Torn ligament

Clemens Gödel is a freelancer for the medical team.

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A torn ligament is usually the result of a (sports) accident. Those affected complain of pain, swelling and restricted mobility in the injury area. Depending on the type and severity of the injury, a torn ligament is treated either conservatively with physiotherapy or surgically. Read everything you need to know about the torn ligament here: causes, symptoms, diagnosis and therapy!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S63S83S93

Ligament tear: description

The ligaments are located around the joints. They stabilize, guide and limit joint movements. For this reason, a torn ligament (ligament rupture) impairs the biomechanical function of the affected joint.

Ligament injuries are very common and result from forcible movement of a joint. Depending on the intensity of the force, this results in a ligament stretching, a ligament tear or a sprain (distortion).

In most cases, a torn ligament is a sports injury. However, ligament tears also occur in other accidents, such as a fall or a car accident. In sports, ligament injuries often occur in the ankle, knee, elbow, wrist and shoulder area.

Classification

Ligament tears are divided into first to third degree injuries, depending on the extent. This is important for planning therapy and assessing the prognosis. Most classifications speak of a first-degree injury when the ligament is overstretched or there is a torn ligament. A partial ligament tear usually corresponds to a second degree injury, and a complete ligament tear corresponds to the most severe injury (third degree).

Outer ligament tear

You can find out everything you need to know about the rupture of an external ligament (e.g. at the ankle) in the article External ligament tear.

Inner ligament tear

You can find out everything you need to know about the rupture of an internal ligament (e.g. at the ankle) in the article Internal ligament tear.

Torn ligament - foot

You can read more detailed information on ligament ruptures in the foot area in the article Torn ligament - foot.

Torn ligament - knee

You can find out more about ligament ruptures in the knee area in the article Torn ligament - knee.

Cruciate ligament tear

You can find out everything you need to know about the rupture of a cruciate ligament in the article Cruciate ligament tear.

Ski thumb

You can read what a ski thumb is and how it is diagnosed and treated in the article Ski thumb.

Torn ligament: symptoms

The torn ligament symptoms are more or less specific depending on the type and severity of the injury. Sudden tearing of a tape can be accompanied by an audible noise ("cracking"). The affected person feels sudden, violent pain, which in some cases can be localized to a specific area. The injured joint swells and the surrounding skin area may turn blue over the next few hours (bruise). If, for example, the outer ligament tears at the ankle, you will almost always see a clear blue color. In contrast, injuries to the knee rarely result in a bruise under the skin.

The affected person can no longer properly load the injured joint. A ligament injury can also be present if the injured person can still walk. When a ligament ruptures, those affected often feel the feeling of "kinking away" and instability.

Cruciate ligament tear: symptoms

You can read about the symptoms caused by a cruciate ligament tear in the article Cruciate ligament tear: Symptoms.

Torn ligament: causes and risk factors

In general, joint movement that is greater than normal and is forced by high force is the cause of a ligament tear. For example, the cruciate ligaments or the inner ligament of the knee tear if the knee is twisted very strongly or if the knee is overstretched. This often happens when skiing or playing football, for example.

In the so-called ski thumb, a lateral ligament of the thumb joint tears. This happens more often when skiing, when you fall with your thumb on the slope, or when you fall with your thumb getting stuck in the loop of the ski pole.

Even with certain ball sports (especially volleyball), finger joints are often injured, such as a torn ligament.

The ankle ligaments are affected when twisting ankle, for example when running or jumping (tennis, soccer, basketball, etc.).

Other ligaments such as the posterior cruciate ligament tear, especially in high-speed accidents in traffic. If a torn ligament affects the shoulder or wrist, a fall is often the cause.

Risk factors for a torn ligament

The risk factors for a torn ligament include high-performance sport, poor fitness, certain types of sport depending on the type of torn ligament, obesity and previous injuries to the same joint. It is controversial whether gender also plays a role and whether or not women have a higher risk of certain types of ligament rupture.

Torn ligament: examinations and diagnosis

Specialists in the diagnosis and treatment of a torn ligament are orthopedic surgeons, trauma surgeons and sports medicine specialists. The suspicion of a torn ligament usually arises from the details of the accident and the description of the complaints that the doctor will ask the patient about. Among other things, he can ask the following questions:

• Can you describe the accident?
• Where is the pain localized?
• Are certain movements painful or difficult?
• Have you already had an injury in the affected area?
• Do you have any previous illnesses?

After that, the doctor will examine the patient. He also pays attention to swellings and misalignments in the injury area and checks the circulation, motor skills and sensitivity (DMS) of the joint. The doctor can locate pain and pressure points by palpation, which often provides important information about the affected ligament.

