Rupture of the radioclavicular joint (2023)

After surgical treatment of a radioclavicular joint fracture, patients are recommended to participate in mechanical physiotherapy and hypothermia to relieve pain and swelling.

Anatomy of a radial head fracture

The structure of the elbow joint. The radius articulates with the humerus and the proximal elbow. This joint allows flexion and extension of the forearm, as well as pronation (turning the hand down) and supination (turning the hand up) of the forearm.

The head of the radius is covered with articular cartilage. Thanks to this, the surface of the joint slides in two planes, which is extremely important for the elbow joint. Joint fractures associated with post-traumatic arthritis may therefore result in mechanical limitation of motion.

The head is also an important stabilizer of the elbow joint.

In addition to acute pain, a radial head fracture is characterized by:

• significant limitation of elbow joint mobility, including passive and rotational movements,
• bleeding in the joint
• Deformations of the outer surface of the elbow joint.

If a fracture of the head of the radial bone in the elbow joint is suspected, a fracture of the head of the radial bone with a fracture of the intercondylar membrane should be ruled out. Therefore, if a fracture is suspected, the adjacent joints should also be examined.

Most radial head fractures are isolated, but sometimes they are accompanied by subsequent trauma

• Fracture of the coronoid process of the ulna
• Rupture of the collateral ligament of the elbow joint
• Intercondylar membrane rupture
• Fracture of Goliacci bone by dislocation

This injury, which is accompanied by a fracture of the head of the humerus, can be accompanied by damage to the medial collateral ligaments and a fracture of the ulna with its shortening.

Causes and mechanism of radial head fracture

The fracture usually occurs as a result of an indirect injury, i.e. a fall on an outstretched arm with minimal or moderate elbow flexion with simultaneous forearm pronation. The main axial load in this case comes from the radial joint. The injury occurs as a result of the collision of the head of the radial bone with the occlusion of the humeral bone. A direct blow to the head of the radius rarely causes a fracture of the radius.

This injury causes:

• sharp pain located in the elbow joint,
• swelling of the elbow joint,
• limitation of flexion and/or extension of the forearm,
• sharp pain when axial pressure is applied to the arm.

Anatomical features

The clavicle, humerus and scapula form the crown of the shoulder. The clavicular-humeral joint is a low-mobility joint that connects the clavicle and the scapula.

The joint is supported by bony structures that anchor it to strong ligamentous tissue. The ends of the joints are surrounded by a closed sac filled with synovial fluid.

Causes of X-ray injuries of the clavicular joint

Among the main causes that lead to a rupture of the radioclavicular joint, doctors state:

1. Injuries during sports competitions (such a tear is not uncommon in goalkeepers of football and hockey teams, who forcefully lower their hands to protect the goal);
2. injuries in contact sports (judo, boxing, taekwondo or sumo);
3. Injuries from falling on an outstretched arm (often from ice skating in winter)
4. Injuries resulting from an active lifestyle (after careless rollerblading, skiing or skating).

Types of radius fractures (short classification)

Fracture of the distal radiusit almost always occurs about 2-3 cm from the joint.

Colles fracture

One of the most common fractures of the distal radius is a Colles fracture, where a piece (fragment) of the distal radius migrates to the back of the forearm. This fracture was first described in 1814 by the Irish surgeon and anatomist Abraham Colles.

Smith's fracture

Robert Smith described a similar fracture of the radius in 1847. The cause of this fracture is believed to be exposure of the back of the hand. Smith's fracture is the opposite of Colles' fracture, i.e. the distal fracture is displaced in the direction of the palm.

Classification of fractures of the radius of the hand:

Another classification of radius fractures:

• Intra-articular fracture: A fracture of the radius where the fracture line extends to the wrist joint.
• Extra-articular fracture: A fracture that does not reach the joint surface.
• Open fracture: when the skin is damaged. Skin injuries can involve the bone from the outside (primary open fracture) or involve the bone from the inside (secondary open fracture). These types of fractures require immediate medical attention because of the risk of infection and serious problems with wound and fracture healing.
• fragmentation fracture. When the bone is broken into 3 or more fragments.

The classification of radial fractures is important because each type of fracture requires treatment according to certain standards and tactics. Intramedullary, open, displaced, and radial fractures should not be left untreated, either by closed fracture reduction or surgery. Otherwise, the function of the hand cannot be fully restored.

