Torn capsule on the elbow - this is how it is treated
introduction
If the capsule ruptures, the capsule that surrounds the joint is ruptured primarily through external forces, but also due to other causes.
All functional parts of every joint in the body are surrounded by joint capsules.
The capsule consists of an often very robust, pressure and tensile strength outer shell, as well as an inner so-called "synovial membrane".
Inside the capsule are the bony parts of the joint, the articular cartilage, individual ligaments and a synovial fluid.
This serves the purpose of filling the joint cavity, supplying the cartilage with nutrients, lubricating the joint surfaces and making movements in the joint smoother.
A capsule tear can be associated with numerous accompanying injuries and symptoms and cause severe pain.
Injury to the joint capsule in the elbow severely restricts the function of the joint.
Secondary illnesses can also result from the injury.
How do you treat a ruptured capsule on the elbow?
Treatment of the torn capsule is initially based on 4 acute measures that should be applied within 48 hours after the injury.
These are strict protection, compression of the joint from the outside, adequate cooling, as well as elevating the arm.
Many also know this application under the name PECH rule:
BREAK
ICE
Compression
Elevate
These measures reduce the blood flow to the joint and thus the extent of the effusion and swelling.
In addition, painkillers from the NSAID group are often used.
Their most important representatives are "Diclofenac" and "Ibuprofen".
An operation only has a therapeutic advantage in the case of severe injuries involving the bone.
A particularly severe bruise can be relieved with a short puncture through a needle.
However, this is rather rare with injuries to the elbow.
How does a splint help?
The joint can be immobilized using a splint.
In the acute phase of the capsule rupture as well as in the following weeks of healing, the protection of the joint is the most important therapeutic factor.
This can significantly reduce consequential damage, misalignment and pain.
In addition to immobilization, the splint can also apply compression to the joint.
The splint should be worn until the pain has subsided and the joint capsule has healed sufficiently.
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How does a bandage help?
A bandage can also support the healing process by immobilizing and compressing the elbow joint.
In contrast to the splint, however, the bandage does not completely immobilize the joint.
The bandage is particularly useful in the following weeks of healing and rehabilitation, as it allows little movement in the joint and is easy to change and clean.
Joint bandages can also be used preventively in sports to prevent and dampen rapid movements and external violence.
When do you need an operation?
As a rule, surgery is not necessary if the elbow capsular tears.
However, if particularly severe injuries to the capsule and bone involvement occur, an operation should be performed.
Since the capsule is firmly anchored to the bone, strong tensile loads on the capsule structures can lead to minor fractures of the protruding bones of the humerus and forearm.
This can lead to instability of the joint and muscles, so that the bone has to be treated and fixed surgically.
In the case of particularly severe injuries to the capsule, surgical therapy can bring benefits for the duration of the healing process.
Length of incapacity for work
The incapacity for work can be issued by the doctor depending on the individual case.
The extent of the injury and the symptoms must be taken into account.
As a rule, the incapacity to work is initially issued for 1-2 weeks.
During this period, most of the symptoms will subside.
If the complaints persist, the inability to work can be extended to up to 6 weeks.
Office work can usually be started earlier than physical work.
It is important that when you return to work there are no more restrictions or pain and that the activity does not delay the further healing process.
Duration of healing for a capsule tear in the elbow
The time it takes to heal can vary widely and depends on the extent of the injury.
A capsule tear can be limited to a small tear of a few millimeters or include severe capsule damage and bony involvement. Minimal cracks in the capsule can be almost symptom-free or heal within a few days.
A pronounced rupture of the joint capsule can, however, take a few weeks to heal and also cause pain and impairment of joint function.
Serious injuries can take up to 8 weeks to heal.
Surgical therapy can shorten the healing time for severe injuries.
In any case, the duration is shortened by consistent physiotherapy.
What can the long-term consequences be?
The treatment sequence must be strictly adhered to in the healing phase of the capsular tear on the elbow.
At the beginning, there should be no strain on the elbow, otherwise the acute injury may worsen.
After a few weeks, light physiotherapy must begin to restore movement, build up the muscles, but not yet put too much strain on the joint.
If the therapy is carried out incorrectly or does not have the desired effect, a capsule rupture can lead to serious long-term consequences.
