Who else but athletes with their active lifestyle are susceptible to all kinds of injuries? Different kinds Sports, especially contact and team sports, can lead to various injuries and damages: fractures, dislocations, soft tissue damage. Now let’s figure out which organs and parts of the body are most susceptible to sports injuries. And, naturally, we will learn to prevent them.
Eyes
How can you get an eye injury? Yes, very simple. For example, from hitting a ball - in tennis, cricket, squash, baseball, etc. or with a fist and fingers - in contact sports. Such injuries are often accompanied by hemorrhage, which can occur when blood vessels or the iris are damaged. This may appear 2-4 days after injury due to secondary bleeding provoked by physical activity. In this case, you should immediately consult a doctor and strictly follow his recommendations, because excessive hemorrhage can lead to complete loss of vision.
— strict bed rest for 5 days, with daily examination;
— complete failure from cigarettes and alcohol;
- bandage on the affected eye (for about 4 days);
— sedatives, if there are special indications for this;
— exemption from training for one month;
— aspirin is contraindicated! It thins the blood and may increase bleeding;
- in a month you need to undergo an examination by an ophthalmologist for exclusion
retinal detachment.
Prevention of eye injuries:
Always wear a helmet or safety glasses. After all, as they say, prevention is the best cure.
Teeth
If a tooth is dislocated during a sporting event, then all is not lost - the affected tooth can be replanted (returned to its place). But this must be done by a specialist. In this case, you need to urgently contact dental clinic. If replantation is performed in the first 30 minutes after injury, then a favorable outcome is likely in 90% of cases.
Nosebleeds and nasal bone fractures are the most common sports injuries. To stop bleeding, you need to pinch your nose with your fingers for 5-10 minutes. At the same time, do not throw your head back, but rather tilt it slightly forward. If the shape of the nose is deformed, the patient is immediately referred to a specialist.
NB(important)! Do not neglect protective equipment; be sure to ensure that your face is protected from accidental injury.
Shoulders
The most common types of injuries:
- collarbone fracture;
- dislocation or subluxation of the acromial end of the clavicle;
- shoulder dislocation;
- tendinitis (inflammation) of the supraspinatus tendon.
There is even such a thing as “swimmer’s shoulder.” Shoulder pain affects approximately 60% of professional athletes. The source of pain is tendinitis of the tendons of the muscles that form the muscle capsule (rotator cuff) of the shoulder joint, especially the supraspinatus muscle. Pain can also be observed with pterygoid scapula and osteochondrosis of the cervical and thoracic spine.
Prevention and treatment of injuries:
- exercises that strengthen the muscle capsule of the shoulder joint and the muscles that fix the scapula;
- exercises that increase the mobility of the spine.
Elbows
Another technical term associated with injury to this part of the body is “tennis elbow.” This type of injury is quite common. Tennis elbow is a lateral (outer) or medial (inner) epicondylitis. humerus; Medial epicondylitis of the humerus is also called golfer's elbow and baseball elbow.
Hands
Most often among athletes, fractures and dislocations of the metacarpal bones and phalanges of the fingers occur, as well as damage to the extensor tendons of the fingers (the so-called hook finger). Ligament injuries should be taken very seriously as they can lead to impaired hand function. For skiers, a rupture of the medial collateral (internal lateral) ligament of the metacarpophalangeal joint is typical thumb(skier's finger, huntsman's finger). In this case, urgent consultation with a traumatologist is required.
Hook finger
A very common injury in volleyball, basketball, rugby, baseball and cricket. It occurs when the extensor tendon of the fingers is torn from the nail phalanx, sometimes together with a small bone fragment. It occurs as a result of a blow to the tip of the finger in the direction of its axis, causing a sharp bending of the nail phalanx.
Treatment
The patient is recommended to immobilize (immobilize) the finger in the position of maximum extension of the nail phalanx for a period of 6 weeks. And in case of an avulsion fracture of the distal (nail) phalanx, an operation is performed: open reduction (return is not the place) and fixation of the fragment. If left untreated, the outcome may vary. If the angle between the nail phalanx and the axis of the finger is less than 45°, then the function of the hand suffers little. Large deformation sharply impairs the function of the hand. In addition, a significant cosmetic defect remains.
Bowler's hand
This type of injury is characterized by pain and stiffness of the fingers involved in gripping the ball. Repeated damage can lead to neuritis between the digital nerves, which is manifested by paresthesia (impaired sensitivity, numbness, tingling, goosebumps).
Treatment
As a rule, the patient is prescribed rest and massage. severe cases- injections of long-acting corticosteroids and local anesthetics into the compaction zone.
