Ligaments

As mobile anatomical elements of the joints, ligaments are essentially involved in the musculoskeletal system. Despite good mobility, they must provide stability in certain joint positions. With these complex requirements, corresponding overloads and ruptures are not uncommon.

In principle, any band can tear or exhibit chronic instability. Due to the complex anatomy, this question cannot be answered conclusively. Since certain ligaments have a pronounced exposure to accidents and stress, there are typical ligament problems in the hand. In the skiers thumb, the ligament of the thumb on the ulnar side is torn due to a certain injury. Severe pain and subsequent instability occur. Ligament injuries to finger joints are common in contact sports such as handball, basketball and boxing. Injuries with high energy impact (traffic accidents, falls from great heights) also lead to typical lesions (SL: Scapholunar ligament).

An operation is necessary if the remnants do not stand correctly one to another. With the so-called Stener lesion (severing of the thumb ligament on the ulnar side and concealment under the tendon plate), the ligaments have no contact and cannot heal in the correct position. Then an operation is unavoidable to prevent future instability or even arthrosis. In the case of complex wrist injuries with corresponding rupture of the ligaments, operations are often also indicated to prevent future instability and arthrosis. In the case of ligament injuries to the finger joints, surgical interventions are only necessary in rare cases.

If you have been suspected of having ligament problems as part of an accident or after several accidents, or if a suspected diagnosis has been made, an operation may be necessary. This in turn depends on the affected ligament and the extent of the injury. No general statement can be made here. In certain cases, ultrasound or MRI imaging is necessary to clarify the extent of the injury and provide appropriate therapy recommendations. Under certain circumstances, immobilization by means of specially customized splints may be sufficient for a specified period to bring the ligament into the correct position for healing.

The result again depends on the diagnosis and the therapy. With direct suturing of the ligaments, a good to very good result can be expected after appropriate healing. The pain often lasts relatively long. The long course is explained by the poor blood circulation of the corresponding ligament structures. In the case of special ligament injuries (scapholunate ligament), various surgical techniques are described which reflect the not always satisfactory results after surgery. Individual pre-existing conditions or pre-operations may have a significant influence on the final result.

During the initial consultation we will try to make a diagnosis. Here the conversation regarding the complaints and the examination is decisive. Imaging is used for special questions. Usually by ultrasound or MRI. In each case, a detailed explanation of the planned intervention or conservative therapy is given.

Depending on the diagnosis, the surgical intervention is planned. A simple direct suture of the ligaments in the finger and thumb area can be performed on an outpatient basis with regional anesthesia. In the case of major ligament injuries in the wrist or distal radio-ulnar joint area, inpatient stay are usually indicated due to the size of the injured structures. Sometimes the ligament structures can no longer be sutured directly. In this case, more complex reconstructions are indicated, in which tendon transplants or artificial material can be used as replacements. In any case, we try to keep the procedures as simple as possible so that no additional and unnecessary scarring occurs.

Since every intervention, no matter how small, involves a certain risk of complications, certain measures should be observed. The first few days you will feel normal, timely pain, which can be relieved with painkillers. For larger operations, in-patient stays are possible. Regular wound checks are carried out to ensure safe wound healing. Depending on the anatomical region affected, immobilization may also be necessary. A hand-therapeutic accompaniment to mobilisation may also be indicated. All follow-up treatments have in common the goal of early movements with great safety and freedom from pain. The follow-up treatment is already discussed in the initial consultation so that you can plan the postoperative phase already and any help for everyday life and inability to work can be organized.

Every intervention, however small, involves a certain risk of complications, since an operation in the broadest sense always leads to tissue injuries. A complication does not necessarily occur due to an error. Rather, the human body reacts individually and has certain tendencies to complications. The initial clarifying discussion serves to address such tendencies and to take appropriate precautions.

Risks associated with every surgical intervention

• secondary bleedings
• wound healing disorders
• infections
• excessive scars
• thromboses
• embolisms

Specific risks for ligament injuries depend on the diagnosis and localization of the operation. We will be happy to advise you specifically in the context of surgery clarification.

Do you have the impression that you have a feeling of instability or that a diagnosis such as skiers thumbs or other ligament injuries has already been made?

The skiers thumb is a frequent hand injury. Because of its name, it is also known to people who are often not medically trained. Typical here is the instability of the thumb, which leads to unpleasant pain and poor function when gripping everyday objects such as a PET bottle. In sports injuries, ligament injuries of the hand are typical and are often underestimated at the beginning.  In order to avoid consequential damages, a thorough clarification and diagnosis is unavoidable. We will be happy to advise you within the framework of an initial consultation on referral by your family doctor or directly with us. Please note whether you are in an HMO or other family doctor model and inform your family doctor.  During the initial consultation, we will work out the diagnosis together and, if necessary, take the first therapeutic steps. An operation will always take place later and should be well weighed.

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