JOINT MECHANICS AND SPORT INJURIES

JOINT MECHANICS AND SPORT INJURIES
Chapter 4 p

TYPES OF JOINTS Fibrous joints
bound tightly together by connective tissue and allow no movement. These are the joints between the interlocking bones of the skull, known as sutures. After birth, all sutures joints become immobile. Cartilaginous joints (or fibrocartilaginous joints) – the body of one bone connects to the body of another by means of cartilage, and slight movement is possible. The intervertebral “discs” of the spinal column (of which there are 23) are of this type. These have a hard, elastic outer ring with a soft core, permitting some movement while at the same time providing protection against severe jolts, such as landing hard on one’s feet.

TYPES OF JOINTS Synovial joints –
joints that allow the most movement. The bony surfaces are separated by a lubricating fluid (the synovia) and by cartilage. They are also joined by ligaments, tough bands of elastic tissue that enclose the ends of articulating bones and form a capsule containing the synovial membrane. Typical synovial joints are the KNEE, SHOULDER, and the ANKLE.

Types of Joints – Fibrous Joints
Sutures in Skull Radioulnar Syndesmosis Gomphotic Joint

Types of Joints – Cartilaginous Joint
Intervertebral Discs

Types of Joints – Synovial Joints
Anterior Shoulder Joint Bent Elbow Joint Anterior Hip Joint

Characteristics of Synovial Joints
Synovial joints permit movement between two or more bones and can be distinguished by the following characteristics: Articulating cartilage located on the ends of bones that come in contact with one another. This hyaline cartilage protects the ends of the bone and allows for a smooth contact surface for the bone to move around while acting as a shock absorber.

Joint capsule fibrous structure that consists of the synovial membrane and fibrous capsule. Synovial membrane The synovial membrane allows certain nutrients to pass through. Fibrous capsule the fibrous capsule keeps synovial fluid from leaking.

Joint cavity located between the two bony articulating surfaces. It is filled with synovial fluid, which acts as a lubricant for the joint. This lubricant is essential in reducing friction and providing nutrients for the articulating cartilage. Bursae small, flattened fluid sacs found at the friction points between tendons, ligaments, and bones (bursa is singular)

Intrinsic ligaments thick bands of fibrous connective tissue that help thicken and reinforce the joint capsule. Extrinsic ligaments are separate from the joint capsule and help to reinforce the joint by attaching the bones together.

The Characteristics of a Synovial Joint
Bone Blood vessels Nerve Joint cavity (filled with synovial fluid) Joint capsule Synovial membrane Fibrous capsule Articular cartilage Bursa Tendon sheath Membranous layer Tendon Periosteum Fibrous layer

Types of Synovial Joints
Ball-and-socket joint Gliding joint Hinge joint Pivot joint Saddle joint Ellipsoid joint

Gliding (or plane or arthrodial joints) – connects flat or slightly curved bone surfaces (i.e. joints in the foot between the tarsals and in the hand among the carpals. Hinge (ginglymus) joints – convex portion of one bone fits into the concave portion of the other. And allow movement in one plane. The joints between the bones of the fingers (phalanges) and between the ulna (“inner” bone of the forearm) and the humerus are examples.

Pivot (trochoid) joints – allows rotation in one plane (uni-axial). A rounded point of one bone fits into a groove of another. An example is the atlantoaxial articular joint between the first two vertebrae in the neck, which allows the rotation of the head (“saying NO”). Ellipsoid joints – allow movement in two planes (i.e. between the second metacarpal and the first phalanx of the second finger). The wrist is an example of an ellipsoidal joint.

Saddle joints – like ellipsoidal, allow movement in two planes (i.e. flexion-extension and abduction-adduction), but do not allow for rotation like a ball-and-socket joint. A key saddle joint is found at the carpo-metacarpal articulation of the thumb. Ball-and-socket (spheroidal) joints – the “ball” at one bone fits into the “socket” of another, allowing movement around three axes. The most familiar joints of this type are the HIP (the femur rests in the acetabulum of the pelvis) and the SHOULDER (the humerus rests in the glenoid cavity).

