the shoulder joint, relative to the ligamentous apparatus, stretching is assumed with partial damage to the fibers of the ligaments, while maintaining the integrity of the vessels, nerves and muscles. The middle degree is characterized by partial tearing of tendon fibers, the surrounding injured muscle region is involved in the process, the joint capsule may be damaged. The first degree refers to the extension of the ligaments, the second - to stretching with a partial rupture.

Severe damage is accompanied by a complete disruption in the integrity of the tendon (ligament) structure-rupture of the ligament of the shoulder joint, damage to local vessels, involvement of nerves, and defects in the joint capsule. At this degree, intra-articular and detachable fractures, hemorrhages to the joint (hemarthrosis) are possible.

Choice of treatment tactics

Depending on the severity of damage to the ligament apparatus of the shoulder joint, conservative or surgical treatment can be used. If there is an incomplete rupture of the ligaments of the shoulder joint, the treatment is limited to conservative methods. Anesthesia and immobilization (immobilization) are used. It is possible to apply a bandage or plaster bandage, depending on the severity, nature of the injury and the volume of the affected structures. Bandage or gypsum immobilization can be replaced by braces (bandages) of the shoulder joint of medium or rigid fixation.

At full rupture, especially with damage to the muscles and capsule of the joint, surgical treatment is applied. The victim needs hospitalization in the hospital trauma profile and further long-term rehabilitation after discharge from the hospital.

Operational benefit of defect recovery

The earlier the corrective rupture of the ligaments of the shoulder joint is applied, the greater the chances for a full restoration of the joint function and the less the percentage of complications of the injury. Surgical repair of the damaged ligament (tendon), located next to the muscles, damaged vessels and elimination of the capsule defect is reduced to their cross-linking.

Under general anesthesia (anesthesia) direct access over the damaged locus, layer-by-layer dissection and tissue separation are performed. The detected defects are sutured. The wound closes layer by layer. In the early postoperative period, immobilization with a plaster dressing with a window for the postoperative suture is used.

The terms of gypsum immobilization and inpatient treatment are determined by the volume of affected structures. An important factor for the number of bed-days is the age of the patient, the nature of his work activity and concomitant diseases.

Elbow ligament injury

Very rare in domestic conditions, this trauma is more common for professional athletes when using an active and sharp swing arm, bent at the elbow. The risk group includes, first of all, tennis players, golfers, handball, baseball, water and horse polo.

The most often injured ring-shaped ligament of the radius, collateral ulnar or radial ligament. A sign of damage is pain, accruing during movements. Characterized by edema, hemorrhage in surrounding tissues. Possible hemarthrosis. If there is a complete rupture of the ligaments, there may be a slight displacement of the bones of the forearm in the joint.

Radiography will allow to differentiate the fracture from the dislocation. MRI will show where the ligament of the elbow joint is localized. Treatment for partial and incomplete rupture is conservative. Immobilization is applied for several weeks. With a complete rupture, surgical plasty of the damaged ligaments is performed.

Short anatomy of the wrist joint

Complex in structure of the joint is formed by the articular surface of the radial and cartilaginous plate of the ulna from the forearm and scaphoid, semilunar and trihedral on the part of the hand. The pea stone is located in the thickness of the tendon and does not directly participate in the formation of the joint.

The joint is strengthened by five ligaments. On the palm side it is the elbow and wrist bands, from the back surface - the back bunch of the brush. On each side are the lateral palmar (from the side of the thumb) and the ulnar (from the little finger) ligament.

Damage to the ligaments of the wrist is much less common than the rupture of the ligament of the shoulder joint. But more often than a ligament ligament.

Rupture of the ligaments of the wrist joint

The mechanism of injury is associated with a fall on the forward hand or a blow on a bent or unbent hand. The position of the brush at the time of injury is of immediate importance in determining which of the ligaments is possibly damaged. The most strongly injured is the connective tissue structure, which is opposite to the fold of the wrist.

Leading signs of ligament damage: pain, edema, dysfunction of the joint and hematoma of soft tissues. If there is soreness when moving in the fingers of the hand or it sharply increases when turning in the joint, then it is possible to suspect the rupture of the ligaments of the wrist joint. Symptoms are supplemented in diagnosis by hardware research: radiography - to exclude bone fracture, ultrasound and / or MRI. They are necessary for determining the nature of damage to ligaments and other soft tissues surrounding the joint.

As in any other case, if there is a rupture of the ligaments of the wrist joint, the treatment will depend on the severity of the damage. For mild and moderate severity, conservative, with heavy - operational tactics.

Regardless of the damage, the nature of the damage to the integrity of the joint structures, which joint is injured, wrist, ulnar, or partial or complete rupture of the ligament joints, treatment should always be prescribed by a specialist doctor. Obligatory consultation in the profile department (trauma clinic, in traumatology in the clinic or in the admissions department of the hospital of traumatology profile). This is especially true for children's trauma, as young patients have a number of age characteristics that can mask a serious injury. And untimely application for competent medical care can lead to negative long-term consequences.