Injuries in skiers
Experts note that in Lately the percentage of injuries among skiers has decreased slightly because, firstly, it has improved sport equipment, and, secondly, the safety of the routes has increased. But, nevertheless, skiing is not without injuries.
The most common injuries in skiers:
- damage to the tibia collateral ligament knee joint and internal meniscus(24.3% of cases);
— bruises (17.6% of cases);
— wounds (15.5% of cases);
— spinal injuries (7.8% of cases);
- fractures (7.6% of cases) and dislocations.
Among the fractures, the most common are screw-shaped fractures of the tibia and fibula (tibia), fractures of the clavicle, humerus, and wrist bones. When falling on hard snow, dislocations of the shoulder and acromial end of the clavicle occur.
Skier's finger
Now let's talk about another term in sports medical terminology. “Skier's toe” (or as it is also called “gamekeeper's toe”) is a rupture of the medial collateral (inner lateral) ligament of the metacarpophalangeal joint of the thumb, sometimes with an avulsion fracture of the base of the proximal (main) phalanx. The mechanism of injury is a sharp abduction and hyperextension of the thumb when pushing off the snow with a ski pole. For a more accurate diagnosis, it is recommended to take an x-ray. At incomplete rupture the ligaments are applied with a pistol bandage for 3 weeks. In case of complete rupture and avulsion fracture, surgery is indicated.
Spine
The most dangerous injuries are spondylolysis (fracture of the interarticular part of the vertebral arch), spondylolisthesis (slippage of the overlying vertebra), damage intervertebral disc with the formation of a hernia and fracture of the vertebral body. The latter injury is rare in athletes. Damage to the back muscles and intervertebral joints, osteochondrosis, especially cervical and lumbar regions spine. Treatment is usually conservative (without surgery) and necessarily includes physical therapy and physical therapy, which should be recommended by the attending physician.
Legs
In athletes, leg injuries are more common than injuries to other parts of the body. Damage can occur either from a single exposure to a damaging factor or from functional overload. With friction, tendonitis (inflammation of the tendon) occurs, with ischemia (low blood flow) - fascial bed syndromes, with functional overload - damage to the tendons in the popliteal fossa and a stress fracture of the tibia or metatarsal bone.
Functional overload
Injuries due to functional overload are becoming more common. This is due to the fact that everything more people play sports, especially running. When running, the main load falls on the lower leg and foot, so these sections lower limb suffer more than others. With repeated damage, even minor ones, the tissues do not have time to recover, and constant pain, and eventually a tendon rupture or fracture (fatigue or marching) occurs. The most common tendon injuries are in the popliteal fossa and stress fractures.
Treatment
— Depending on the type of injury, complete rest is prescribed or only exercises that involve damaged muscles, tendons or ligaments are prohibited.
- In the first 2-3 days after injury, cold is used for 20-30 minutes every 2 hours; cold is not used at night.
— If soft tissues are damaged, the leg is tightly bandaged for at least 2 days.
- Not yet swelling will subside, the leg is given an elevated position.
— For pain, NSAIDs (non-steroidal anti-inflammatory drugs) are prescribed.
- Care must be taken to ensure that such injuries do not recur in the future. You may have to train in special orthopedic devices.
— During the recovery period, the patient is prescribed a complex of physical therapy.
This is the area most prone to injury among weightlifters. Acute pain in the groin can occur as a result of functional overload of the legs, as well as damage to muscles and tendons. Diagnosing and treating such injuries is not difficult. It is much more difficult to identify the cause of referred pain in the groin, which can occur with problems with the lower back or sacrum, hip joint, and pelvic organs.
The most common cause of acute groin pain can be damage to the following muscles:
- adductor longus muscle;
- rectus femoris muscle;
- sartorius muscle;
- iliopsoas muscle.
In adolescents, acute groin pain may be caused by an avulsion fracture. Prolonged groin pain may occur due to the following reasons:
- damage to muscles and tendons;
- bursitis;
- osteoperiostitis of the pubic bone;
- stress fractures of the neck femur, branches of the pubic bone;
— diseases of the sacroiliac and hip joints;
- damage intervertebral discs L1, L2, L2-L3;
- inguinal and femoral hernias.
Hematomas
The most common localization of hematomas, or as people say - bruises, is the thigh and lower leg. Hematomas can be located deep within the muscle or intermuscular connective tissue. A hematoma can be complicated, in which case a scar, suppuration, cyst, or thrombophlebitis may form in its place. As a rule, an injury of this kind is treated with rest, applying cold, applying pressure.
Knee joints
This is perhaps one of the most dangerous injuries for an athlete. The most common injuries are to the meniscus, ligaments of the knee joint, as well as damage to the joint due to functional overload. In the latter case, the pain, as a rule, occurs gradually, intensifies with movement and subsides with rest. No swelling is observed. To avoid this unpleasant symptom choose comfortable shoes, change your training regimen and technique. In addition, knee pain can occur due to diseases hip joint or joints of the feet, which lead to changes in the biomechanics of the legs.
