Distortion: Description
A distortion (sprain) is an injury to the ligaments (ligaments) or the joint capsule. It is usually caused by twisting of the joint. The ligaments serve to stabilize the joints. They guide the movement and ensure that the joint moves only to a certain extent.
The ligaments are made of elastic collagen fibers. However, if the pull on the fibers becomes too strong, the ligaments become overstretched and the tissue is damaged. Because a sprain often also tears smaller blood vessels in the capsule, severe swelling and bruising form at the injury site.
A sprain is difficult to distinguish from a ligament sprain or tear. The doctor cannot make an accurate diagnosis based on the symptoms alone. Medical professionals therefore often define the term sprain somewhat more broadly and define ligament sprain and ligament tear as a subtype of sprain.
- Grade 1 (mild sprain): Overstretching of the ligaments without instability or structural damage to the ligaments.
- Grade 2 (moderate distortion = ligament strain): Severe overstretching or partial tearing of one or more ligaments, also still without joint instability
- Grade 3 (severe distortion = ligament tear): Rupture of one or more ligaments with joint instability
Ankle sprains are the most common of all ligament injuries. It occurs mainly in sports in which very powerful movements are made quickly and frequently with the legs, so for example in soccer or even skiing. A sprain can also occur in normal everyday life, for example when you run down the stairs too fast, or when you walk on uneven terrain. It can happen quickly that you twist your ankle and get a sprain.
Doctors divide ankle sprains into different subtypes, depending on which ligaments of the joint are affected. Supination trauma is the most common of all sports injuries. Medical experts refer to supination trauma as the classic “twisting of the ankle” in which the sole of the foot flips inward (toward the other foot). The outer ligament is overstretched in the process. Colloquially, the injury is referred to as a “sprained ankle”.
As a first treatment step, you should always cool the affected area immediately and preferably elevate it. Distortions that occur in everyday life should also be examined by a doctor (general practitioner, trauma surgeon or orthopedist). The severity of a sprain can usually only be reliably assessed by a medical professional, especially because the severity of the injury does not necessarily correlate with the severity of the pain. Thus, even more severe injuries can cause comparatively little pain. An untreated distortion can cause irreparable damage to the joint.
Distortion: Symptoms
A sprain is usually very painful. Injured people usually notice they have suffered a sprain immediately during or after the injury. Sometimes the affected joint can no longer be moved properly and it swells severely after a short time. If blood vessels are ruptured, a bruise (hematoma) also develops at the injured site.
The risk of twisting again increases considerably. Since the joint is no longer limited in its range of motion by the stabilizing ligaments and the joint capsule, it can become misaligned under load, which over time leads to premature joint wear (arthrosis).
In the case of a cervical sprain, other symptoms occur in addition to severe pain. These include a feeling of stiffness in the neck, headaches and dizziness. The severity of the symptoms depends on the severity of the injury. A severe sprain may also cause difficulty swallowing, sleep disturbances, impaired vision and hearing, and tingling sensations in the face or arms.
These symptoms occur when nerves and blood vessels in the neck area can be crushed. In very severe cases, there are pronounced neurological symptoms such as gait unsteadiness or speech disorders. They occur when the vessels supplying the brain (Ae.vertebrales) have been damaged by the distortion and the brain stem and cerebellum do not receive enough oxygen-rich blood.
Distorsion: Causes and risk factors
A distortion in the knee joint occurs when the knee is jerkily twisted outward, for example. Distortions are particularly common in fast sports such as soccer, handball, volleyball or basketball. However, they can also occur in everyday life when walking or climbing stairs.
A sprain in the shoulder, elbow or finger joints is very rare. You can also get them while playing sports, falling or moving awkwardly. A sprain in the shoulder can also occur if you do unaccustomed heavy lifting.
Distortion of the thumb is common when skiing, for example: When the thumb gets caught in the loop of the ski pole while falling, the external ligament is overstretched. In most cases, it tears. A so-called ski thumb develops.
