distortion

Distortion: Description

Distortion (sprain) is a violation of the ligaments (ligaments) or the joint capsule. Mostly it is caused by a rotation 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 bands are made of elastic collagen fibers. If the pull on the fibers is too strong, the ligaments become overstretched and the tissue is damaged. Since in a sprain often smaller blood vessels of the capsule tear, forming a strong swelling and bruising at the injury site.

A sprain is difficult to distinguish from ligament extension or torn ligament. The doctor alone can not make an accurate diagnosis based on the symptoms. Physicians therefore often take the term sprain somewhat further and define the ligamentous extension and torn ligament as a subform of the sprain:

• Grade 1 (slight distorsion): Overstretching of the ligaments without instability and without structural damage to the ligaments
• Grade 2 (moderate distorsion = ligament strain): Strong overstretching or partial tear of one or more ligaments, also without joint instability
• Grade 3 (severe distorsion = ligament tear): Tear of one or more ligaments with joint instability

Distortion can occur on all joints of the body. Knee and ankle joint are particularly common in distorsions. Somewhat less often, the wrist and fingers are injured. Distortion in the elbow or shoulder is almost never done.

The ankle distorsion is the most common of all ligament injuries. It is especially common in sports in which fast and often very powerful movements are performed with the legs, for example when playing football or skiing. Distortion can also occur in everyday life, such as when you run down the stairs too fast, or when walking on uneven terrain. It can quickly happen that you bend over and contract a distorsion.

Physicians divide the ankle distorsion again into different subforms, depending on which ligaments of the joint are affected. The supination is the most common of all sports injuries. As a supination trauma, physicians describe the classic “kinking”, in which the sole of the foot works inwards (towards the other foot). The outer band is overstretched. Colloquially, the injury is considered “ankle sprain” designated.

Another form of distortion is the Halswirbeldistorsion, in which the cervical spine is dislocated by strong force. Cervical distortion occurs much less frequently than ankle distortion. Cause is often a whiplash, for example, in a car accident. In a cervical spine distension, important nerves and vessels can become trapped and damaged. Therefore, it must be examined as soon as possible by a doctor in any case.

As a first treatment step, you should always cool the affected area immediately and store it up. Distortions that occur in everyday life should also be examined by a doctor (general practitioner, accident surgeon or orthopedist). The severity of a distorsion can usually only reliably assess a physician, especially because the severity of the injury does not necessarily correlate with the strength of the pain. Thus, even heavier injuries can cause relatively little pain. Untreated distortion can cause irreparable damage to the joint.

Distortion: Symptoms

A sprain is usually very painful. The injured usually notice immediately during or after the injury that they have contracted a distorsion. Sometimes the affected joint can not move properly and swells after a short time. If blood vessels are torn, a bruise (hematoma) is additionally formed at the injured site.

If a sprain is insufficiently treated, it may heal badly and the joint will be less stable in the future. For example, having an unstable ankle will cause you to fold more often and be less sure about walking. If the ligaments are repeatedly overstretched, they will gradually leach out. It comes to a so-called “Schlottergelenk”, which has little or no stability of its own. The danger of overturning again increases considerably. Since the joint is no longer limited in its range of motion by the stabilizing ligaments and the joint capsule, it may fall under load in a malposition, which leads in the course of time to premature joint wear (osteoarthritis).

In a cervical torsion next to severe pain other symptoms appear. These include a stiffness in the neck, headaches and dizziness. The severity of the symptoms depends on the severity of the injury. Severe distorsion can also cause dysphagia, sleep disorders, visual and hearing problems, and tingling sensations on the face or arms. These symptoms arise when nerves and blood vessels in the neck area can be squeezed. In very severe cases, pronounced neurological symptoms such as gait insecurity or speech disorders occur. They occur when the vessels supplying the brain (Ae.vertebrales) have been damaged by the distortion and the brainstem and the cerebellum receive too little oxygen-rich blood.

Distortion: causes and risk factors

Distortion is usually caused by unfamiliar, fast and powerful movements, in which individual bands are stretched beyond the normal level. Classical for the ankle distorsion is the “kinking”, in which the sole of the foot is folded inwards and thus the outer band at the ankle is greatly stretched (supination trauma). Distortion in the knee joint occurs when, for example, the knee is jerked outwards. Distortions are common, especially in fast sports such as football, handball, volleyball and basketball. But you can also walk in everyday life when walking or climbing stairs occur.

Distortion in the shoulder, elbow or finger joints is very rare. You can also pull them in sports, in falls or in a clumsy movement. Distortion in the shoulder can also occur if you are lifting unusually heavy. For example, a distortion of the thumb occurs frequently when skiing: If the thumb gets stuck in the loop of the ski pole when falling, the outer band is overstretched. In most cases it breaks. It creates a so-called ski thumb.

