Rupture: causes, symptoms, diagnosis, treatment

Rupture (rupture) is a violation of the anatomical integrity of tissues caused by a force exceeding their elastic capabilities. Ruptures are mechanical injuries to soft tissues and internal organs with a violation of their anatomical integrity. They occur when a force exceeds the extensibility of the tissue is applied. Ruptures are possible: subcutaneous tissue, nerves, vessels, muscles, tendons, joint ligaments, hollow and parenchymatous organs. The clinical picture is different in each case.

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What causes the rupture?

The cause and mechanism of injury are similar to those of stretching: a pull that exceeds the physiological elasticity of the tissues.

Symptoms of a rupture

The victim complains of pain at the site of injury, limited functionality, and tries to protect the injured area.

Ruptures of the subcutaneous fat tissue are manifested by the development of bruising and subcutaneous hematoma.

Ruptures of the fascia (usually of the thigh) are determined by palpation as a slit-like defect. When the muscles are tense, an elastic, slightly painful formation (muscle hernia) is palpated through the fascia defect, which disappears when the muscles relax.

Muscle ruptures are: complete or partial (tears); located either in the muscle belly area or, more often, at the transition point of the muscle into the tendon. The most frequently damaged muscles are: biceps, calf muscles of the lower leg, less often - the bellies of the quadriceps of the thigh. Ruptures of other muscles are extremely rare.

At the moment of rupture, there is a sharp pain, often a clicking sensation, after which a dysfunction of the limb develops with loss of action of the damaged muscle. The belly of the muscle contracts towards the undamaged tendon (in case of rupture in the belly area - towards the abductor and adductor side of the tendons). In this case, a defect in the location of the muscle is determined by palpation, and its spasmodic areas are palpated as elastic and painful ridges. The diagnosis of a partial muscle rupture is made only on the basis of assumptions: the nature of the injury (at the moment of muscle tension); pain that intensifies upon palpation of the muscle; pain upon palpation of the abductor and adductor tendons; the presence of edema and bruising, dysfunction of the muscle.

Tendon ruptures - most often Achilles, heads of the quadriceps; thigh muscle and biceps brachii - are accompanied by: loss of muscle function, hyperfunction of the antagonist muscle, faulty position of this segment, displacement of the belly of the muscle towards the undamaged tendon. Treatment, as with muscle ruptures, is surgical and should be carried out as early as possible due to cicatricial changes in the muscle itself and fraying of the tendon ends, which can determine the ineffectiveness of surgical plastic surgery.

Ruptures of joints (symphyses) - the most frequently observed are ruptures of the pubic and acromioclavicular joints.

Acromioclavicular joint ruptures are also defined as dislocations of the acromial end of the clavicle: complete and incomplete. Occurs when the acromial process of the scapula is hit or when falling on the adducted shoulder. When examining while standing, a protrusion of the end of the clavicle is detected; when pressing from above, a "key" symptom is determined - the clavicle springs under the hand. The diagnosis is confirmed radiologically, but the images are taken while standing, since in a lying position the displacement can be eliminated.

Ruptures or tears of the pubic symphysis are quite rare and are more often a complication of childbirth of a large fetus with a clinically narrow pelvis, very rarely occur with pelvic fractures. Pain in the pubic symphysis area, inability to raise straight legs (symptom of "stuck heel"), inability to turn on the side. Palpation reveals pain in the pubic symphysis area, divergence of the pubic bones by more than 1 cm, their mobility. The diagnosis is confirmed radiologically.

Nerve ruptures - usually accompany bone fractures. In this case, the function of the innervated area and sensitivity are lost. Together with the traumatologist, a neurosurgeon is urgently called. To clarify the diagnosis, electromyography can be additionally performed.

Ruptures of large vessels - often accompany bone fractures, but can also form with contusion trauma, manifested by the formation of a tense hematoma, the absence of pulsation in the peripheral arteries, sometimes pulsation and systolic noise can be determined over the hematoma. Given the development of anemia and gangrene of the limb, the patient is urgently sent to traumatology even in questionable cases where angiography is impossible.

Ruptures of internal organs have a rather vivid clinical picture: ruptures of the liver, gall bladder, pancreas, urinary bladder, stomach and intestines give a picture of peritonitis; rupture of the spleen gives a picture of hemoperitoneum; ruptures of the lung and bronchi are manifested by hemopneumothorax; with a rupture of the diaphragm, along with hemoperitoneum, a diaphragmatic hernia is formed; with a rupture of the kidney and ureter, paranephritis develops.

Diagnosis of rupture

The anamnesis includes an injury similar in mechanism to a sprain.

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Inspection and physical examination

In addition to the signs typical of a sprain, when a tear occurs, symptoms specific to this injury appear:

• extensive hemorrhage into soft tissues, extending far beyond the area of damage;
• pathological increase in the range of motion in the joint;
• a sharp impairment of limb function, such as loss of support (stability) in the knee joint.

If a muscle is torn, when it contracts, a protrusion of the belly of the muscle stump is detected.

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Laboratory and instrumental studies

X-rays do not reveal bone pathologies.

Differential diagnosis

A rupture must be radiologically differentiated from a fracture.

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Treatment of rupture

Treatment of rupture can be conservative and surgical.

Conservative treatment

Conservative treatment is used more often for incomplete ruptures of ligaments and muscles (less often - tendons) and in the early stages - no later than 3-5 days after the injury. Circular plaster immobilization is used with fixation of one or two adjacent joints in a position of maximum relaxation of the injured ligaments and tendons for a period of 3-6 weeks. For this purpose, the limb is given a state of hypercorrection - maximum deviation towards the damaged tissues. For example, when stretching the internal lateral ligament of the knee joint, the lower leg is placed in the adduction position (cms varus), when the Achilles tendon is damaged, the limb is bent at the knee and ankle joints up to 150 ° (pes equinus) in order to maximize relaxation of the triceps surae muscle. The injured limb is given an elevated position on a pillow. From the 3rd-4th day, UHF is prescribed (6-8 procedures) through a plaster cast. After immobilization, massage, exercise therapy, warm pine baths, rhythmic galvanization of the affected muscles, electrophonophoresis of procaine and multivitamins to the damaged area are indicated.

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Surgical treatment

The most reliable method of repairing ruptures is considered to be surgical. In the early stages, it is necessary to suture the ruptured formations; in later stages, various types of plastic interventions are used.