In many cases, limited movement of the elbow joint persists even after a long time.
Restricted degrees of movement, as well as pain when the arm is bent or extended, can be a long-term consequence.
A dreaded complication of the capsular rupture is osteoarthritis of the elbow.
As a result of the injury, the articular cartilage can wear out over years and decades.
This is often associated with pain and functional restrictions in the joint.
What are the causes?
In most cases, the cause of the capsule rupture is an act of force majeure.
This not only means bruises and blows, but also tensile and compressive loads on the elbow joint.
These can arise in sport but also in everyday life, and less often from falls.
The capsule is taut and connective tissue as well as muscularly robust, but it is also under great tension.
If there is sufficient force, the tear can quickly enlarge and expand on its own due to the tension in the connective tissue structures.
In addition to the force exerted on the elbow capsule, weak connective tissue or previous damage can also be involved in the capsule tear.
Connective tissue weaknesses can have many causes and be caused by long periods of inactivity, previous illnesses or even hereditary.
If you suffer from weak connective tissue, then read in our article how you can strengthen it: Strengthen connective tissue - These tips will help
Concomitant symptoms
The capsule tear on the elbow is a very painful affair in most cases.
Both in the acute phase and in the following weeks of lengthy rehabilitation, the focus is on intense, sharp pain.
This also leads to a restriction in the function of the elbow joint, which in some cases can persist for a longer period of time.
After the capsule ruptures, joint fluid escapes and minor bleeding leads to joint swelling.
Overheating and redness can also be seen from the outside.
After a few days, these develop into blue, green and yellowish hematomas.
It is not uncommon for elbow dislocation to be an accompanying symptom of the capsular tear.
Due to the force applied during the injury, the bones involved in the elbow joint are dislocated, which leads to malpositions and a severely restricted function of the joint.
Pain in the elbow
Pain is the leading symptom of the ruptured capsule on the elbow.
As soon as the injury occurs, there is severe, stabbing pain.
Many pain-sensitive structures are involved in a capsular tear.
This affects the bones and joint surfaces themselves on the one hand, but also the sensitive capsule structures, muscles, ligaments and surrounding vascular and nerve tracts on the other.
Often there are also minor ruptures in the blood vessels, which in turn causes pain.
The pain can take on a throbbing and dull character.
Due to the swelling, it can persist during the entire healing phase of the joint capsule and also persist beyond that.
Secondary diseases can still cause chronic pain for a long time after a capsule rupture.
You can read how you can explicitly treat pain in the elbow in our article: Elbow Pain - What Can You Do About It?
Swelling
The swelling occurs within a few minutes and hours after the injury and can persist for weeks.
The swelling is the leakage of synovial fluid and small bruises.
When the capsule ruptures, it almost always injures the smaller blood vessels that cause the hematoma.
The swelling can increase the pain enormously and severely restrict movement in the elbow.
The healing time also depends on the extent of the swelling and can be significantly extended by the swelling.
The most important immediate measures to reduce the swelling are compression, cooling and elevation of the elbow.
If there is a lot of blood in the joint, a puncture may also be used therapeutically.
Large parts of the bruise can be suctioned off with a needle.
That's the diagnosis
In many cases, the diagnosis does not require any complex and technical investigations.
Inquiring about the cause of the accident and a physical examination are often enough to make the diagnosis.
During the physical examination, the affected side should be compared to the opposite side, particularly with regard to swelling, redness and mobility.
An X-ray examination or an MRI image can be made to reliably differentiate capsule strains from capsule tears or other injuries to the joint.
Bony involvement can be optimally recognized in the X-ray examination.
The MRI image, on the other hand, shows the soft tissue defects of the muscles, the capsule and the fluid accumulation in the joint.
MRI of the elbow
With magnetic resonance tomography, soft tissue in particular can be identified with high resolution.
Particularly in the case of a capsule rupture, this examination can detect the defects of the connective tissue, effusions on and in the joint, as well as injuries to the ligaments and muscles.
The MRI examination takes about 20-40 minutes and costs more than other radiological procedures.
The advantage, however, is that special tissues can be displayed with significantly higher resolution and the examination does not result in any radiation exposure for the patient.
You can find a lot more information under our topic: MRI of the elbow