Sometimes a fracture of the radius is accompanied by a fracture of the adjacent ulna.

ENTRANCE

In recent decades, the interest of medical literature in the diagnosis and treatment of carpal ligament injuries and their consequences has not waned all over the world. In our country and abroad, these issues have been studied [1-6], but they are still valid, which is explained by the occurrence of these injuries in young people with the need for increased functional load on the hand [7] and the fact that there are still difficulties in diagnosing and treating this pathologies.

Diagnostic errors and treatment failures can cause instability of the scapholunate joint and lead to advanced scapholunate collapse (SLAC) [ 4 , 6 , 8 , 9 ] [ 4 , 6 , 8 , 9 ]. According to the literature, damage to this ligament can be associated with distal radius fracture [10-14], navicular bone fracture, and other wrist injuries [8, 15] in 16-40% of cases.

This ligament is C-shaped and belongs to the internal interosseous ligaments of the wrist, which run parallel and stabilize the navicular and semilunar bones [3, 7, 8, 16-21]. During the throwing motion, which begins with wrist extension in radial deviation to wrist flexion in ulnar deviation, minimal stress is placed on the semi-navicular ligament. This specificity of wrist kinematics is taken into account in rehabilitation after navicular-semicircular ligament injuries [7, 22, 23].

The diagnosis of ligament injury is based on physical symptoms, such as pain in the scapholunate compartment, Watson's sign [1, 24] and indirect radiological findings, such as enlargement of the navicular lunate space by more than 2 to 4 mm, an increase in the angle of 60° and the navicular-lunar ring sign [3, 7, 9, 19, 24-27]. However, there is no radiological evidence of ligament damage in the early stages of so-called "pre-dynamic" instability, although ligament rupture can be demonstrated by modern imaging techniques or during surgery. Contrast arthrography of the wrist, proposed more than half a century ago, has been criticized for its low specificity and accuracy [28]. Ultrasound [29, 30], computed tomography (CT) [3, 31] and MRI of the wrist are suggested for visualization of ligament injuries. Many studies have shown the superiority of magnetic resonance arthrography (MRA) with contrast [3, 7, 8, 28, 32-35]. Currently, wrist arthroscopy is recognized worldwide as the gold standard for imaging ligament injuries, as it allows direct examination of the scaphoiliac space and assessment of the extent of ligament damage [7, 9, 21, 24].

Classification

A review of the literature reveals several classifications of scapholunate ligament injuries. WB Geissler and Garcia-Elias et al. The proposed classifications take into account arthroscopic ligament injuries and treatment guidelines. J.C. Messina et al. presented the European Society for Wrist Arthroscopy (EWAS) classification, which is essentially a modification of WB Geissler's classification with a more detailed description of ligament ruptures [7, 9, 13, 21, 24]. R. Luchetti et al. proposed a detailed clinical classification of scapholunate ligament injuries along with recommended treatments. Depending on the degree of expression, they were defined as pre-dynamic, dynamic, static with possible stretching of the scaphoid ligament, and static instability with an irreducible gap [36].

N Morrell et al. (2017) presented an algorithm for the treatment of collateral ligament injuries (Table 1) [24].

Review of available literature and treatment algorithm N. Morrell et al. found that the treatment tactics for scapholunate ligament injuries largely depend on the extent of the injury, the severity of degenerative changes in the joint, and the time since the injury. In a 2017 review, J. Andersson suggested that ligament injuries should be considered fresh or acute within four weeks of injury, and subacute between four and six weeks [13]. Injuries are considered chronic six weeks after the injury [37]. Many authors note that treatment efficiency and prognosis are worse in chronic injuries, stressing the importance of early recovery [38,39].

In our review, we divided the treatment of scapholunate ligament injuries into conservative (table 1.2) and surgical (table 3) methods.

