Capsule tear

introduction

Each joint is surrounded by a joint capsule. Above all during sport, incorrect movements, falls or knocks on a joint can lead to capsular rupture. Fingers and toes are particularly affected, but the knee and ankle joint often tear as well.

General information on the capsule tear

Each joint is completely enclosed by a joint capsule, which consists of an inner and an outer layer. The inner layer, the synovial membrane, connects directly to the articular cartilage and produces the synovial fluid that fills the joint cavity. The outer layer of the joint capsule consists of tight, collagenous connective tissue and is attached to the bone.

The thickness and strength of the outer layer varies depending on the joint. The joint capsule is additionally reinforced and stabilized by ligaments made from tight, collagenous connective tissue. Depending on the joint, the number and strength of these so-called guide bands are different. The guide ligaments are partially fused with the joint capsule. A capsule tear is an injury to the joint capsule by tearing the connective tissue that makes up the capsule. Often times, not only is the joint capsule injured in a capsule tear, but in many cases the guide ligaments are injured and the affected joint is sprained or dislocated.

Symptoms of a ruptured capsule

A capsule tear is very painful because the joint capsule is equipped with a large number of pain receptors. The stabbing pain sets in immediately after the injury, and over time there is increasing swelling of the affected joint and the surrounding areas. Since smaller blood vessels can also tear when the capsule is torn, bruises are not uncommon after an injury to the capsule-ligament apparatus.

After a capsule rupture, the function of the affected joint is significantly restricted in many cases: On the one hand, the pain prevents the joint from being able to use the normal range of motion.On the other hand, when the capsule ruptures, structures of the joint that are necessary for movement and that no longer function properly due to the injury may have been injured.

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How is a capsule tear treated?

In many cases, the treatment of a ruptured capsule is initially carried out with conservative methods. Treatment of a ruptured capsule should be done according to the PECH scheme.

• "P" stands for pause: The joint should be immobilized for some time, affected patients should relieve the joint, protect it from excessive strain and take a break from training.
• "E" stands for ice: cooling the injured joint accelerates the process of swelling and relieves the pain.
• "C" stands for compression: the affected joint should be bandaged with elastic bandages or special joint bandages. The bandage stabilizes the joint without completely restricting its movement.
• "H" stands for elevation: Elevating the affected extremity supports the swelling and thus the pain relief.

Of course, pain relievers can also be used to relieve pain. Physiotherapeutic treatment can be useful in some cases to maintain the mobility of the joint or to accelerate the breakdown of severe bruises.

Surgical treatment of the capsule rupture should be considered in the event of severe capsule injuries and osseous involvement. During the operation, depending on the type of damage, the torn parts of the capsule are sutured or reattached to the bone.

Finger splint when the capsule ruptures

A capsule tear on the fingers is not uncommon and can be treated with a finger splint in the later healing process in addition to acute therapeutic measures such as protection, cooling and compression.

The finger splint should generally only be used when the finger swelling has receded slightly. However, the swelling often lasts for a long time, especially on the finger.

A finger splint can therefore be worn even if the finger is still slightly swollen. However, it is important to carry out adequate compression therapy to reduce the swelling. To relieve and at the same time to stabilize flexion and extension vision, which have been affected by a capsular tear, a so-called "squeeze splint" can also be helpful. With the fingers in particular, it is very important that they can be fully stretched again after the capsule has ruptured. This is usually the case after consistently wearing a brace. Otherwise the tendons can shorten as a result of the healing process of the capsule tissue, which forms a scar, so that complete stretching is no longer possible.

Further information also under our topic: Capsule tear on the finger

Thumb splint / thumb orthosis in the event of a capsule tear

As with your fingers, wearing a thumb splint can be helpful after a capsule tear. After the swelling has subsided, the thumb splint can take on a stabilizing function and positively influence the healing process of the capsular tear.

The Quengel splint is not only used for the fingers but also for complex capsule tears in the thumb. As soon as the flexion and extension vision have been injured, such a whine splint is important in order to ultimately achieve the ability to flex and extend the joints in the thumb as they did before the capsular tear.

In addition to the thumb splint that is typical for a capsule tear, there are also variations such as a thumb bandage or a thumb orthosis. These differ somewhat in their structure from the thumb splint.

Please also read the article:

• Capsule tear on the thumb
  and
• Thumb brace

Taping when the capsule ruptures

The technique of taping has been enjoying increasing popularity for several years and is used in various areas, especially sports medicine, but also orthopedics. Various mechanisms of action are ascribed to taping. Among other things, the applied tape is supposed to transfer forces acting on the joint to the skin and thereby relieve the structures of the joint.