Shin
Shin injuries can also occur due to functional overload. Moreover, 60% of cases are caused precisely by errors in the training regimen. Professional athletes can suffer from overexertion, while beginners can suffer from poor warm-up before training. How to overcome the disease? First, the doctor recommends rest for you, then a special set of exercises. Be sure to change the mode and intensity of your training, exercise only in comfortable shoes, do not neglect the warm-up and try to perform all exercises technically correctly. The doctor may recommend taking non-steroidal anti-inflammatory drugs, but only if there is inflammation, which is characterized by pain at rest.
Stress fractures
This type of sports injury accounts for approximately 5-15% of all types of sports injuries. The most common fractures are the tibia, fibula, scaphoid, calcaneus and metatarsal bones.
The main cause of this type of injury is excessive and long-term stress on the bone, for example, during long-distance running and jumping. If an injured athlete complains of leg pain, he should definitely be checked for the presence/absence of a stress fracture.
Tennis player's shin
Behind this term lies a rupture of the medial head calf muscle at the border with the Achilles tendon. As you may have guessed from the name of the injury, it most often occurs in tennis players. One risk factor that contributes to injury is poor pre-game warm-up.
What characterizes the injury:
- sharp pain in the lower leg;
— the pain intensifies when the foot is dorsiflexed, it hurts to step on the heel, so the victim moves on tiptoe;
- pain in the ankle during palpation;
- hemorrhage may occur in the area of muscle rupture.
Treatment:
- rest, cold, compressive bandage, elevated position of the leg for about two days;
- immediately after injury it is necessary to apply elastic bandage and apply ice on top of it to the damaged area, it is recommended to hold it for 20 minutes. Repeat this procedure every 2 hours;
— it is advisable to carry out massage and physical therapy;
Ankle ligament damage
Getting such an injury is quite simple - you just need to twist your leg. You stumbled on an uneven surface, your foot buckled, or you landed poorly after a jump - and now you have appeared discomfort, indicating damage to the ankle ligaments.
Main symptoms:
- instability ankle joint, twisting of the foot when walking on an uneven surface;
- swelling from moderate to severe depending on the degree of damage;
- the patient is unable to stand;
- pain can be of varying degrees of intensity;
- extensive hemorrhage, which may appear within the first 24 hours after the injury and indicate what has happened serious damage ligaments
To clarify the extent and severity of damage, it is recommended radiographic examination. Treatment depends on the severity of the injury. Damage of the I and II degrees is treated conservatively. The pain usually goes away within 1-6 weeks, and movement in the ankle is restored in full.
Patients with grade I trauma are recommended to rest for the first two days, apply cold to the ankle for 20 minutes 3-4 times a day, a pressure bandage, and elevated position of the leg. If the ligament is not completely torn, an immobilizing (immobilizing) bandage is recommended to reduce pain. Analgesics are prescribed to reduce pain. For the first few days, the patient is recommended to move with the help of crutches. You need to start grooming as early as possible to restore movement in the joint. Isometric exercises are recommended. After two days, instead of ice, you can start thermal procedures. Walking barefoot on the sand helps a lot. Motor activity is restored after approximately 2 weeks. For injuries of the second degree of severity, the first two days require rest, cold over the bandage, a pressure bandage every 2-3 hours, and an elevated position of the leg. For the first few days, the patient is recommended to move with the help of crutches. Then the load is gradually increased and a complex is prescribed special exercises. A soft immobilizing bandage is recommended. For grade III injuries, treatment is selected individually. The degree of damage is determined by radiography. Conservative or surgical treatment is possible.
Heel injuries
In what cases can heel pain occur:
- lesions of the Achilles tendon;
- “broken heel”;
— achillobursitis;
— osteochondropathy of the calcaneal tuberosity;
— “black heel”;
- calluses and warts.
What is it characterized by:
- pain in the tendon area;
- a feeling of stiffness, especially when climbing uphill;
- thickening of the tendon;
- pain on palpation.
To avoid this injury, be sure to warm up well before training and do stretching exercises. Choose comfortable sports shoes with 1 cm of arch support under the heel. Rest is recommended as treatment. acute period, in severe cases, immobilization with a plaster cast. Non-steroidal anti-inflammatory drugs may be prescribed to reduce pain. Ultrasound therapy, massage, gradual increase in physical activity and physiotherapy, especially stretching exercises.
