The symptoms and treatment of patellar subluxation

Patellar subluxation is a condition in which changes the position of the small sesamoid bones located in the knee joint between the tibia and the femur. The common name of this bone - patella. When subluxation is manifested partial restriction of the joint, while the full dislocation leads to absolute loss of functionality. When complete dislocation occurs, the output of the articular surfaces of bones outside the joint capsule or a significant change in their position relative to each other, which leads to flexion of the knee at an unnatural angle.

The symptoms of trauma

Sesamoid bones are used in the body to enhance the strength of the key compounds, which are assumed maximum load. The tendon responsible for flexion and extension of the lower leg, formed by the connection of the quadriceps muscles and the ligaments of the patella, which over the hill attached to the tibia. Hard surface of the patella is easily detectable through the skin. With extension of the knee the patella moves freely in any direction up to an anatomically permissible limit. When flexing the knee the patella enters the groove between the bones, where it protects the articular surfaces of the tibia and femur from shifting. The thickness of the cartilaginous surface of the patella is approximately 5 mm. Cartilage serves to amortize and mitigate the movements. Subluxation of the knee joint can occur when the sports injury, the result of a bad fall or slip on an inclined surface, from shock, excessive tension of ligaments and their break-up. Nature subluxation can be:

• chronic, that is caused by valgus bending of the tibia or other impairments in musculoskeletal system;
• acute, that is occurring as a result of the injury.

Very often, an injury like patellar subluxation occurs when playing Amateur football, basketball and volleyball, when falling on a hard surface. Method of prevention can serve as a study of the fundamentals group of the body during shock or loss of balance. You should also pay attention to safety and to protect the knee of the special protective devices. What are the symptoms of injury?

• sharp pain in knee joint due to rupture of ligaments;
• the inability to fully straighten and bend the leg;
• swelling and a feeling of local heat at the site of injury;
• subcutaneous hemorrhage, hemarthrosis;
• visible deformation.

In some cases, blanching of the skin, fever,strong traumatic shock. Sesamoid bone is held on the sides by two small cords, and with extension of the knee sideways, they can suffer until the break. Displacement of the patella relative to its normal position in the groove between the bones may occur due to asymmetrical injury of the restraint cords. For convenience in describing the repositioning of the events in trauma subluxations are divided into:

• side outer when suffering ligament with the external side of the sesamoid bones;
• lateral internal when the damaged ligament is located closer to the groin area;
• torsion, when sesamoid bone changes the vertical axis to its location;
• vertical when the patellar tendon is interposed in the gap between the femur and tibia bones.

The frequency of the incidents ahead is the outer lateral subluxation, it can be caused by a direct blow to the knee, for example, in the game of football. The most rare injury are vertical and torsion subluxations. The reflex contraction of the quadriceps at the moment of impact causes injury of the patella, when the knee was unbent. If you are able to fully bend his knee injury is impossible, because the patella is included in the natural groove between the tibia and the femur. In some cases there is involuntary independent reduction of dislocation, when the athlete correctly relies on the injured limb and the patella gets it clicks into place. After this operation, you should still visit the emergency room to make sure that the signs of injury are eliminated. According to the degree of limitation subluxations of the patella can be divided into:

• fresh, that is what happened three days ago;
• stale, remoteness of injury up to three weeks;
• old, happened more than three weeks ago.

The later happened and seek medical help, the harder it is to straighten the dislocation. Chronic dislocations reduce only method of operation.

What should be the first aid

The victim need to be taken to the emergency room. You should immobilize the injured joint with tires from scrap materials. If possible, the knee joint applying ice pack for 15 minutes. To relieve severe pain, you can give any non-narcotic analgesic of home, sports, or a car kit, to drink water.

Transport must be carried out in the most painless position. On their own not to drive, even ifthere is still limited mobility of the knee.

Reduce a subluxation should only professional trauma, otherwise healthy knee, the victim can only dream. Incorrect repositioning of the sesamoid bones threatens to disability, chronic pain, inflammatory process in the knee joint and other very serious consequences. Increased swelling and expansion of the hematoma can cause a pinched nerve, in this case in the limb, disturbed sensitivity, you will experience numbness and tingling. Severe swelling will prevent the doctor to set a bone, so the delivery of the victim to a medical facility should be arranged as soon as possible.

How is the treatment of trauma

First, the surgeon makes the decision about the adequate extent of analgesia, followed by medical history and studies are the following:

• radiography;
• magnetic resonance imaging;
• CT.

It is important to consider not only damage to the joint and ligaments, but also the soft tissues - blood vessels and nerve endings. If there's a possibility of surgical intervention is carried out arthroscopy of the knee joint.

In most cases surgical intervention is required and manual reduction under local anesthesia is enough.

The surgeon flexes the leg at the hip to relax the quadriceps muscles, and then bend it at the knee, gently restoring the proper anatomic position of the patella. Used for fixing plaster bandage. After repositioning is carried out a control x-ray to check for a positive result. Surgery may be required in the case of formation of osteochondral bodies and adverse changes in the knee joint that can cause new dislocations. All subluxations prescription more than three weeks require surgery, that is why immediately after the injury to seek help. Plaster bandage is normally removed after a month.

Recovery after injury

All exercises for the development of the knee joint should be done only in consultation with your doctor. Patients undergoing rehabilitation after patellar subluxation, basically is assigned to the following procedures:

• therapeutic massage, which is carried out either by a specialist in a hospital or at home by yourself according to the instructions;
• therapeutic exercise to restore function of the knee;
• vitamins and specialty drugs to regenerate damaged tissues.

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Fullrehabilitation of uncomplicated subluxation of the patella is about two and a half months. Then it is important to observe safety precautions to avoid re-dislocation in the same place. Good protection against such injuries is exercise calf and thigh muscles, development of coordination of movements, usage of hard knee pads for knee protection, as well as learning the basics of good groups during falls and bumps.