However, an actual proof of effectiveness based on large-scale studies has not yet been provided. Nonetheless, various taping techniques also exist for the treatment of torn capsules. However, it should be emphasized here that the healing of capsular tears takes patience so that it can take place without permanent damage and movement restrictions of the joint. Taping is a good supportive method, especially after the injury has healed, to give the joint additional stability. In any case, it is not able to accelerate the healing process or to replace the adequate immobilization of the joint.

Read more about this under Kinesio tape

How long does a capsule tear last?

The healing process after a capsule tear can take different lengths of time. It is from a few days to several months, depending on where the affected person has torn the capsule and how much the surrounding tendons and ligaments are affected.

A slight tear in the capsule can only last a week until the affected person can move the joint freely and without pain. As a rule, however, you have to be more patient and expect a period of several weeks to months. Approximately 6 weeks are a guideline until complete healing, so that the corresponding joint is neither swollen nor painful and is fully resilient and mobile again.

The duration can of course vary individually and depends, among other things, on the patient's patience and how consistently they adhere to the therapeutic measures of rest and rest. Unfortunately, some still complain of pain in the once torn capsule even after 8 weeks.

Regular exercise under physiotherapeutic supervision can have a positive effect on the healing process. Physiotherapy performs controlled and targeted movements in the area of ​​the capsular tear. It is generally important that independent stress should only take place again when the capsule is completely painless and there is no feeling of restricted movement or blockage.

What is the prognosis for a capsular tear?

It takes several weeks for a capsule to heal. But even after six to eight weeks, the joint can still be painful. It is important that after the healing process is complete, one slowly begins to stress the joint and does not immediately strive for full stress.

Unfortunately, a capsule rupture can increase the risk of developing osteoarthritis.

Localization of the capsular tear

Capsule tear on the shoulder

A capsular tear of the shoulder occurs mainly in the context of a shoulder dislocation, the "Jumping out“The shoulder in front. Shoulder dislocation primarily affects younger, physically active patients and middle-aged patients with weak muscles that stabilize the shoulder joint (rotator cuff).

In 95% of cases, the head of the humerus jumps forward out of the shoulder joint when the shoulder is dislocated. When the humerus pops out of the actual joint socket, the capsule of the shoulder joint is overstretched, and the capsule can tear due to the increased tensile load.

A common complication of shoulder dislocation is Bankart's lesion. In the Bankart lesion, the glenoid labrum, the acetabular lip (a cartilaginous part of the shoulder joint) of the shoulder joint, along with the joint capsule, tears away from the shoulder blade. Due to the resulting capsular tear, the joint capsule is now unstable in the anterior direction, which encourages renewed shoulder dislocations. The Bankart lesion is also known as the capsule-labrum lesion and is treated surgically after several shoulder dislocations. The torn labrum is reattached to the shoulder blade, the torn and flaccid capsule is tightened with sutures or shortened using heat or laser.

At this point you can also read our main page: Capsule tear in the shoulder

Capsule tear on the hand

Capsular tears in the hand are typically the result of sports injuries in which the joints are overstretched. Volleyball and handball players represent classic patient groups here. Capsular tears in the finger joints are also common in skiing. As with differently localized capsular tears, the capsular tear of the hand manifests itself as a strong, stabbing pain over the affected joint. Later the pain takes on a rather dull, pulsating character. In addition, the leaking synovial fluid causes the affected joint to swell. A bruise is also common (Hematoma) visible, which is caused by the injury to small blood vessels.

In terms of diagnosis and treatment, tears in the capsules on the hands are similar to those in other joints. A diagnosis is often difficult because injuries to other structures of the joint, such as the ligaments, show up through comparable symptoms. X-rays are of little use here, whereas ultrasound examinations in particular, but also MRI images, can provide information about the type of injury.

The acute therapy for a ruptured capsule of the hand is based on the so-called PECH rule. This acronym is made up of the words pause (i.e. to protect the joint), ice (cooling to relieve pain and swelling), compression (also against swelling) and elevation (to reduce blood flow). Applied immediately, these measures can alleviate the acute symptoms and help heal the injury. In addition, the joint should be immobilized by a doctor, as early movement can cause permanent damage to the joint apparatus. Movement training under physiotherapeutic guidance may also be prescribed. It takes at least six weeks for a capsule to heal properly. During this time, the healing process can only be slightly influenced by decongestant medication, targeted movement exercises and cooling the joint. Nonetheless, the injury may result in permanently restricted mobility of the joint.