Disease Treatment SpecialistsFinger injuries upper limbs(damage to the joint capsule and ligamentous apparatus) arise as a result of mechanical displacement of one of the articulating segments in an unnatural direction for the movement of the joint.
Damage to the joints of the fingers
Pathologies of the joint capsule are caused by dislocations and subluxations of joints, tears and ruptures of ligaments, and bone fractures. Before defining effective method When treating a damaged finger joint, you should understand the following issues:
The joint capsule or joint capsule is a kind of shell of a bone joint, formed from connective tissue. This shell is attached to the bones located in close proximity to the surface of the articular joint. The main functions of the joint capsule are to protect the articular bone joint from damage and prevent friction, which leads to wear and tear of the joints.
Joint capsule
Structure of the joint capsule:
- Outer layer or fibrous membrane. It is a strong and thick layer formed from elastic fibers of the connective muscles in the longitudinal direction. The purpose of the fibrous membrane is to protect the joint.
- The inner layer is synovial membrane, which is responsible for the production of special synovial fluid. This substance is also called intra-articular lubricant. Synovial fluid prevents wear and tear of the joint and prevents the development of pathological inflammatory processes.
From this video you will learn the structure and functions of the joint, the purpose of the synovial membrane, ligaments and cartilage.
Types of capsule damageAs a result of careless actions, you can get the following types finger joint injuries:
- injury;
- dislocation and subluxation;
- tear or rupture of ligaments;
- fracture with rupture of the joint capsule.
Contusion of the joint capsule
A bruise is an injury that is accompanied by an unpleasant sensation of pain and rarely leads to negative consequences. From an anatomical point of view, a bruise is an injury or minor damage to soft tissue in the joint area without visible damage to the integrity of the skin. The ligaments of the thumbs are the most commonly bruised.
When a bruise occurs, the integrity of the ligaments is damaged, resulting in hemorrhage into nearby tissues and the articular cavity. The functionality of the finger with this type of injury is not impaired, and the symptoms of this pathology include:
- the occurrence of edema as a result of stretching of the joint capsule of the finger with liquid;
- severe pain in the injured area;
- slight numbness of the finger;
- the appearance of a hematoma.
Dislocation of the joint
As a result of the impact of a negative factor on the fingers, the patient may experience a displacement of the joint, which is called a dislocation. Dislocation is accompanied by severe pain in the injured area and is almost always accompanied by rupture of the joint capsule.
Depending on the location affected negative impact, dislocations are divided into the following types:
Dislocation of the joint
It is very easy to recognize a dislocation - pronounced swelling appears, the head of the phalanx protrudes (displacement of the joint is visible to the naked eye), the skin at the site of injury becomes red, and pain is felt when moving the finger.
Dislocation differs from subluxation in that with the first there is a complete displacement of the surface of the joint, and with subluxation the joint is practically not deformed.
Rupture and tear of capsule ligamentsA rupture or tear of the ligaments occurs as a result of a sharp fall on the hand, when there is excessive deviation of the finger to the ulnar or radial side.
Rupture of ligaments and joint capsule
Ligaments are tough structures that strengthen the joints of the fingers and guide their movement. Therefore, after a rupture, the functionality of the finger is impaired - lateral instability of the joint appears. There are several types of ligament ruptures:
The most common symptoms of ligament rupture and damage to the joint capsule include:
Partial ligament rupture
- inability to move the injured finger;
- instability (instability) of the joint, which is determined by a change in its natural contour;
- increased swelling;
- when you try to change the position of your finger, a specific cracking sound occurs;
- There may be a tingling sensation.
Fracture – pathological disorder the integrity of the bone and, accordingly, the articular capsule that is attached to it. A finger fracture is accompanied by a complete loss of finger functionality, which affects a person’s overall performance.
Finger fractures are divided into two general types- closed and open. With a closed fracture, the integrity of the skin remains unchanged, while an open fracture is characterized by damage to the epithelium by the sharp edges of the bone.
Note! Failure to promptly contact a traumatologist in the event of an open fracture of a finger can lead to this negative consequence, like osteomyelitis - an intense inflammatory process in the bone marrow.Open and closed fractures of the phalanges can be either with or without displacement of bone fragments. Depending on the number of bone fragments, fractures are divided into the following types:
- non-comminuted fracture;
- fractures with one or two fragments;
- comminuted or comminuted fractures.
Types of fractures
Depending on the line of bone fracture, fractures are divided into screw, transverse, longitudinal, oblique, T-shaped and S-shaped. Only a doctor can determine what type of fracture a patient has after examining an x-ray.
The symptoms of a finger fracture are divided into probable and certain. Reliable signs of a violation of bone integrity:
- the presence of a crack, which is easily determined by palpation;
- the shape of the bone changes;
- finger mobility is detected in places where it should not be;
- when trying to move the bones, a specific crunch is heard;
- the damaged finger visually appears shorter than the same finger on the other hand.