A cervical spine (cervical spine) distraction occurs as a result of whiplash injuries, such as occur in traffic accidents. Especially in the event of a rear-end collision, the risk of a cervical spine twist is high. A cervical sprain can also occur during sports and recreational accidents.

In rare cases genetic connective tissue disorders (eg Marfan syndrome, Ehlers-Danlos syndrome) can lead to excessive extensibility of the ligaments and thus joint instability. People with these disorders are at an increased risk for distortion and dislocation (dislocation) of joints.

Distortion: examinations and diagnosis

In case of a distortion or suspicion of another injury to the joints is a Orthopedist or accident surgeon The right person to speak to. If in doubt, you can also visit your family doctor. With a slight twist, he may seem to be articulating and giving you tips on how to behave in the near future. In case of a severe distortion, he will refer you to a specialist.

The description of your current complaints and any pre-existing conditions provides the doctor with important information. In this anamnesis You should report as accurately as possible how the accident or injury occurred. To get more clues, the doctor may ask questions like:

• When exactly did the pain occur?
• How did you behave after the accident?
• Did you cool the place?
• Have you already injured yourself at this point?

After the anamnesis finds one physical examination instead of. The doctor first carefully scans the affected joint. If a pressure pain occurs, this is the first sign of a distorsion. The pressure pain is expressed at the site of injury and the immediate environment.

Examination Distortion OSG (Upper Ankle)

In the case of the ankle distorsion, the doctor first checks whether the band structures on the inner and outer ankle are intact. He always tests both legs to be able to compare the mobility of the uninjured joints with the injured one. The doctor fixes the lower leg with one hand, with the other hand he tries to gently turn the sole of the foot in and out. Normally the range of motion is very limited by the bands on both sides. In the event of ligament damage on one side, the sole of the foot can be turned excessively far to the side (increased unfolding of the ankle). Another examination method on the ankle is the drawer test. In this test, the doctor fixes his lower leg again with one arm while trying to push the foot forward (toe-toe) and backward (heel-toe). Also, this movement is usually allowed by the band structures only very limited. If the foot is excessively slippery, it is likely that there is moderate distortion (ligament hyperextension) or severe distortion (ligament tear).

Further investigations: Distortion OSG

As a rule, the doctor examines the injured joint after the physical examination with imaging techniques that show the extent of the injury. Most commonly, an ultrasound scan (sonography) of the injured region is performed. This allows the doctor to tell if a ligament or capsule is torn or overstretched. Another more sophisticated method is magnetic resonance imaging (MRI). However, MRI is usually only needed for injuries that are to be treated surgically. The MRI images give the surgeon a good overview of the extent of the damage even before the procedure. To exclude injuries to the bones – especially in the case of more serious accidents – an X-ray can also be taken.

Examination of Distortion of the cervical spine

A cervical spine distortion is potentially very dangerous, as there are important structures in the area of ​​the cervical spine, such as the spinal cord, important neural pathways and brain-supplying blood vessels (Ae. Vertebrales). Before the actual physical examination begins, mostly immediate imaging (CT, X-ray, MRI) is used to exclude serious injuries. If life-threatening injuries, such as an unstable fracture of the cervical spine, are excluded, the physical examination can be carried out. In addition to the examination of the range of motion, a neurological examination is particularly important in suspected spinal cord distortion.

First, the doctor checks the mobility of the cervical spine. The patient should turn his head to both sides, lower him to the chest and stretch backwards. Decisive for the diagnosis is whether the patient has pain and how far he can move his head in different directions. The neurological examination depends on which complaints the patient expresses. Basically, a coarse neurological examination is always performed to exclude dysfunctions of the cerebrum, brain stem and spinal cord. In addition, specific examinations, for example, can reveal the malfunction of peripheral nerves. In the area of ​​the neck numerous nerves run, which steer in particular the hands and the arm by motor and forward sensory stimuli from these body regions to the brain. Damage to these nerves can be detected with electroneurographic examinations (for example measurement of nerve conduction velocity, electromyogram, etc.).

Distortion: Treatment

The treatment of a distortion depends on the severity of the injury. Distortions of the joints of the foot and leg are generally treated conservatively (non-surgically). Surgery is usually only necessary if the joint is very unstable as a result of the injury or if the patient puts special strain on the joints due to private or professional requirements (professional athletes, construction workers, etc.). In the case of distortion of the cervical spine (distortion of the cervical spine), only serious injuries, for example, a bony injury to the cervical spine, must be operated on. In any case, sufferers should carry out “first aid” measures immediately after the accident so that the injury heals as well as possible. Care should be taken with cervical spine injuries.