Capsule tear on the finger

The fingers are at risk of tearing the capsule, especially in ball sports such as volleyball or handball. A capsule rupture can result from overstretching due to excessive or too long stress or from forcibly overstretching a finger joint due to the impact of a ball, in which a finger is bent in the wrong direction. But even in the case of unfortunate falls on the hands, the joint capsule can tear due to excessive force.

Capsular tears in the finger joints lead to painful swellings due to the leakage of synovial fluid into the surrounding tissue and to bruises due to the rupture of small blood vessels in the affected joint.

Misalignments are also possible: a lateral kinking of the finger often leads to a tear in the outer ligament of the capsule and thus to instability of the finger joint in the lateral plane. If the capsule is completely ruptured when the capsule ruptures, dislocations of the finger joint are common.

The painful swelling significantly limits the mobility of the finger. The doctor makes the diagnosis by carefully palpating the finger and examining the mobility of the finger. A supplementary ultrasound examination of the finger is useful in order to show the ligament structures of the capsule if scanning cannot provide clarity about the degree of injury to the ligaments. An x-ray may be needed to rule out additional bony injuries.

The treatment of an uncomplicated rupture of the capsule on the finger involves cooling, immobilization for two to three weeks and the use of painkillers for severe pain. The healing can be supported by physiotherapeutic measures. It takes at least six weeks for the healing process to fully complete. If the examination reveals bony involvement, surgery may be necessary to repair the bony injury.

Even after a torn capsule has healed, the joint capsule can remain thickened and permanently restrict the mobility of the finger. The use of a squeeze splint is a way to stretch a shortened joint capsule after a capsule rupture and to maintain mobility. As a long-term consequence of a capsule rupture, osteoarthritis can occur in the affected joint.

Read more on the topic: Capsule tear on the finger

Capsule tear on the elbow

Capsular tears in themselves represent classic sports injuries. This is also the case with capsular tears of the elbow, which is usually associated with a dislocation of the elbow joint. In addition, however, it is often the result of falls or other forms of violence. Apart from that, ruptures of the elbow joint capsule are similar to other joint capsule tears in terms of symptoms, diagnosis, and treatment.

Read more about this under Elbow dislocation

Immediately after the injury, the rupture becomes noticeable in the form of an intense, stabbing pain, which later takes on a dull, pulsating character.

The leakage of synovial fluid causes the joint to swell. A bruise often forms as well. In order to achieve pain relief and to prevent excessive swelling of the elbow, the so-called PECH rule should be followed in acute treatment of the capsular tear.

This acronym is made up of the words pause (protecting the joint), ice (cooling to relieve pain and swelling), compression (also against swelling) and elevation (to reduce blood flow).

Further therapy of the capsular rupture, after possibly necessary repositioning of the joint surfaces, is based primarily on the competent immobilization of the joint, since early movement of the joint can lead to permanent damage to the joint apparatus.

It will still take at least six weeks for the injury to heal completely. In the meantime, the healing process can be promoted primarily through exercises guided by physiotherapy, cooling the joint and possibly also taking decongestant medication.

Nevertheless, in some cases, the injury results in permanently restricted mobility of the elbow joint.

Capsule tear on the thumb

Capsular tears in the thumb joints are often the result of excessive overstretching of the respective joint due to external forces. This is the case, for example, when falling on the outstretched thumb or when a ball hits the thumb unfavorably. A lateral kink of the thumb can also tear the capsule. This often happens when getting stuck in the loop of a ski pole, which is why the subsequent injury, including a collateral ligament and capsule tear, is also referred to as the "ski thumb".

As with other capsular tears, the first thing to do in the acute situation is to cool and rest the thumb. Once the diagnosis of the capsular tear is made, the joint will be immobilized for the next few weeks. Provided the tendons of the thumb muscles remain uninjured, in most cases there is no permanent restriction of movement after the injury has healed completely.

Please also read the article: Capsule tear on the thumb

Capsule tear on the knee

The knee is particularly stressed in running and jumping-intensive sports. Sudden extreme movements, such as falling or playing a ball incorrectly while playing football, can tear the capsule in the knee joint.

At the moment of the injury, there is an acute, stabbing pain, which over time turns into a dull, pressing pain due to the leakage of synovial fluid and the resulting swelling. Either the capsule is affected as part of a ligament injury or there is only a tear in the capsule in the knee joint. The doctor can make a simple distinction through an ultrasound examination. Bony involvement can be ruled out on x-rays; more complicated injuries should be examined and assessed using an MRI of the knee.
With an MRI of the knee, the ligaments that cannot be seen in the X-ray image, for example, can be shown particularly well. Even with ultrasound, it is difficult to differentiate between partial cracks and cracks in the capsule. This is why the MRI of the knee is usually the most valuable diagnostic tool for a capsule rupture.