Labels: joint
234567 Start of work (date): 03/02/2021 15:47:00
234567 Created by (ID): 989
234567 Key words: Wrist, Wrist, Ligamentum scapholunate, Trauma.
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treatment complications

Possible complications of conservative treatment include:

• It is not possible to revert to previous loads
• Frequent recurrence of symptoms such as B. inability to throw with full force or full distance, pain when throwing, and loss of ball control, especially if exercise is resumed shortly after the injury
• damage to other structures of the elbow, including the cartilage of the outer part of the elbow; limited hand mobility, ulnar nerve damage, medial epicondylitis and hand flexor tendon strain.
• Damage to the articular cartilage that leads to inflammation of the elbow joint
• Elbow stiffness (limited range of motion)
• Ulnar nerve neuropathy symptoms

Possible complications of surgical treatment include:

Specific complications of surgical treatment of the disease:

• inability to restore normal stability
• There is no return to the previous level of activity
• Ulnar nerve damage
• Irritation of skin area associated with palmar tendon graft removal

prognosis

Ulnar collateral ligament injuries usually do not heal completely with conservative treatments. Returning to sports often requires surgical treatment. It can take three to six months to return to sports after an injury without surgery, and nine to 18 months after surgery.
Rehabilitation (LFC) can increase muscle strength and endurance. Exercises should be chosen in agreement with the LFC doctor.

• Proper warm-up before training or competition
• Keep your hand, forearm and wrist muscles strong.
• Use proper fall and throw protection techniques
• Functional orthotics can effectively prevent injuries, especially re-injuries, in contact sports.

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Causes of forearm bone fractures

• Some sports.
• Active movements that require physical contact and increase the risk of falling: football, gymnastics, skiing, skateboarding, etc.
• bone abnormalities.
• Doctors associate osteoporosis and bone tumors with pathological fractures of the hand, even when no high-energy force is applied to the hand.
• gunshot wounds.
• An open fracture of the forearm resulting from a gunshot wound is a serious injury with a high rate of non-healing and infection.

This article has been reviewed

Symptoms of a forearm fracture

Clinical symptoms depend on the type of injury. In open fractures of the forearm, the skin is torn and bone fragments can protrude from the wound. Along with severe pain and accompanying blood loss, damage to blood vessels leads to post-traumatic shock, which is manifested by pallor, rapid breathing, tachycardia, etc.

In less severe cases, the first symptom of an upper extremity injury is an audible creaking/thumping sound and deformity of the extremity. Typical features include:

• Severe pain that may worsen with movement
• Swelling, bruising/irritation
• skin tension
• inability to move fingers
• Extremity deformity - unnatural bending of the arm or joint

Radial head pain or swelling may be the only physical symptom in a patient with a reduced joint lesion or radial head fracture.

treatment options

conservative method

Conservative treatment– consists in wrapping the injured arm with an immobilizing bandage (standard cast or light plastic bandage). This treatment is used for fractures that do not require surgery. After placing the cast, you should first check whether the shoulder is comfortable, and secondly, 5-7 days after the swelling has subsided, an X-ray should be taken to rule out accidental dislocation.

Surgical treatment

Surgical treatment is performed in case of unstable and displaced fractures, severe intra-articular injuries and multiple fractures. The main method of treatment is reposition (compression of bone fragments). Closed reposition. In closed reduction, bone fragments can be reassembled by the hands of a specialist without surgery - the trauma surgeon compresses the fracture with special movements. Open repositioning. Open repositioning is performed when it is not possible to repair the fracture with another method. During the operation, an incision is made at the site of the injury through which the broken bone is accessed, bone fragments are mobilized, the dislocation is removed and immobilized with a special construction - osteosynthesis.

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• Rich practical experience since 2004.
• He trained in Austria, Germany and Russia.
• He performs arthroscopy, osteosynthesis of limb fractures, deformity correction, joint endoprosthetics and other procedures.
• He is a member of the European Association for Osteosynthesis (AO Foundation), the Union of Traumatologists and Orthopedists of Russia and the Russian Arthroscopy Society.

Frequently asked questions

The length of rehabilitation depends on the severity of the injury: for a non-displaced fracture, full recovery takes about 3-4 weeks. In the case of a medium-severe injury with bone dislocation, rehabilitation lasts 1-3 months.

The fracture is primarily characterized by pain, which is strong and violent when falling, sometimes even a characteristic bang is heard. On the other hand, the pain of a bruise varies in intensity and gradually subsides after a few hours, resulting in relief.

For the treatment of a radius fracture in Moscow, you should contact the Medical Center named after. Elena Malysheva. Experienced doctors will diagnose the problem, determine the presence of complications and prescribe effective treatment. Make an appointment for a consultation.

