Torn Ligaments: Causes, Symptoms & Treatment

A torn ligament is one of the most common sports injuries, along with ligament sprains or strains. Jerky movement and overuse of the ligaments can lead to a torn ligament as a result of extreme physical activity. Known causes, therefore, include twisting the knee or twisting the ankle. One of the best-known ligament tears is the outer ligament tear at the upper ankle joint. At the cruciate ligaments, this can lead to the so-called cruciate ligament tear.

What is a torn ligament?

A torn ligament is a partial or complete tear of a joint ligament. This most commonly affects the joint ligaments of the foot as well as the ankle, knee, wrist, shoulder and elbow. The thumb can also be affected by a torn ligament – this is known as ski thumb. Typical of torn ligaments is localized and sometimes severe pain, combined with instability of the affected joint. Bruising is also common and causes swelling. Four degrees of severity are distinguished in torn ligaments. They range from incomplete tearing, in which the joint remains stable, to complete tearing of the ligament, which destabilizes the joint.

Causes

A torn ligament occurs when a joint ligament is overstretched to the point that its fibers are affected. This usually occurs during violent joint movements in which an excessive force is applied to the ligaments – such as an abrupt turn. Joint ligaments consist of tight connective tissue, stabilize the joint and are normally extremely strong. However, excessive stretching can damage the connective tissue – from a rather harmless sprain to a torn ligament. Such severe stretching occurs primarily during sports, which is why torn ligaments are considered a typical sports injury. A common example is balls hitting joints hard, or collisions from players twisting a joint, causing a torn ligament. However, twisting the ankle can also cause a torn ligament. The weight of a person’s body at an awkward angle is enough to overload the joint ligaments. Multiple ligament tears are rare and are most likely to occur in car accidents.

Symptoms, complaints, and signs

Torn ligaments are among the most common sports and exercise injuries and usually occur under stress and only very rarely from a state of rest. Most often, the torn ligament occurs in the knee, foot or shoulder, but all other areas of the body where ligaments are present can also be affected. The ligament tear is perceived by a strong pain. Usually an event takes place before it, for example, a twisting of the ankle, a fall or a blow. Sometimes the tearing of a ligament can also be felt directly – the damaged ligament retracts into the adjacent muscle, this type of retraction can be clearly felt in some circumstances. The joint affected by the torn ligament can usually only be moved with great pain, and often mobility is even completely restricted at first. This is especially the case with tears, but can also be observed with ruptures. In most cases, the region around the affected joint swells visibly within a few minutes and feels hot, furry and numb. This remains the case during the healing process and only subsides completely over the course of several weeks. Whether the torn ligament requires surgery is decided by the orthopedic surgeon after a thorough diagnosis. Torn ligaments can partially regenerate themselves.

Course

In most cases, a torn ligament becomes noticeable at the moment of the actual tear: Many affected individuals hear a noise (often a pop or snap). At the same time, a sharp, localized pain occurs, although in most cases this quickly subsides despite the ligament being torn. What remains, however, is an altered mobility of the joint, which in the case of torn ligaments in the foot area is often manifested by an unsteady gait. Swelling and bruising quickly appear. Since a torn ligament may be difficult to distinguish from sprains and strained ligaments, a doctor should be consulted whenever a ligament is suspected. If left untreated, torn ligaments can lead to chronic instability and damage to the joint.

Complications

Some instability may remain after a torn ligament.For example, a knee may not regain its original stability after an operated cruciate ligament tear. In the case of a ski thumb, slight restrictions in grasping may remain despite good treatment. In the case of a torn lateral ligament in the upper ankle joint, residual symptoms may remain. Often, the affected person underestimates the injury, continues to play sports and does not go to the doctor despite swelling and pain. In the long term, the torn ligament can then cause problems and result in secondary symptoms. An insufficiently healed or undetected ski thumb can lead to permanent and painful instability. The so-called wobbly thumb is restricted in its movement, for example when gripping a ball. If a torn lateral ligament in the ankle joint is not adequately treated, permanent lateral ligament instability can develop. The affected person may repeatedly twist his ankle – especially on uneven ground. A cruciate ligament tear that is not adequately treated can lead to regular pain in the knee and an unstable gait. In addition, over the years, it can cause injury to the cartilage and/or meniscus. A torn ligament can also become chronic and lead to joint wear and tear (osteoarthritis).