A cervical spine (C-spine) distortion results from whiplash injuries such as those that occur in traffic accidents. The risk of a cervical spine distortion is particularly high in a rear-end collision. However, a cervical spine distortion can also occur in sports and recreational accidents.
Distortion: examinations and diagnosis
If you have a distortion or suspect another joint injury, an orthopedic or trauma surgeon is the right person to contact. If in doubt, you can also consult your family doctor. In the case of a mild distortion, he can splint the joint and give you tips on what to do in the near future. In the case of a severe distortion, he will refer you to a specialist.
Describing your current symptoms and any previous illnesses provides the doctor with important information. In this medical history discussion, you should report as precisely as possible how the accident or injury occurred. To get further clues, the doctor may ask questions such as:
- When exactly did the pain occur?
- What did you do after the accident?
- Did you cool the area?
- Have you injured yourself at this site before?
After the anamnesis, a physical examination takes place. First, the doctor carefully palpates the affected joint. If a pressure pain occurs, this is the first sign of a distortion. The pressure pain is felt at the site of the injury and in the immediate vicinity.
Examination of OSG (upper ankle joint) distortion
The doctor fixes the lower leg with one hand and with the other hand tries to gently turn the sole of the foot inward and outward. Normally, the range of motion is very limited by the ligaments on both sides. If there is a ligament injury on one side, the sole of the foot can be turned excessively to the side (increased hinging of the ankle joint).
Another method of examination of the ankle joint is the drawer test. In this test, the physician again fixes the lower leg with one arm while trying to push the foot forward (toward the toes) and backward (toward the heel). This movement is also normally only allowed to a very limited extent by the ligament structures. If the foot can be moved excessively easily toward the lower leg, a moderate distortion (ligament overstretch) or severe distortion (ligament tear) is probably present.
Further examination: Distortion OSG
Usually, following the physical examination, the physician still examines the injured joint with imaging techniques that show the extent of the injury. Most commonly, this involves an ultrasound examination (sonography) of the injured region. This allows the doctor to see whether a ligament or the joint capsule is torn or overstretched.
To rule out injuries a the bones – especially in more severe accidents – an X-ray can also be taken.
Examination of cervical spine distorsion (cervical spine)
A cervical spine distortion is potentially very dangerous because important structures such as the spinal cord, important nerve pathways and blood vessels supplying the brain (vertebral/vertebral arteries) are located in the area of the cervical spine. Before the actual physical examination begins, imaging techniques (CT, X-ray, MRI) are usually used immediately to rule out serious injuries.
Once life-threatening injuries, such as an unstable fracture of the cervical spine, have been ruled out, the physical examination can proceed. In addition to checking the range of motion, a neurological examination is particularly important in cases of suspected cervical spine distortion.
First, the physician checks the mobility of the cervical spine. To do this, the patient should turn his or her head to either side, lower it to the chest, and stretch it backward. Decisive for the diagnosis is whether the patient has pain during this process and how far he or she can move the head in the various directions. The neurological examination depends on what complaints the patient expresses.
Numerous nerves run in the area of the neck, which control the hands and arm in particular and transmit sensory stimuli from these regions of the body to the brain. Damage to these nerves can be detected with electroneurographic examinations (for example, measurement of nerve conduction velocity, electromyogram, etc.).
Distortion: Treatment
Treatment of a distortion depends on the severity of the injury. Distortions of the joints of the foot and leg are usually treated conservatively (non-surgically). Surgery is usually only necessary if the joint is very unstable due to the injury or if the patient puts extra stress on the joints due to personal or professional demands (professional athletes, construction workers, etc.).
In the case of a distortion of the cervical spine (cervical spine distortion), surgery is also only required for serious injuries, for example, a bony injury to the cervical spine. In any case, affected persons should perform “first aid” measures immediately after the accident so that the injury heals as well as possible. In the case of injuries to the cervical spine, this must be done very carefully.
First aid
P= Pause: Stop athletic activity immediately. Sit down and avoid putting any more weight on the joint if possible. This applies even if the pain is not so severe at first. Any further stress can further damage the ligaments and capsule, making the prognosis much worse.
