How long does a capsule rupture last?

The healing process after a capsule rupture can take different lengths of time. It can last from a few days to several months, depending on where the capsule rupture occurred and how much surrounding tendons and ligaments are affected. A slight rupture of the capsule can only last one week until the affected person can move the joint freely and without pain.

As a rule, however, one must be more patient and expect a duration of several weeks to months. Approximately 6 weeks is a guideline until complete healing is achieved, so that the corresponding joint is neither swollen nor painful and can be fully loaded and moved again. Of course, the duration can vary individually and depends, among other things, on the patience of the person affected and how consistently they adhere to the therapeutic measures of rest and immobilization.

Some unfortunately still complain of pain in the once ruptured capsule after 8 weeks. Regular exercise under physiotherapeutic supervision can positively influence the healing process. Physiotherapy carries out controlled and targeted movements in the area of the torn capsule. It is generally important that independent movement should only be resumed when the capsule is completely pain-free and there is no feeling of movement restriction or blockage.

What is the prognosis for capsule rupture?

It takes several weeks for a capsule tear to heal. But even after six to eight weeks, the joint can still be painful. It is important to start slowly with a loading of the joint after the healing process is complete and not to aim for full loading immediately. Unfortunately, a capsule tear can increase the risk of developing osteoarthritis.

Localization of the capsule rupture

A capsule tear of the shoulder occurs mainly in the context of a shoulder dislocation, the “jumping out” of the shoulder. The shoulder dislocation mainly affects younger, athletically active patients and middle-aged patients with a weakness of the muscles that stabilize the shoulder joint (rotator cuff). In 95% of cases, the head of the humerus jumps forward out of the shoulder joint in a shoulder dislocation.

The capsule of the shoulder joint is overstretched by the humerus jumping out of the actual socket, and a capsule tear due to the increased tensile load is also possible. A frequent complication of shoulder dislocation is the Bankart lesion.In the Bankart lesion, the labrum glenoidale, the glenoid lip (a cartilaginous part of the shoulder joint) of the shoulder joint, tears off the scapula together with the joint capsule. As a result of the capsule rupture, the joint capsule is now unstable in the anterior direction, which favors renewed shoulder dislocations.

The Bankart lesion is also called capsule labrum lesion and is surgically treated after several shoulder dislocations. The torn labrum is reattached to the shoulder blade, the torn and flaccid capsule is tightened by sutures or shortened by means of heat or laser. Capsule tears in the hand are typically the result of sports injuries, in which the joints are overstretched.

Volleyball and handball players represent classic patient groups in this case. Capsule tears of the finger joints are also common in skiing. As in the case of differently localized capsule tears, the rupture of the hand capsule is manifested by a strong, stabbing pain over the affected joint.

Later, the pain takes on a rather dull, pulsating character. In addition, the escaping joint fluid causes the affected joint to swell. Frequently, a haematoma is also visible, which is caused by injury to small blood vessels.

As far as diagnosis and treatment are concerned, capsule tears in the hands are similar to those in other joints. Diagnosis is often difficult, as injuries to other structures of the joint, such as the ligaments, can cause similar symptoms. X-rays are of little use, whereas ultrasound examinations in particular, but also MRI images, can provide information about the type of injury.

The acute therapy of a capsule tear of the hand is based on the so-called PECH rule. This acronym is made up of the words pause (i.e., sparing the joint), ice (the cooling to relieve pain and swelling), compression (also against swelling) and elevation (to reduce blood flow). Applied immediately, these measures can help to alleviate the acute symptoms and contribute to the healing of the injury.

Furthermore, the joint should be immobilized by a doctor, since early movement can cause permanent damage to the joint apparatus. It may also be possible to prescribe exercise training under physiotherapeutic supervision. It takes at least six weeks for a capsule tear to heal properly.

During this time, the healing process can only be slightly influenced by decongestant medication, specific movement exercises and cooling of the joint. Nevertheless, the injury may result in permanently limited mobility of the joint. The fingers are at risk of rupturing the capsule, especially during ball sports such as volleyball or handball.

A capsule tear can occur as a result of overstretching due to excessive or prolonged strain or violent hyperextension of a finger joint due to the impact of a ball, in which a finger is bent in the wrong direction. But also in unfortunate falls on the hands, the joint capsule can tear due to excessive force. Torn capsules of the finger joints lead to painful swelling due to leakage of synovial fluid into the surrounding tissue and to bruising due to the tearing of small blood vessels of the affected joint.

Malpositions are also possible: especially a lateral kink of the finger often leads to a rupture of the outer ligaments of the capsule and thus to instability of the finger joint in the lateral plane. If a rupture of the capsule results in a complete rupture of the capsule apparatus, dislocations of the finger joint are common. The painful swelling significantly restricts the mobility of the finger.

The diagnosis is made at the doctor’s office by thoroughly palpating the finger and testing the mobility of the finger. A supplementary ultrasound examination of the finger is useful to visualize the ligament structures of the capsule if the palpation cannot provide clarity about the degree of ligament injury. An X-ray may be necessary to exclude additional bony injuries.