When should you see a doctor?

A doctor must be seen in any case of a torn ligament. In many cases, this complaint is an emergency that must be treated immediately to avoid further complications. As a rule, the doctor must be consulted when the affected person complains of very severe and especially stabbing pain in a certain part of the body. These occur not only during exertion, but also in the form of pain at rest. Bruising or swelling can also be indicative of torn ligaments and should be examined in any case. This is especially true if the discomfort occurs after an accident or after strenuous athletic activity and does not go away on its own. If the torn ligament is not treated, the joints may be damaged. Therefore, after an accident, an emergency doctor should always be called or the hospital should be visited directly. If the symptoms are not acute, a sports physician can also be consulted. Treatment depends on the severity of the tear.

Treatment and therapy

If a torn ligament is suspected, the so-called PECH rule should be used as first aid: Rest, ice, compression, elevation. The cooling, pressure and elevation will reduce blood flow and pain. Afterwards, even if the joint is pain-free, a doctor should be consulted to clarify the extent. Depending on the region of the body, X-rays and magnetic resonance imaging are also used during the examination. Joint stability is tested – if necessary under anesthesia, as severe pain can occur. Depending on the location and degree, the torn ligament is now either operated on openly or minimally invasively, or treated conservatively. Conservative treatment is based primarily on consistent movement exercises and muscle training, but support bandages and, if necessary, a plaster cast can also be considered. If the torn ligament is treated conservatively, this usually takes eight weeks.

Outlook and prognosis

With early diagnosis and treatment, the patient with a torn ligament has a good chance of recovery. For the healing success, the use of physiotherapy has a very crucial part. In addition, the prospect of complete recovery depends on the type of injury. Depending on the severity, the course of the disease is more optimistic or less favorable. The injured ligament as well as the patient’s state of health must also be taken into account when making a prognosis. Adults with a healthy immune system, no previous illnesses and a normal weight are often largely free of symptoms after one to two weeks with good medical care. If less favorable conditions exist, several months may pass before recovery. Fitness for sports is usually certified by a doctor after 3 months. It should be noted that permission to participate in intensive sports is granted only later and usually only with the use of joint protection. If the torn ligament affects the capsular ligaments, the healing process is delayed. Nevertheless, with good medical care and the patient’s cooperation, freedom from symptoms is achieved within 3-6 months in this case as well.The natural healing processes of the tissue last up to a year despite a certified recovery by a physician. Patients also report increased sensitivity in the area for even longer.

Aftercare

Torn ligaments are often underestimated, especially by athletes. The result is inadequate healing, even when the injury is operated on or treated. It requires an especially large amount of patience and extensive follow-up care, which can last for months. After the treatment, the doctor will prescribe physiotherapy and at the same time a gentle way of dealing with the injured body part in everyday life. Under no circumstances should sports activities be resumed too soon, as there is a risk of re-tearing. Exercises in physiotherapy should also be started gently and only performed if they do not cause pain. As a rule, the doctor and therapist will draw up a joint exercise plan. They will also decide on the right time to start training. Starting too early can cause damage, while valuable time is wasted if exercises are started too late. The goal of physical therapy is to rebuild and strengthen the muscles that have been weakened by the torn ligament and subsequent immobilization. If the foot is affected, the muscles of the leg should also be exercised. Accordingly, patients with a torn ligament must be patient and gentle with themselves in order to be fully healed and able to resume training.

Here’s what you can do yourself

A torn ligament is not a medical emergency. If it occurs in the middle of the night, for example, or while jogging on a remote forest trail, there are a number of effective ways to help yourself. First of all, it is usually important for the affected person to quickly relieve the pain caused by a torn ligament as well as to prevent swelling of the affected joint as much as possible. Both can be achieved by rapid cooling. If ice is used, care should be taken not to apply it to bare skin so that frostbite does not occur. It is important that the joint is not exposed to great heat under any circumstances, such as direct exposure to the sun. The appearance of swelling can also be mitigated by bandaging quickly. If a bruise is already visible, heparin ointment can also be used. The bandage also serves to stabilize the joint. This is particularly important if rest is not possible at first because, for example, the person affected by a torn ligament in the ankle still has to walk a few meters home. In principle, the joint should first be rested immediately after the torn ligament. Ideally, the joint should be elevated. This also serves to counteract swelling and to largely prevent any accumulation of blood in the injured area.