First aid

The aim of the first treatment for a distortion is to reduce the swelling of the joint as much as possible and to relieve the pain. Doctors recommend for the first treatment the so-called PECH Rule:

P = break: Stop exercising immediately. Sit down and avoid, if possible, further stressing the joint. This is true even if the pain is not so strong at first. Any additional stress can further damage the ligaments and capsule, significantly worsening the prognosis.

E = ice: Cool the affected area for about 15 to 20 minutes. Use ice packs or envelopes with cold water. The cold causes the blood vessels to contract and less blood to escape. Do not lay the ice directly on the skin, otherwise frostbite may occur, but put some fabric in between.

C = Compression: If possible, you should create a compression bandage. This stabilizes the joint, compresses the tissue and thus prevents the escape of blood from injured vessels. Even a compression bandage prevents such a larger bruise and swelling.

H = high camps: Best store the affected joint. So the blood from the joint flows back to the heart more easily. This reduces the pressure in the venous vessels in the injury area so that less blood escapes from the injured veins.

In the first help of a Cervical sprain be careful. It is important not to over-move the neck before a serious injury to the cervical spine has been ruled out. If suspected spinal cord distortion is the first step, the patient should be hospitalized as soon as possible.

Treatment at the doctor

Distortion is usually treated conservatively (non-surgically). This means that the joint should not be stressed until the ligaments have completely recovered from the injury. To make sure that you no longer burden the joint, even with slight sprains a stabilizing bandage (“bandage”) is created. If the ankle or knee is distended, it is recommended that crutches be used in the first few days after injury. In the case of a distortion in the finger or in the wrist, it is sufficient to apply a stabilizing bandage so that the joints are immobilized. After the close season, under the guidance of the doctor, you should then start with light gymnastic exercises for the joint to gradually get used to the movement.

Treatment Distortion OSG (upper ankle joint)

Also, ankle distorsion is usually treated conservatively. The patient must protect the ankle and may not burden it for a few weeks, depending on the severity of the injury. To ensure permanent relief, the doctor puts on a so-called ankle brace. These are two fixed rails that lie on the side of the ankle and are connected together by a more stable bandage. For the first few days, a crutches can be useful.

Severe distorsion (torn ligaments, clamped capsule or ligaments) or people whose joints are exposed to particularly high loads (professional athletes, construction workers, etc.) may require surgery. An attempt is made to repair the damage to tapes and capsule. Unless the bands are completely demolished, they can usually be sewn. 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 Distortion cervical spine

In case of a possible cervical spine distorsion, you should keep your head and neck as calm as possible and consult a doctor as soon as possible. Do not try to “neck down” your neck. Until a severe injury (especially the bony cervical spine) has been excluded by imaging techniques (X-ray, CT, MRI), you should not move the neck as possible. The attachment of “Stiff-Necks” or ruffs should also be carried out only by trained personnel. The further treatment depends on the severity of the injury. In mild forms of cervical spine twisting, restraining and administering analgesics are usually sufficient for several days. If the injuries to the neck are severe, a hospitalization may be necessary for monitoring or even surgery.

Until recently, a so-called cervical collar was used to treat a cervical spinal cord distortion, with which the cervical spine was largely immobilized. This method of treatment is now discouraged, since the cervical joints are thus moved too long time too little, which can limit the ability to function. Today the neck is immobilized only for a few days. Thereafter, the physician sets up a gentle exercise program, which is progressively increased until the cervical spine and surrounding structures are fully regenerated.

Distortion: Disease course and prognosis

With early treatment, consequential damage and complications can often be avoided. 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 distorsions – the joint becomes increasingly unstable. With increasing damage to the ligaments it eventually comes to the so-called “Schlottergelenk”, which is hardly loadable. Such a dorsal joint develops especially in athletes.

These often burden their joints fully again as soon as the doctor’s prescribed season is over. In fact, the burden should initially be easy and only gradually increase. In addition, the specified by the doctor rest is only an approximate guide. If the joint hurts under load, you should continue to protect it. Instead, start with light exercises and increase exercise intensity and duration over several weeks. In case of ankle dysfunction or a sprain of the knee, you should also start with light sports such as swimming or cycling. Sports such as jogging or ball sports strain the joints very much and should be taken up only slowly.

Another danger that an unstable joint brings with it is a misalignment. Under stress, the cartilage is disproportionately worn and the joint can wear out – arthrosis develops.

A slight distortion without accompanying damage and with sufficient and rapid treatment usually heals without complications. Make sure that you protect your joint long enough and do not start exercising immediately when the pain subsides. Only after a suitable therapy and sufficient time for rest is the joint stable enough to be loaded again. After a slight distorsion, the joint usually recovers completely and is then as stable again as an unhurt joint. After moderate or severe distorsions, some instability may be left behind. To another distortion In the future, you should wear bandages during sports.