The treatment of an uncomplicated capsule tear on the finger is done by cooling, immobilization for two to three weeks and the intake of painkillers for severe pain. The healing process can be supported by physiotherapeutic measures. It takes at least six weeks until the healing process is completely complete.If an osseous involvement was found during the examination, surgery may be necessary to treat the bony injury.

Even after a capsule tear has healed, the joint capsule may remain thickened and permanently restrict the mobility of the finger. The use of a splint is one way of stretching a shortened joint capsule after a rupture of the capsule and maintaining mobility. As a late consequence of a capsule rupture, arthrosis can occur in the affected joint.

Capsule tears themselves are classic sports injuries. This is also the case with a rupture of the elbow capsule, which is usually accompanied by a dislocation of the elbow joint. However, it is also often the result of falls or other violent impacts.

Apart from this, ruptures of the elbow joint capsule are similar to other joint capsule ruptures in terms of symptoms, diagnosis and treatment. Capsule ruptures of the thumb joints are often the result of a severe overextension of the respective joint due to external force. This is the case, for example, when a person falls on the thumb when it is stretched out or when a ball hits the thumb unfavorably.

A lateral bending of the thumb can also cause a rupture of the capsule. This often happens when the thumb gets caught in the loop of a ski pole, which is why the subsequent injury including a collateral ligament and capsule tear is also called a “ski thumb“. As with other capsule tears, the thumb should first be cooled and immobilized in acute situations.

Once the diagnosis of the capsule tear has been made, the joint is immobilized for the next few weeks. Provided that the tendons of the thumb muscles remain uninjured, in most cases there is no permanent restriction of movement after complete healing of the injury. The knee is strained especially during running and jump-intensive sports.

Sudden extreme movements, for example, a fall or the wrong way to play a ball in soccer can lead to a rupture of the capsule in the knee joint. At the moment of the injury, there is an acute, stabbing pain that changes over time into a dull, pressing pain due to the leakage of synovial fluid and the resulting swelling. Either the capsule is also affected in the context of a ligament injury or there is only a capsule tear in the knee joint.

The doctor can easily differentiate between these two by means of an ultrasound examination. An X-ray image can rule out bony involvement; more complicated injuries should be examined and assessed by means of an MRI of the knee. MRI of the knee is particularly good at visualizing the ligaments that cannot be seen in the X-ray image, for example.

Even with ultrasound it is difficult to distinguish between partial tears and ruptures of the capsule. For this reason, an MRI of the knee is usually the most valuable diagnostic tool in the case of a torn capsule. The treatment of a torn capsule in the knee joint is no different from the treatment of a torn capsule in other joints: cooling, immobilisation, elevation, and pain medication.

Capsule tears in the knee joint have a very favorable prognosis if the knee is sufficiently protected and only loaded again when the capsule tear has healed. If the knee joint is loaded too early, chronic instability of the knee joint may result or knee arthrosis may develop. Injury to the outer ligament of the ankle joint is the most common ligament injury.

Runners, handball players, tennis, volleyball and basketball players are particularly affected. But also the capsule tear in the ankle joint is common, it is almost always accompanied by a torn or stretched ligament. The outer ligaments (outer ligaments of the foot) are part of the joint capsule.

If the ligaments tear when the ankle is bent, this means that you have not only torn your ligament but also torn your capsule. The trigger for a rupture of the outer ligaments of the ankle joint is a so-called supination trauma, known as “outward twisting”. Immediately after the injury, the patient complains of severe pain, and the joint also swells significantly.

The pressure-painful swelling can extend from the end of the lower leg to the middle of the foot and can also be accompanied by bruising. During the examination, the doctor checks the stability of the ligaments by means of various functional tests on the ankle joint. An X-ray is taken to rule out bony injuries such as an external ankle fracture.

If so-called held images are taken, a torn ligament can be confirmed or excluded. From a torn ligament of the ligamentfibulotalare anterius is assumed if the distance between the ankle bone and the lower leg bone is 5 mm more on the affected side than on the healthy side. After a severe supination trauma, it may be necessary to take an MRI scan to better assess the joint surfaces.

The therapy of a capsule-ligament rupture at the ankle joint is mainly performed conservatively by immobilizing the joint with a splint. The splint can be applied as soon as the swelling has subsided. It prevents the ankle joint from buckling again and restricts its upward and downward mobility.

Patients are then treated with physiotherapy to strengthen the muscles and tendons in order to prevent them from buckling again with a rupture of the capsule-ligament. However, one-fifth of the patients complain of complaints even after completion of the conservative therapy. There is pain after heavy exertion, which is caused by cartilage damage from the first injury.

Other patients have a feeling of instability in the ankle joint. The consequence of a capsule-ligament rupture in the ankle joint is chronic instability in the upper ankle joint in 10% of cases. The affected patients often snap over, but the pain decreases with each event. Chronic instability in the upper ankle joint is treated by wearing an elastic bandage, by physiotherapy or by applying a shoe elevation, either with insoles or with specially made shoes. If these measures are unsuccessful, an operation can be performed to reconstruct or replace the capsule-ligament apparatus.