Possible signs of a fracture with rupture of the capsular bag:
- the fracture site becomes swollen, the skin acquires a purple tint;
- pain appears at the site of injury;
- it is impossible to move a finger voluntarily.
Skier's finger
Injuries to the hand and fingers entail consequences such as rupture of the joint capsule, swelling and hemorrhage into the cavity of the joint capsule. A person can be injured as a result of an unsuccessful fall on an extended or bent hand, when receiving strong blow or in the process of unnatural squeezing of the hand. Other causes of joint capsule rupture include:
- hit on a straight finger;
- falling on an extended finger;
- forceful wringing of a finger in an unnatural direction;
- cut wounds.
Particularly often, damage to the joint capsule is diagnosed in athletes (mountain climbing, bodybuilding, wrestling, gymnastics), children and the elderly.
Note! After 50 years, the risk of getting a finger fracture increases several times. This is due to hormonal imbalance, which leads to insufficient absorption of calcium and other beneficial microelements by the body. Diagnostic methodsto install accurate diagnosis you need to visit a traumatologist who will visually examine the sore finger, determine the type of damage using the palpation method and prescribe instrumental methods diagnostics:
X-ray
- X-ray examination - X-ray is carried out in frontal and lateral projection. This type of examination helps to establish the exact type of injury, the presence or absence of a bone fracture, the nature and depth of the damage, and the degree of injury to nearby tissues.
- Ultrasound is a method for determining the condition and functionality of ligaments and tendons. By examining the hand using ultrasound, the specialist identifies the presence of damage to the nerve threads, nerve pinching and small ossicular fractures that are not visible on x-rays.
It is extremely rare to see a procedure such as an MRI prescribed. This type of examination is expensive, and the degree of damage assessment is no different from diagnosing a hand using ultrasound.
First aidAfter receiving an injury, it is important not to become confused and provide first aid to the patient. Correct Actions will help reduce pain, prevent blood poisoning and the development of swelling. What to keep in your first aid kit for first aid injuries with capsule rupture:
- cooling pack “Snowball” or ice;
- bandage sterile medical;
- bactericidal adhesive plaster;
- furatsilin, hydrogen peroxide (2%), medical alcohol or antiseptic wipes;
- iodine solution (3%);
- anti-inflammatory pain reliever (Nimesulide, Ibuprofen or Xefocam);
- ointment with antibacterial effect(Argosulfan, Sintomycin, Tetracycline, Levomekol).
Pre-medical fixation of the injured area
Dressing
If the joint capsule is damaged as a result of a fracture, then the following treatment methods are used:
- Reduction of the bone by traction of the finger along its axis. This method is called "single-stage closed reduction" and is used only in cases closed fracture. Before the actual procedure, the patient is given an anesthetic (Lidocaine or Novocaine). After comparing the bone fragments (reposition), the doctor immobilizes the sore finger by applying a plaster splint. It should be noted that only the damaged finger is fixed, since immobilization of healthy ones leads to ankylosis (hardening of the ligamentous apparatus, followed by immobility of the joints).
Extension of a limb
- In the case of a comminuted closed fracture, the patient is given an anesthetic and the finger is immobilized with a plaster splint. A silk thread attached to a rubber rod is pulled through the nail plate (finger pull).
- At open fracture carry out surgical intervention(open reduction). Bone fragments are fixed with knitting needles or screws.
In case of dislocation with damage to the joint capsule, the doctor sets the finger, which is done by pulling the limb by the phalanx. After a characteristic click, the joint snaps into place. Depending on the severity of the dislocation, the patient may need to fix the finger with a plaster or adhesive plaster.
If a patient is diagnosed with a rupture or sprain of the ligaments, then the patient is given a “novocaine blockade”, which consists of solutions of novocaine, analgin and cyanocobalamin. The injection mixture is injected into the injury site once every few days. The doctor also prescribes the application of anti-inflammatory ointments to the affected area.
What medications should be used for injuries to the ligamentous apparatus and joint capsule of the finger?Drug treatment consists of using the following groups of drugs:
- NSAID drugs. Medicines in the form of tablets are taken to eliminate pain, reduce inflammation and associated elevated temperature bodies. Representatives - Nimesil, Nise, Ibuprofen, Xefocam, Ibuklin. Listed medicines prescribed in the first days after injury. To reduce the process of inflammation and anesthetize the site of direct injury, it is recommended to use ointments and gels that should be applied daily for a month - Nise, Nimesulide, Fastum gel, Bystrumgel, Diclofenac.
