Topic #2 Injury Assessment

Joints/ligaments Joints are where two bones meet Ligaments hold bone to bone Tendons hold muscle to bone)

Types of joints 1) Fibrous joints- immoveable joints, connect with fibrous connective tissue. Examples: Skull, pelvis 2) Cartilaginous joints- slightly moveable, connected with cartilage Examples: sternum and manubrium, rib cage, between vertebrae 3) Synovial Joint- Moveable joint

Synovial Joint Cont. Freely moveable Different degrees of movement depending on joint type Different types of synovial joints Structure: 1 ) Articular cartilage- protects ends of joint- Usually hyaline cartilage 2) Joint cavity- space between bones and filled with synovial fluid 3) Joint Capsule- covers joint cavity, includes synovial membrane 4) Synovial fluid- gives cushion and support 5) Ligaments- support joint, found connected to capsule right outside

Synovial joint Synovial Membrane

Types of Synovial Joints Six major categories: Gliding Hinge Pivot Condyloid Saddle Ball & socket

Hinge joints Examples: elbow (humerus and radius) and interphalangeal joints Pivot Joints Examples: Elbow (radius on ulna) Elipsoid Joints Examples: Wrist Saddle Joint Examples: Thumb Ball and Socket Examples: Shoulder

Skeleton

Axial and Appendicular Skeleton 1) Axial Skeleton The skull The ear The Hyoid Bone (throat) The Sternum Rib Cage Vertebral Column

2) Appendicular Skeleton Upper and Lower Limbs 26 bones

Long, short, irregular, flat (sesmoid) Types of Bones Long, short, irregular, flat (sesmoid)

Structure of Long Bones Epiphysis- Spongy Bone Articular Cartilage Diaphysis Compact Bone Bone Marrow Marrow Cavity Blood Vessel Periosteum

1) Epiphysis- round end of long bone 1) Epiphysis- round end of long bone. It is covered in articular cartilage. It includes the growth plate (epiphyseal plate) 2) Spongy Bone Lighter, softer, weaker, contains blood vessels, surrounded by compact 3) Articular Cartilage (Hyaline Cartilage) smooth Shiny surface that covers ends of bones no nerves or blood vessels

4. Diaphysis- main midsection of long bone Compact Bone- hard, dense, outer cover that is smooth and white

6. Bone Marrow- Flexible inside where red blood cells are made and lymphocytes 7. Bone Marrow Cavity- tunnel where bone marrow is found 8. Blood Vessels- vessels surround bone and travel into marrow through canals 9. Periosteum- tough outer membrane of bone richly supplied with blood vessels

Fracture Notes Simple fx- Bone breaks, but does not break the skin Compound fx- Bone breaks and breaks through skin

Compound FX Simple FX

Types of Fractures Transverse Segmental Oblique Spiral Comminuted Compacted Greenstick

Different Types of Fractures Transverse – Break occurs in a straight line across the bone Oblique – Break occurs diagonally when torsion occurs on one end while the other is fixed Spiral – Jagged bone ends are S-Shaped because excessive torsion is applied to a fixed bone

Different Fractures Comminuted – Bone fragments into several pieces Compacted – Another bone is impacted, or driven into, another piece of bone Greenstick – Bones break incompletely like how a green stick breaks CREPITUS – Crunchy sound bones make PICTURES IN PAGE 50 OF TEXTBOOK

Special Types of Bone Fractures Three types: Epiphyseal Avulsuion Stress

Epiphyseal Fracture- Growth Plate

Avulsion Fx- When a tendon or ligament pulls off a piece of bone

Stress FX- repeated low magnitude force -worsen over time Common sites: Metatarsals, Femoral neck, Lumbar, Pubis, Tibia Does not show on X Ray

Evaluating a FX- when in doubt send for X ray 1) Pain will be point tender in one spot (PT) 2) Sometimes obvious deformity 3) Symptoms: * PT * Throbbing * Bother at night

FX tests for evaluation Percussion – Tapping that produces force along the shaft of the bone, which causes pain at the sight of injury. Vibration – Using a tuning fork or hammer to test whether the vibration causes pain Compression – Pushing bone together to see if it causes pain Distraction – Pulling bone away from the body feels better than normal, it could be FX

Healing of FXs Blood clot forms around bone and then deposits calcium to form new bone

Soft Tissue Healing 3 Phases Acute Response: 1-3 Days Edema (swelling), Redness/Local Heat, Pain Vasoconstriction : Could lead to Hypoxia (Tissue with low oxygen) or Necrosis (Death of Tissue) So… Vasodilation: Increased Blood Flow (Swelling/Pain) Repair & Regeneration: 6-8 Weeks New Cells/Skin Scar Tissue: Inelastic, Not as Flexible and Strong Recovery: Up to a Year Return to Normal Strengthen Muscles

HOPS History Observation Palpation Special Tests

You are a detective Only Start HOPS after all serious/life threatening injuries are ruled out. It is ideally performed in the training room. The point of HOPS is to find out as much info as possible.

History Listen to Athlete Ask specific questions Mechanism of injury (how it occurred) When? First Time?

How long have you had the symptoms? Does the pain change? Subside? Any Medical History Point with one finger to where it hurts

Observation- just looking and listening Any abnormal movements? Deformities, Asymmetrical, Swollen, Atrophy, Sounds? Remember: Bilateral Comparison

Palpations Begin with light touches to deeper Start away from injury and work towards Feel for edema, increase temp, abnormal protuberances, muscle tension, atrophy, crepitus, pulse

Special Tests 1) Joint Range of Motion (ROM) AROM- ( active range of motion) PROM- ( Passive range of motion) Pain w/ AROM but not PROM- muscle involved - RROM-(resistive range of motion) painful and/or weak

2) Neurological a) Sensory testing b) Reflex testing

3) Special Tests for each Joint -Designed for specific body region

4) Functional Tests -test whether the athlete can return to sport participation. They are sport or job related specific. Start off with less stress and move to more stress