An Overview of Ligament Tears

A ligament is a tough band of fibrous tissue that connects bone to bone or bone to cartilage. While ligaments are extremely strong, they can be stretched or even torn, resulting in different grades of sprains. A ligament tear usually occurs due to extreme force to a joint such as with a fall or another high-impact event. Common ligament tears are to the ankle, knee, wrist, thumb, neck, or back ligaments.

A ligament tear is painful and tender to the touch. You may see swelling and bruising. It may be difficult to move the joint. In the case of some ligaments, you may hear a pop or feel tearing at the time of the injury. You may also experience muscle spasms.

Ligaments support and strengthen joints. Their main function is to keep the bones of the skeleton in proper alignment and prevent abnormal movements of the joints. This will be impaired when a ligament is torn, resulting in looseness in the joint or being unable to move the joint normally.

Forcing a joint out of its normal position can result in a ligament tear. This can occur in a fall, sudden twisting, or a blow to the body.

Injuries to a ligament are especially common during athletic activity, as joints are consistently in action and under a lot of stress. Ligaments in the ankle, knee, and wrist are commonly affected:

• Ankle: Ligament tears are most common for the lateral ligament complex, which include the anterior talofibular (ATFL), the calcaneofibular (CFL), and posterior talofibular (PTFL) ligaments. The medial deltoid ligament is injured less often. A high ankle sprain is less common in everyday life but can be seen in competitive athletes. It involves the distal tibiofibular syndesmotic ligaments.
• Knee: The four major knee ligaments are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). The ACL is the most common ligament to be injured.
• Wrist: There are 20 ligaments in the wrist and tears most often occur in falling on an outstretched hand. The scapholunate ligament and the triangular fibrocartilage complex (TFCC) are the most common ones injured.

Other common sites of ligament tears and the possible causes behind them include:

• Thumb: The ulnar collateral ligament can be torn when skiing (the injury is often called skier's thumb) or in a fall when the thumb is bent in an extreme position.
• Neck: The ligaments of the neck can be torn during whiplash injuries when sudden acceleration and deceleration cause extreme movement of the cervical spine. The ligament tear is just one part of a whiplash injury, which may also damage muscles, nerves, and bones.
• Back: The ligaments in the back can be torn by lifting something that is too heavy.

The diagnosis of a ligament tear begins with a physical examination and medical history. Your healthcare provider will ask what you were doing when you experienced the injury and examine the site. Palpating the site and moving the joint can give them information on the extent of the injury.

The next step is often to perform an X-ray to look for fractured or broken bones. Magnetic resonance imaging (MRI) may be done to determine whether there is a partial or complete ligament tear.

Sprains are graded, with criteria including the extent of tearing of the ligament.

• Grade 1: This is a mild sprain that damages the ligament but does not cause significant tearing.
• Grade 2: This is a moderate sprain that includes a partial tear of the ligament. As a result, the joint may show abnormal looseness.
• Grade 3: This is a severe sprain with a complete tear of the ligament. It results in instability of the joint and loss of use.

Rest, ice, compression, and elevation (R.I.C.E.) is the initial treatment protocol for a ligament injury.

• Rest: Once injured, further activity that stresses the injured area must be stopped until the injury is allowed to recover over a period of time.
• Ice: Cold contact provides short-term pain relief to an injured area and works to limit swelling.
• Compression: Compression (e.g., wrapping the injured area with an elastic bandage) helps reduce and limit overall swelling. It also occasionally works to ease pain.
• Elevation: This helps control blood flow to the area and, thus, reduce swelling. This is most effective when the injured area is raised above heart level.

Your healthcare provider may recommend an over-the-counter medication (such as ibuprofen) or a prescription medication for pain and swelling as well.

If a sprain is grade 2, it may need bracing to allow for the healing of the partial ligament tear. The location and extent of the injury will determine how long a brace is needed.

A grade 3 sprain involving a complete tear may require surgery to repair the ligament.

Once the pain and swelling have subsided, your healthcare provider may recommend physical therapy or home exercises to help restore the function of the ligament and joint. The recovery time can be a few weeks or up to a year, depending on the severity of the ligament tear.