Chondroprotectors
- Chondroprotectors and hyaluronic acid preparations. These medications are prescribed to strengthen and accelerate the process of bone restoration. Representatives - Chondroitin sulfate, Chondroguard, Mucosat, Glucosamine, Dona, Teraflex.
- Antibacterial ointments and powders. Apply to the site of skin rupture. The main purpose of application is to reduce the risk of infection spreading in the wound cavity. Preparations – Baneocin (ointment or powder), Streptocide powder, Betadine, Levomekol, Zinc ointment, Salicylic ointment.
- Decongestant ointments and gels - effectively reduce swelling, improving blood circulation at the site of application. This group of drugs includes Heparin ointment, Troxerutin, Troxevasin, Lyoton.
After removing the fixing bandage, the doctor prescribes physiotherapy. They restore the natural motor activity of the finger and prevent relapse.
| Name of procedure | Efficiency |
| Ultra-high frequency therapy or UHF | Heating of bone and muscle tissue occurs, due to which blood circulation improves, a slight analgesic effect is noted and the regeneration process is accelerated. |
| Finger exercises after immobilization | Normalization of cellular metabolism and improvement of blood circulation are achieved. |
| Hand baths with added salt and soda | The sensitivity of nerve receptors decreases, which eliminates pain. There is a pronounced decrease inflammatory process and softening of the ligamentous apparatus. |
| Applications from ozokerite | Warming the affected area helps to dilate blood vessels and improve blood circulation. Pain is reduced and metabolic processes in tissues are normalized. |
| Mechanotherapy | Improved blood circulation and motor activity through the use of small objects. Restoration of movement coordination is achieved. |
In this video you will learn a set of exercises for developing joints.
ResultsLimb injuries are common. However, to reduce the risk of their occurrence, it is recommended to follow the following rules:
Most damage elbow joint are caused by its overload, while the wrist and hand more often suffer from injuries. A fall on an outstretched arm often results in a fracture of the scaphoid and sometimes the distal end of the radius. A fracture of the scaphoid is characterized by pain in the area of the anatomical snuffbox. The examination may not reveal other pathological findings, and the fracture may not initially be visible on radiographs. If a fracture of the scaphoid is suspected, the wrist is immobilized and the patient is referred to a traumatologist. Healing of the fracture takes up to 3 months.
Skier's fingerSkier's toe (forester's toe) is an acute sprain or tear of the medial collateral ligament of the metacarpophalangeal joint of the thumb. When falling on the hand, a sharp abduction of the thumb occurs.
During the examination, swelling of the metacarpophalangeal joint is detected; the area of the medial collateral ligament is painful.
If x-rays do not reveal a fracture, a stress test on the medial collateral ligament can be performed to identify ligament laxity and test joint stability.
If the ligament is partially or completely torn, the patient is referred to a hand injury specialist. If you have persistent pain in the wrist, you may need to consult a microsurgeon who will clarify the nature of the ligament damage.
- Thumb ligament rupture accounts for 10% of all ski injuries
- The thumb of the hand moves dorsally and laterally due to the application of force, for example, when sharply picking up a ski pole
- Rupture of the collateral ulnar ligament in the area of the metacarpophalangeal joint of the thumb
- Intraligamentous rupture or bone avulsion (more often distal than proximal) Complications are possible if the free proximal end of the ligament is directed under the tendon aponeurosis of the adductor pollicis muscle (Stener injury), which impedes healing and leads to the development of chronic instability of the joint.
- X-ray examination.
- X-ray examination in two projections
- If a fracture is excluded, a stress x-ray examination
- Examination of both hands: comparison of the damaged and healthy sides
- Severance of a bone fragment due to rupture of the thumb ligaments
- The degree of opening (relaxation) of the joint exceeds 28° or the difference between the injured and uninjured side is more than 20°.
- MRI only if there is doubt about the diagnosis or an old rupture
- Frontal and axial imaging using T1-weighted and T2-weighted fat-suppressed sequences
- Ulnar collateral ligament rupture
- Possible bone avulsion
- Possible displacement of the proximal end of the ligament (damage Stener).
Pain syndrome in the metacarpophalangeal joint of the thumb after increased abduction of the thumb when falling from skis. X-ray examination in the dorsal projection demonstrates the avulsion of an elongated fragment of bone from the ulnar side at the base of the proximal phalanx of the thumb.
A,
b
Falling with a ski pole in hand while skiing. (
a
) Dorsal X-ray demonstrates ossification of the radial aspect of the distal first metacarpal following previous trauma. A fresh fracture is not detected.
( b ) Projection with radial abduction. 37° metacarpophalangeal joint inclination
Clinical manifestationsTypical manifestations of skier's toe or thumb ligament rupture
- Pain on palpation
- Soft tissue swelling
- Hematoma
- The range of motion may be limited.
