Who does not know this? Once inattentively stumbled over a stone and you are already painfully twisted. Fortunately, the pain usually disappears after a few minutes, but a torn ligament can also be the result. Find out here about typical symptoms of a torn ligament as well as common treatment options.
What is a torn ligament?
Ligaments are strong connections between bones, are made of strong connective tissue, and stabilize the joint between them. Almost every joint is secured in this way, but in some joints, ligaments are more stressed by our movements than others and are therefore more susceptible to injury during certain movements. Just like ligaments, tendons are made of strong connective tissue, but they attach muscles to bone. They vary in length and can transmit muscle force over longer distances: many muscles that move the hand are located on the forearm, and only the long tendons extend into the hand area. There is often a connection between tendons and ligaments as they merge: For example, a long thigh muscle ends with its tendon in the ligament that protects the kneecap. It is easy to imagine that ligaments at the knee and leg are subjected to additional stress by our weight, and that an unfortunate movement there is more consequential than at the arm or shoulder.
Origin: how does a torn ligament occur?
Ligamentous joints are often named medically after the particular bones they connect – for example, the ligaments on the outer ankle of the foot are called ligamentum fibulotalare anterius and posterius (anterior and posterior ligaments between the fibula and the talus) and ligamentum fibulocalcaneus (ligament between the fibula and the calcaneus). In the case of a torn ligament (also called a ruptured ligament), the force acting on the ligament is so great that the tight connective tissue tears. In this case, an X-ray must always be used to check where the ligament is torn. If it has torn with its bony attachment, the bone structure will appear irregular on the X-ray. If a ligament does not tear but is severely stretched by a careless movement, it is called a sprain or strain (distortion). It can be more painful than a torn ligament.
Causes: What causes a torn ligament?
Because the connective tissue of a ligament is normally very strong, a ligament tear only occurs when a disproportionate amount of force is applied to the ligament. Unfortunately, we are quite capable of applying this force with our body weight – whether it is a fall on our hand, a wrong movement with our knee or foot.
Torn ligaments in the foot (ankle, ankle).
Theoretically, any ligament in our body can tear, but in practice, ligament tears in the foot – they affect the upper ankle – or knee are the most common. In recent years, it is also possible to observe more frequently a ligament tear in the thumb, the so-called ski thumb. Fortunately, multiple ligament tears are rarer in polytrauma, as occurs in serious car accidents. There, in addition to many other life-threatening injuries, there are often bone fractures or joint injuries that result in lengthy treatments. At the upper ankle joint, as mentioned, there are three ligaments, all of which can tear: However, the anterior external ligament tears most often, then the middle one that pulls to the heel bone, to the posterior external ligament tears least often. It is rare for all three outer ligaments to tear, but it is important for further therapy. In all running sports, there is a risk of provoking a torn ligament by choosing unsuitable footwear – however, you can just as unhappily twist your ankle while walking to the bakery.
Torn ligaments at the knee
There are four ligaments at the knee that can be injured: The medial and lateral ligaments, as well as anterior and posterior cruciate ligaments. In addition, the knee joint is something very special. Here, the ligaments not only pull around the outside of the joint, but also have a connection to the inside of the joint. There are also two cartilage discs, the menisci, which lie between the femur and the tibia. As if that weren’t enough, the meniscus inside has a connection to the inner ligament, so if a ligament tears, the meniscus is also affected. The inner ligament or the cruciate ligaments are often torn; the outer ligament is almost never affected. A typical sport for ligament injuries to the knee is skiing.
Skiing thumb: torn ligaments in the thumb.
Ski thumb is also a typical ligament injury for this sport.If you can’t get your thumb out of the ski pole’s loop when you fall and twist your thumb, the ligament on the inside of the metacarpophalangeal joint can tear.
Symptoms: What are the symptoms of a torn ligament?
Often, the torn ligament causes an audible sound. Otherwise, the affected joint hurts, it swells and a bruise appears. However, the most important sign is the altered mobility of the joint, which is checked during the medical examination. Especially in the case of ankle or knee injuries, one feels unsteady on the affected leg – the joint is unstable. In this case, both the severity of the pain and the bruise vary greatly from individual to individual. It can happen that the X-ray and the doctor’s examination alone result in the diagnosis of ligament rupture, although the patient, for example, has hardly any complaints except for a slight unsteadiness when walking.
Diagnosis of ligament rupture
The held x-rays needed for diagnosis are often very uncomfortable for the patient. The affected ankle is clamped into an apparatus that somewhat resembles an instrument of torture. However, the doctor can tell from properly performed X-rays whether there is a ligament tear, and if so, what type. At the knee joint, there are various tests (Lachmann test, drawer phenomenon, pivot shift test) that show which ligament structures are torn. In addition to X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) imaging techniques are used to determine whether bones or menisci are also injured.
Treatment for torn ligaments
While ligament tears in the upper ankle were treated generously by surgery a few years ago, the procedure has since changed. Surgery is now only performed in athletes if all three external ligaments are torn. In this case, the ligamentous apparatus is restored with a periosteal flap. Otherwise, conservative therapy has proven successful: In addition to relief, a decongestant ointment dressing and sparing, the joint is stabilized with a splint or well-wrapped tape bands. Physiotherapy exercises are used early on to train the long muscles of the foot. At the knee, medial ligament tears are treated conservatively: In addition to relief and mobilization in a splint as soon as possible, physiotherapy is also used here so that the immobilized thigh muscles are not completely out of practice.
Treatment of a cruciate ligament tear
The situation is different for a cruciate ligament tear. Only older patients who do not exercise much will not be suggested surgery. Since a cruciate ligament tear leads to permanent instability of the knee joint and the cartilage surfaces are no longer exactly on top of each other due to the lack of ligament guidance, knee joint arthrosis, i.e. wear and tear of the joint cartilage, occurs more quickly. Since cruciate ligaments cannot be sutured, a so-called cruciate ligamentoplasty must be performed surgically, in which a piece of the patient’s own tendon is inserted in place of the cruciate ligament. Again, mobilization is started quickly because otherwise scarring can limit full mobility in the knee joint. However, it usually takes almost a year to return to any sport after a cruciate ligament injury. To prevent thrombosis in the less-mobile leg, thromboprophylaxis (usually in syringe form) is given until full mobilization.
Treatment of ski thumb
Ski thumb requires surgery only if the thumb joint can be opened too much. Otherwise, three weeks of immobilization of the joint is usually sufficient for the torn ligament to heal.
What complications can occur?
If a torn ligament is not recognized and the ligament cannot heal back together, the joint can become chronically unstable. At the upper ankle, this leads to increased twisting with the foot, at the knee, pain and gait instability, and at the thumb, decreased strength when grasping. Once such instability has occurred, there is usually no way around surgery – from this point of view, you should not take an injury that can lead to a torn ligament lightly, but rather have your doctor clarify whether a torn ligament is present and then have the joint with the injured ligament treated conservatively or surgically according to the doctor’s instructions.