E = Ice: Cool the affected area for about 15 to 20 minutes. Use ice packs or compresses with cold water. The cold causes blood vessels to contract and less blood to leak out. Do not place the ice directly on the skin or frostbite may occur; place some fabric between them.
C = Compression: If possible, you should apply a compression bandage. This stabilizes the joint, compresses the tissue and thus prevents blood from escaping from injured vessels. A compression bandage also prevents a larger bruise and swelling.
H= Elevate: It is best to elevate the affected joint. This makes it easier for blood to flow from the joint back to the heart. This reduces the pressure in the venous vessels in the injury area, so that less blood escapes from the injured veins.
Treatment by the doctor
A sprain is usually treated conservatively (non-surgically). This means that no more weight should be placed on the joint until the ligaments have fully recovered from the injury. To ensure that you do not put any more weight on the joint, a stabilizing bandage (“bandage”) is applied even for mild sprains.
In case of a sprain in the ankle or knee, it is recommended to use forearm crutches (“crutches”) for the first few days after the injury. In the case of a sprain in the finger or wrist, it is sufficient to apply a stabilizing bandage to immobilize the joints. After the rest period, you should then start light gymnastic exercises for the joint under the doctor’s guidance to slowly get it used to movement again.
Treatment of OSG (upper ankle joint) distortion
Ankle joint distortion is also usually treated conservatively. The patient must take it easy on the ankle joint and, depending on the severity of the injury, not put any weight on it for a few weeks. To ensure permanent relief, the doctor applies a so-called ankle orthosis. These are two fixed splints that lie on the side of the ankle and are connected to each other by a somewhat more stable bandage. In the first few days, a crutch may also be useful.
Provided the ligaments have not been completely torn off, they can usually be sutured. However, if parts of the ligamentous or capsular apparatus have completely detached, ligaments can be taken from other regions of the body to reconstruct the structures at the site of injury.
Treatment of cervical spine distortion
In the event of a possible cervical spine distortion, you must immobilize the head and neck if possible and see a doctor as soon as possible. Do not attempt to “immobilize” the neck under any circumstances. Until imaging (X-ray, CT, MRI) has ruled out a serious injury (especially to the bony cervical spine), do not move the neck if possible. The application of “stiff-necks” or neck braces should also only be performed by trained professionals.
Further treatment depends on the severity of the injury. For mild forms of cervical spine distortion, immobilization and administration of pain medication for several days is usually sufficient. If the neck injuries are more severe, hospitalization for monitoring or even surgery may be necessary.
Today, the neck is immobilized for only a few days. After that, the doctor sets up a light exercise program, which is gradually increased until the cervical spine and surrounding structures are fully regenerated.
Distorsion: course of the disease and prognosis
With early treatment, secondary damage and complications can often be avoided. If left untreated, a distortion can have complications and significant late effects. Overstretching or torn ligament structures destabilize the joint. This increases the likelihood of further distortions – the joint becomes increasingly unstable.
As damage to the ligamentous apparatus progresses, at some point the so-called “floppy joint” develops, which can hardly bear any weight. Such a loose joint develops particularly in athletes. They often put full weight on their joints again as soon as the rest period prescribed by the doctor is over.
In fact, however, the load should initially be light and only gradually increase. In addition, the rest period prescribed by the doctor is only an approximate guideline. If the joint hurts under stress, you should continue to take it easy.
Another danger posed by an unstable joint is malalignment. Under load, the cartilage is worn disproportionately and the joint can wear out – osteoarthritis develops.
A mild sprain without accompanying damage and with adequate and prompt treatment usually heals without complications. Make sure that you take care of your joint long enough and do not start sports immediately when the pain subsides. Only after adequate therapy and sufficient rest will the joint be stable enough to bear weight again.
After a mild distortion, the joint usually recovers completely and is then as stable again as an uninjured joint. After moderate or severe distortions, some instability may remain. To avoid further distortion, you should wear bandages during sports in the future.