Symptoms of ACS injury

If the acromion is dislocated, the most characteristic symptoms are pain and limitation of movement. Swelling quickly develops at the site of the injury, and the displaced part rises and retracts a little. There is almost always a specific "wrench" symptom: when you press down on the protruding edge, it swings back when released. Abnormal extension of the arm occurs in the first few hours after the injury.

Unlike a partial injury, a complete rupture of the ligaments of the acromioclavicular joint is accompanied by marked instability of the joint. A massive contusion occurs on the left or right side of the clavicle. The pain is unbearable and leads to immobilization of the upper limb.

diagnosis

Imaging methods are used to determine the type of clavicular joint injury:

In the past, it was considered that a shoulder fracture on X-ray was sufficient to establish the diagnosis. However, in the case of incomplete dislocations, the radiological image does not always reflect the actual condition of the patient. Therefore, MRI is considered the most reliable method of diagnosing ACL injuries. Thanks to this safe and painless imaging method, it is possible to assess the condition of all soft tissues and determine the degree of damage to the intra-articular ligaments, joint capsule and synovial membrane with the greatest accuracy.

Diagnosis of ligament rupture

The correct diagnosis can only be made by a qualified trauma surgeon with experience in the treatment of these types of injuries. The examination usually begins with a conversation in which the fact and nature of the injury play an important role. A clinical trial follows, which always begins with a healthy joint. A number of clinical studies are being conducted that clearly indicate a specific intra-articular injury. In most cases, examinations provide a clear picture of the lesion and a preliminary diagnosis is made. Additional research methods are often used to confirm the diagnosis

• X-ray – always performed to get an image of the joint and rule out bone or traumatic injury. X-rays of a healthy joint are also often recommended;
• MRI - enables the visualization of cross-sections of soft tissues and intra-articular masses in order to determine the type, extent and degree of damage to ligaments, muscles, cartilage, etc.
• ultrasound examination;
• computed tomography;

In difficult situations, when the injury is severe or long-lasting, or when clinical examinations do not give a clear clinical picture, various additional tests can be done to clarify the diagnosis.

What are the symptoms of a sprained shoulder?

The following symptoms appear immediately after a shoulder injury

• Sharp pain at the site of injury;
• Increased discomfort when trying to move the shoulder;
• limitation of hand mobility;
• slight swelling and swelling at the site of the injury.

In addition, body temperature may rise, which may indicate ligament damage and inflammation. If the person does not do anything - does not go to the doctor, continues to actively move the shoulder, the pain will intensify, and the swelling will deepen. All these symptoms may indicate tendonitis - tendonitis. In such a situation, it is urgently necessary to visit the nearest medical facility for specialist treatment.

Rehabilitation after injury

Ligaments in the shoulder can heal very quickly after a sprain. Much depends on the regenerative capacity of the individual, the severity of the injury and whether the patient follows all the recommendations of specialists. Some diseases, such as diabetes, immunodeficiency, thyroid disease, etc., can delay the process of tissue regeneration and reconstruction. During rehabilitation, the body needs a lot of vitamins, proteins and microelements - a proper diet that will satisfy all the body's needs during that period is of great help.

For sprains of the first and second degree, rehabilitation usually does not last longer than 7-10 days. When the ligament is completely torn, recovery takes timelonger - up to six months.

After completing the main treatment, the trauma surgeon will prescribe physical therapy and exercise therapy. The goal of rehabilitation is to restore joint mobility, strengthen ligaments and maintain their flexibility.

In the rehabilitation period after a shoulder injury, physiotherapy is very important: during inactivity, connective tissue fibers are formed instead of damaged elastic tissue. This is scar tissue that cannot stretch the way ligaments normally should. Each training should be gentle, without sudden movements and with a gradual increase in load. Under no circumstances should you train when you are in pain, as this can re-injure the joint ligaments. The first 2-3 times physiotherapy should be carried out under the supervision of a specialist who will monitor the technique in order to avoid unnecessary loads.

After the rehabilitation phase, the person concerned should take some preventive measures to prevent further dislocations. This includes maintaining a healthy weight, regular physical activity and a sensible diet.

Read more:

• Pronator - what does it mean?.
• The pronator is in anatomy.
• Calcaneal displacement fracture.
• supinatori ramena.
• DMS rupture.
• Collateral ligament rupture.
• Rupture of the thigh tendon.
• Rupture of the medial collateral ligament.