Read more on this topic at: MRI of the knee

Therapy for a torn capsule in the knee joint is no different from treating a torn capsule in other joints: cooling, resting, elevating and taking painkillers. Capsular tears in the knee joint have a very favorable prognosis if the knee is sufficiently spared and only stressed again when the capsular tear has healed. If the knee joint is loaded too early, chronic instability of the knee joint can result or knee osteoarthritis can develop.

Capsule tear at the ankle

The ankle ligament injury is the most common ligament injury; runners, handball players, tennis, volleyball and basketball players are particularly affected. But the capsular tear in the ankle is also common; it is almost always associated with a torn or stretched ligament. The outer ligaments (outer ligaments of the foot) belong to the joint capsule, the ligaments tear when twisting, so you have not only torn a ligament, but also torn a capsule. The trigger for a tear in the outer ligament of the ankle is a so-called supination trauma, known as an outward twist.

Immediately after the injury, the patient complains of severe pain and the joint swells significantly. The tender swelling can reach from the end of the lower leg to the middle of the foot and be accompanied by bruises.

During the examination, the doctor checks the stability of the ligaments through various functional tests on the ankle. An x-ray is taken to rule out bony injuries such as an external malleolus fracture. If so-called held recordings are made, a torn ligament can be confirmed or excluded. A torn ligament of the anterior fibulotalar ligament is assumed if the distance between the talus and the lower leg is 5mm more on the affected side than on the healthy side. After a severe supination trauma, it may be necessary to take an MRI image in order to better assess the joint surfaces.

The treatment of a torn capsule ligament on the ankle is mainly conservative by immobilizing the joint using a splint. The splint can be put on once the swelling has subsided. It prevents the ankle from twisting again and restricts the mobility of the ankle up and down. The patients are then given physiotherapy in order to prevent them from twisting again with a rupture of the capsule and ligament by strengthening the muscles and tendons.

However, a fifth of patients complain of symptoms even after conservative therapy has been completed. There is pain after heavy exercise, which is caused by cartilage damage as part of the first injury. Other patients experience a sense of instability in the ankle. The consequence of a capsule ligament rupture in the ankle joint is chronic instability in the upper ankle joint in 10% of cases. The affected patients often bend over, but the pain decreases with each event. Chronic instability in the upper ankle joint is treated by wearing an elastic bandage, by physiotherapy or by attaching a raised shoe outer edge, either with insoles or with specially made shoes. If these measures are unsuccessful, an operation can be performed to reconstruct or replace the capsule and ligament apparatus.

You can find a lot more information under our topic: Capsule tear at the ankle

What are the causes of a capsule rupture?

A capsule tear is a common sports injury caused by incorrect movements or tensile stress on the joint capsule. When a joint is sprained or dislocated, strong tensile forces act on the tendons and the joint capsule, for example due to the uncontrolled impact of a ball on a finger in volleyball. Even a fall can cause the joint capsule to tear under unfavorable conditions.

The stronger the force acting on the capsule-band apparatus, the more serious the damage. The capsule tear represents the most serious damage to the joint capsule: the connective tissue structures of the capsule are destroyed by the strong tensile force when the capsule tear, the wound healing can then only proceed with scarring.

A lighter form of injury is straining the capsule, which causes long-term discomfort but no structural damage.

The mildest form of capsule ligament injury is overstretching, which only causes short-term discomfort and also heals without permanent damage.

How is a capsule tear diagnosed?

examination

Just by taking a detailed anamnesis, the doctor can collect important information that speaks for or against a capsule tear. The affected joint should be examined carefully and the range of motion compared with the unaffected side.

roentgen

If the physical examination cannot safely rule out bony involvement, an X-ray is taken, in which, for example, the tear of a piece of bone can be determined.

Ultrasonic

An ultrasound scan can also help to assess how badly the capsule and ligaments are injured.

MRI

Magnetic resonance imaging (MRI) is used in some cases, especially when the damage to the soft tissue structures cannot be reliably assessed by the physical examination and the X-ray image.

How can I prevent capsule rupture?

A good warm-up before exercising will reduce the risk of breaking your capsule. The load should be increased slowly while warming up in order to prevent cracks in the joint capsule during the actual training through improved mobility.