- Incomplete rupture of the ulnar collateral ligament is treated by immobilizing the metacarpophalangeal joint using a thumb splint for 4 weeks.
- If there is a complete rupture of the thumb ligament or if there is a bone avulsion, and there is a suspicion of a Stener lesion, treat for the first 10 days with repair of the ligament by suturing.
- For avulsion fractures, transosseous cerclage, suturing or fixation (wire, screw, fixator) is used.
- Failure to treat or improperly managed skier's toe results in limited function (eg, inability to grasp a bottle) with chronic instability of the metacarpophalangeal joint ("floppy joint") and dysfunction that may extend to the entire hand.
- Bone lesion
- The degree of joint opening (relaxation).
Fracture and/or dislocation of the phalanges and metacarpal bones are clearly visualized by X-ray examination.
In the stress view, careful dorsal projection of the metacarpophalangeal joint of the thumb and correct positioning of the metacarpal bone in relation to the proximal phalanx is necessary so that the stress effect can be assessed on radiographic examination.
One of the most common injuries to the lateral ligaments of the hand is a rupture of the ulnar collateral ligament of the thumb. This injury is also called “skier's thumb” or “gamekeeper's thumb.” The term "skier's finger" is more applicable to acute injury, and "gamekeeper's finger" to chronic injury. The term "jaeger's finger" (i.e. "jaeger's thumb") originated in 1955. in describing the chronic thumb injury of gamekeepers in Scotland who killed wounded rabbits with cervical dislocation honeydew
, squeezing their neck into a fist, between the base of the large and index finger(Demirel M. and al., 2006).Rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb is a common injury in alpine skiers. This type of injury also occurs in contact sports (boxing), as well as sports in which falls on the hands are possible. This injury to skiers was first described back in 1939 by Petitpierre.
Injury to the ulnar collateral ligament of the first finger is the second most common (9.5%) and common upper extremity injury (37.1%) in downhill skiing.
The mechanism of injury to the ulnar collateral ligament is a fall on the snow, during which the thumb is forced into a position of abduction and excessive straightening. As the skier's instinctive attempt to break the fall with an outstretched arm, holding the ski pole places the thumb in a vulnerable position (Figure 1).
In this regard, they began to recommend the use of ski poles that do not have straps, which allows the skier to free himself from the pole if he falls. Ski manufacturers have created ski poles with a “new grip”, but this has not completely solved the problem.
Similar injuries can happen in other sports. For example, in ice hockey, when any forces move the player’s stick in such a way that it critically pulls the thumb back. In handball, volleyball and goalkeepers in football, such an injury is also possible when, when catching a ball at high speed, the thumb is pulled back excessively.
The metacarpophalangeal joint of the thumb is unique in its anatomy and functional biomechanics. Stability of this joint is necessary for a powerful grip, creating leverage. Its mobility varies greatly: some are able to extend it excessively, others do not achieve full extension. The flexion angle ranges from 5 to 115°. The radial deviation can be 0-30° in the straightened position and 0-15° in the full flexion position.
phalanges of the thumb.Damage to the ulnar collateral ligament in skiers was: 34.8% first degree - microscopic rupture of the fibers of the ulnar collateral ligament without loss of integrity; up to 47% of the second degree - partial rupture of fibers without violating their integrity, but with their elongation; up to 18.2% third degree - complete rupture, usually at the distal
end near the entry point into the proximal phalanx. In addition, a fracture was observed in 23.3% of cases.A thorough examination of an athlete with a potential for joint injury is very important. great importance for accurate diagnosis and prescribing timely and appropriate treatment. Neglecting an injury can lead to undesirable consequences - serious and chronic impairment of function.
After an injury to the ulnar collateral ligament, the victim may complain of pain and swelling in the area of the ulnar part of the metacarpophalangeal joint. If the physician suspects an ulnar collateral ligament injury (based on the patient's complaints), an x-ray should be taken to determine whether an avulsion fracture has occurred (Figure 3). If such a non-displaced fracture is identified, immobilization is carried out; if displacement occurs, surgical intervention may be required. If the bone is not damaged, then the victim is monitored with a clinical examination and assessment of joint stability. Testing of the radial load on the joint is carried out in extended and bent positions. The results obtained are compared with the results shown by the other limb. Lack of stability at 0° extension indicates loss of integrity of the accessory collateral ligament with the volar plate. Instability during flexion indicates a violation of the integrity of the ulnar collateral ligament itself.
