First aid for ligament sprains

Pre-hospital stage and first aid

Providing first aid begins directly at the scene of the injury. The main principle of the pre-hospital stage is ensuring complete rest for the injured area.

• Transport immobilization: The lower limb must be rigidly fixed using standard transport splints. The leg must be in a strictly extended position. A critically important rule: mandatory fixation of the foot. Without meeting this condition, immobilization is considered inadequate.
• Pain management: Local administration of any anesthetics in non-sterile conditions is strictly contraindicated due to the high risk of tissue infection. Practice shows that correct and adequate limb splinting provides a sufficient analgesic effect on its own.

Clinical Presentation (using the patellar tendon as an example)

Typical symptoms of a severe injury to the ligamentous apparatus:

• Visual changes and palpation: Normally, the inferior pole of the patella is located at the level of the joint line. Upon rupture, it easily displaces proximally and laterally. Palpation reveals a characteristic tissue depression or decreased muscle tone in the projection of the ligament.
• Functional tests: When attempting to contract the quadriceps femoris muscle, the injured ligament does not tighten, and patellar dislocation visually increases.
• Assessment of motion: With a complete rupture, the patient cannot actively extend the lower leg from a sitting position (movement is impossible or sharply limited due to pain). Meanwhile, passive extension is fully preserved.
• Specific symptom: Patients report that when descending stairs, the lower leg suddenly "gives way".

Instrumental diagnostics

To confirm the diagnosis, diagnostic imaging methods are used:

1. Standard radiography: Performed in two projections to assess the height of the patella and rule out bone injuries. If necessary, the height is compared with a lateral radiograph of the healthy joint.
2. Functional (stress) radiographs: Lateral images taken at the moment of quadriceps muscle contraction. They allow for differential diagnosis: if superior patellar displacement increases, it is a patellar tendon rupture; if there is no displacement, it is an injury to the quadriceps tendon expansion.
3. Additional methods: In doubtful cases, ultrasound and MRI are prescribed (the most informative and non-invasive methods).

Note: Contrast radiography is currently practically never used.

Surgical treatment

In complete ruptures, the only correct strategy is surgical treatment.

• Goal: Anatomical restoration of the knee extensor mechanism (a mandatory condition for functional recovery).
• Methods: End-to-end suturing of the ligament ends or reattachment directly to the bone.
• Timing: The optimal time for surgery is considered to be the first 24 hours. In early periods (up to 7 days), a closed (percutaneous) suture may be used.

Principles of Rehabilitation After Injuries and Surgeries

The recovery program is formulated by a physical and rehabilitation medicine (PRM) physician or exercise therapy physician. Early mobilization principles are applied to both lower and upper limbs (e.g., in distal humeral fractures).

Program for the first 2 weeks:

• Active movements of the fingers and in the shoulder joint.
• Assisted movements (self-help) in the elbow and wrist joints.
• Passive continuous passive motion (CPM) and gentle soft tissue stretching (positioning).
• Hydrokinesiotherapy and superficial manual massage.
• Physiotherapy: low-frequency pulsed electrostatic field therapy.
• For arm surgeries: immobilization with a soft orthosis, isometric muscle contraction permitted from the first days.

Program after 2 weeks (following a medical examination):

• Dynamic exercises with additional resistance and loading.
• Biofeedback (BFB) training based on strength and joint angle metrics.
• Electromyostimulation (EMS) for contracture correction (strictly indicated).
• Manual therapy and occupational therapy (training in activities of daily living).

Class and exam questions

What else to study on this topic

• Biomechanics of the knee extensor mechanism.
• Technique of percutaneous suturing in the early stages of injury.
• Methodology of biofeedback (BFB) training.
• Features of hydrokinesiotherapy in the early postoperative period.
• Physiotherapeutic application of a low-frequency pulsed electrostatic field.

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.