ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. S33S83S93T03S13ArtikelübersichtDistorsion
- Causes and risk factors
- Examinations and diagnosis
- Disease course and prognosis
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.To the table of contents
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.To the table of contents
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 "buckling", 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.To the table of contents
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.