The range of motion of the joint should be checked to assess the limitation caused by the torn ligament. The suspicion of a particular ligament tear can be confirmed with the help of targeted function tests.In some cases, however, these examinations are not possible in the acute phase due to the pain.

Imaging

Imaging procedures are used in unclear cases or to clarify additional injuries (e.g. to the bone). There are various methods to choose from.

Experienced doctors can help with the ultrasound examination of the joint, which can be carried out without exposure to radiation.

An X-ray is especially taken if there is suspicion of additional bone damage in addition to the torn ligament or a torn ligament. However, a torn ligament can also be seen indirectly on an X-ray image, which is particularly true for the so-called "stress images". The affected joint is held in certain positions during the exposure.

Magnetic resonance imaging (MRI) is particularly suitable for showing a torn ligament. It works without damaging rays.

Torn ligament: treatment

The acute treatment for a torn ligament (or a corresponding suspicion) is based on the PECH rule: break, ice, compression, elevation. Ice (cryotherapy) or cold water can be applied every two to three hours for 20 minutes each. The compression of the affected area should begin as quickly as possible: If possible, apply a pressure bandage to the affected joint to counteract swelling. When elevating, it is important to ensure that the affected area is as close as possible to the level of the heart.

If necessary, patients can take a pain reliever. So-called non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are particularly suitable. The knee joint should also be protected from further injuries. These measures should be continued for about three days so that inflammation and swelling will stop. To give the foot rest, crutches should be used until normal walking is possible.

Treatment at the doctor

A torn ligament is treated either conservatively or surgically. Whether an operation is necessary depends on many factors such as the type and severity of the injury (partial tear or complete tear) and the biomechanical limitation of the affected joint. Age, activity level and, last but not least, the wishes of the patient are taken into account when planning the therapy.

Conservative treatment

If the ligament is stretched and the ligament is slightly torn, it is usually sufficient to stabilize the joint for a while with bandages. The symptoms should go away within about two weeks. During this time, the joint can be loaded, but should not be exposed to full (sporting) loads. Because the risk of renewed injury to the overstretched ligament is too great in the early phase.

The early start of physiotherapy is crucial for a successful healing process and good biomechanical joint function. In addition to pure muscle training to promote joint control, good coordination training is also important. For example, the tilt board or wobble board is used for ligament injuries in the area of ​​the ankle.

Stabilizing the joint with special bandages or orthotics can also be useful.

Operative treatment

Surgery can be necessary for a number of reasons. In most cases, only a severe ligament tear is operated on. The advantages of an operation are often cited as the fact that the procedure means that pain becomes less chronic and that joint stability can be better restored.

For certain types of ligament tears, surgery is the method of choice, such as cruciate ligament tears in the knee joint. Fresh injuries can be sewn and the cruciate ligament is additionally reinforced by a piece of the body's own tendon. In older tears, the cruciate ligament is replaced by a piece of tendon (cruciate ligament plasty). A skier's thumb should also be operated on within a short time in order to maintain the full function of the hand. A bony ligament tear (tearing out of the ligament on the bone together with a bone fragment) is usually also operated on and then usually immobilized for a few weeks.

In addition to the severity and type of injury, other factors also play a role in the decision for or against an operation. Competitive athletes have a specific requirement profile for the affected joint. For this reason, in competitive athletes, depending on the extent of the injury, torn ligaments are often put together and surgically sutured.

Physiotherapeutic support is also very important before and after an operation, as is the case with conservative treatment. A ligament splint can be prescribed to stabilize the joint after an operation.

Cruciate ligament tear: Op

You can read everything you need to know about the surgical treatment of this torn ligament in the article Cruciate ligament tear: Op.

Torn ligament: disease course and prognosis

In most cases, if the injury is treated early and correctly, the prognosis for a torn ligament is good. In particular, well-planned physiotherapy is crucial for the success of the treatment. The prognosis also depends on the affected ligament, the severity of the injury and other factors, so that no general statements can be made. The question of when the patient can return to full activity cannot be answered across the board either. The healing process for a torn ligament can take anywhere from a few weeks to a few months.

Prevent ligament rupture

If you want to prevent a torn ligament, you should above all train and strengthen those muscles that support particularly stressed joints (such as ankle, knee joint). When doing high-risk movements in sports, you can use bandages as additional support. You should also warm up before exercising.

Torn ligament: Consequences if no treatment is given

If a torn ligament is not treated, there is a risk of long-term consequences such as frequent kinking, impaired joint function and chronic pain. In addition, an untreated torn ligament increases the risk of osteoarthritis.

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