Stener damageSome experts, after identifying an avulsion fracture, recommend using a joint x-ray as a means of diagnosing a ulnar collateral ligament tear. This allows not only to determine its complete rupture, but also to differentiate a ligament rupture from a Stener injury. A Stener lesion occurs when the adductor aponeurosis becomes displaced and lies in front of the torn ulnar collateral ligament at its attachment to the base of the proximal collateral ligament. phalanx. Distal part of the ligament is retracted and located under the adductor aponeurosis (Fig. 4, B). Thus, the ends of the torn ligament are separated by an aponeurosis and therefore will never heal on their own. With such a displacement of the adductor aponeurosis, surgery on restoration correct position ligament and adductor aponeurosis.
The lack of such a specific diagnosis may explain why some patients had good results when applying plaster cast(without displacement), and in others it is very bad (in patients with a displaced ligament and with interposition of the adductor aponeurosis). There is also concern that intensive joint stability testing may lead to Stener injury in the previously undisplaced ulnar collateral ligament, necessitating surgical intervention.
Treatment of ulnar collateral ligament injuryImmediately after an injury, the athlete should ice the joint and keep the thumb elevated to avoid Stener injury. Contact your doctor immediately.
In case of a first degree injury, a splint is applied to the forearm or hand until pain disappears; in case of second degree damage, a plaster cast is applied for 3-4 weeks; in case of third degree damage with divergence of the ends of the ligament, a plaster cast is applied for 4-6 weeks. In case of severe instability of the joint, surgical treatment is performed, which is carried out in the first few weeks after the acute injury. The essence of the operation is to apply a removable wire suture to a torn or torn ligament along with the bone plate (Fig. 5) or fixation of the torn fragment using Kirschner wires
(Demirel M. and al., 2006).During the course of treatment, the athlete can resume training sessions skiing and other sports activities when applying a protective plaster cast or splint. A plaster or splint is placed on the thumb so as to cause radial deflection forces on the proximal phalanx, as well as ulnar deviation of the first metacarpal bone under the influence of the first dorsal
interosseous muscle, which can cause indirect abduction of the metacarpophalangeal joint. Thumb apposition should be avoided as this may lead to abduction of the metacarpophalangeal joint. The metacarpophalangeal joint should be flexed at about 30°, while the interphalangeal joint should be flexed at an angle of 20°.The fiberglass cast should be stiff enough to allow return to skiing with minimal risk of re-injury. The splint does not provide adequate mobilization and protection. The splint can be used after the cast is removed to protect the injured area during physical activity. It can be secured using elastic material. Application protective equipment Once treated, second to third degree injuries can be discontinued after approximately 8 to 12 weeks.
After 4-6 weeks the athlete can return to training, provided full recovery(this is determined by the attending physician), having previously completed a course of physical therapy.
Untreated injury to the ulnar collateral ligament can cause intermittent or permanent instability of the joint, weakening of the grip, and also lead to arthrosis
joint Surgery advanced cases often gives good results. Prevention of ulnar collateral ligament injuryThe damage may be caused by a ski pole. This conclusion was made on the basis of subjective information and observations, which showed that only 5% of skiers who held poles without grasping the straps were injured. These data speak in favor of this particular method of holding ski poles. Therefore, the straps on the poles should either be removed altogether or placed on the outside of the pole. This will allow you to get rid of the stick when it falls on the snow. Skiers should discard their poles when falling.
Eisenberg et al. studied a specially designed system for protecting the thumb from damage to the collateral ligament - built into a ski glove protective device. It allowed all the normal movements of the thumb, but prevented excessive stress on the elbow. In preliminary studies, 170 thousand person-days of skating (the sum of all days of skating for all athletes studied) were recorded with a protective system without a single thumb injury, compared to 1 thumb injury per 8 thousand person-days without the use of such protection. .
References- Sports injuries. Clinical practice prevention and treatment/ under general ed. Renström P.A.F.H. - Kyiv, “Olympic Literature”, 2003.
- Traumatology and orthopedics/Guide for doctors. In 3 volumes / ed. Shaposhnik Yu.G. - M.: “Medicine”, 1997.
- Sport Injuries: their prevention and treatment/ L. Peterson & P. Renstrom - published by "Martin Dunitz", London, 1995.
- Demirel M, Turhan E, Dereboy F, Akgun R, Ozturk A. Surgical treatment of skier's thumb injuries: case report and review of the literature. 2006, Mt Sinai J Med. vol.73, no.5, pp.818-821
- O"Callaghan BI, Kohut G, Hoogewoud HM. Gamekeeper thumb: identification of the Stener lesion with US. 1994, Radiology. vol.192, no.2, pp.477-480
- Leggit JC, Meko CJ. Acute finger injuries: part II. Fractures, Dislocations, and Thumb Injuries. 2006, Am Fam Physician. vol.73, no.5, pp.827-834.
Loading...