The Shoulder Joint Clavicle Acromioclavicular ligament
Coracoclavicular ligament Acromion Coracoacromial ligament Coracoid process Glenohumeral ligaments and joint capsule Scapula Tendon of biceps brachii (long head) Humerus

The Knee Joint – Anterior
Quadriceps tendon Patella Medial (Tibial) collateral ligament Patellar ligament Fibula Tibial tuberosity Tibia

The Knee Joint Anterior (deep)
Femur Posterior cruciate ligament Lateral (Fibular) collateral ligament removed Medial (Tibial) collateral ligament removed Lateral Condyle Medial Condyle Anterior cruciate ligament Lateral Meniscus Medial Meniscus Tibial Tuberosity Fibula Tibia

The Knee Joint – Posterior
Femur Adductor magnus tendon Medial head of gastrocnemius tendon Lateral head of gastrocnemius tendon Semimembranosus tendon Oblique popliteal ligament Medial (Tibial) collateral ligament Lateral (Fibular) collateral ligament Fibular head Fibula Tibia

The Knee Joint – Posterior (deep)
Femur Anterior cruciate ligament Posterior meniscofemoral ligament Medial meniscus Medial (Tibial) collateral ligament Popliteal tendon Lateral meniscus Posterior cruciate Lateral (Fibular) collateral ligament Fibula Tibia

The Ankle Joint – Medial View
Tibia Medial malleolus Deltoid ligament Calcaneal (Achilles) tendon Long plantar ligament

The Ankle Joint – Lateral View
Tibia Fibula Lateral malleolus Anterior tibiofibular ligament Posterior tibiofibular ligament Posterior talofibular ligament Anterior talofibular ligament Calcaneus Anterior talofibular ligament

Common Sport Injury Terms
Tissue Properties: TENDONS – attach muscle to bone. Composed of large bundles of white, fibrous protein called COLLAGEN. They possess a greater stretching range than ligaments. However, if the force is too great, they will tear. LIGAMENTS – attach one or more bones together. Less rigid than bones. Made up of tough bands of white, fibrous tissues that allow a certain amount of stretch, but they do not have the same stretching ability as tendons. They are generally referred to as “static stabilizers of joints”, while tendons and muscles are “dynamic stabilizers”.

Tissue Properties Tendons:
Composed of collagen (bundles of white, fibrous protein) Attach muscle to bone Vascular Ligaments: Tough bands of white, fibrous tissue Attach bone to bone Avascular

Vascularity Vascularity – amount of supplied blood a tissue has or requires. Ligaments and cartilage are avascular (their nutritional needs are not met through blood; hence the prefix “a” meaning without, and “vascular,” meaning blood supply. Ligaments receive their nutritional needs through compression. Bones and muscles are vascular; their nutritional needs are met through blood. The more vascular a tissue, the less time it takes to recover from an injury

Common Sport Injuries Strains, pulls, and tears
Terms used to describe injuries to all joint tissue types Tendinitis Inflammation of a tendon Dislocations Bone displaced from its original location Separations Fibrous ligaments that bind the bones tear and separate Cartilage Torn cartilage Shin splints Tearing of the interosseous membrane or the periosteum Tendinitis

1st to 3rd Degree Tears, Sprains, and Pulls
The terms strains, pulls, and tears are usually used to describe injuries to all joint tissue types. Pulls and Strains – associated with muscles Sprains – associated with ligaments and tendons

Tendon or muscle tissue is stretched or torn
STRAIN Tendon or muscle tissue is stretched or torn SPRAIN Ligament or the joint capsule is stretched or torn

Three Categories of Severity
First-degree injuries Second-degree injuries Third-degree injuries

Severity of sprains and strains
First-degree Slightly stretched or torn; few muscle fibres Second-degree Moderately stretched or torn, more muscle fibres Third-degree Complete rupture Surgery required E.g. ACL tear

Ankle Sprain – Third Degree

Third Degree Ankle Sprain

Ruptured Achilles Tendon

Achilles Tendon Rupture & Repair

Common Strains Adductors Hamstrings Quadriceps Hip flexors
Rotator cuffs

Emphasize hamstrings and quadriceps equally
Hamstring Strains Most frequently strained muscles Mechanism: Rapid contraction in a lengthened position E.g. sprinting and running Due to strength imbalance Hamstring strength >>> quadriceps strength Emphasize hamstrings and quadriceps equally

Hamstring Pull

Other common injury terms…
Tendinitis Bursitis Dislocations Separations Cartilage damage Shin splints Stress Fractures Other fracture Concussions

Inflammation of tendon as a result of a small tear in the tendon
TENDONITIS Inflammation of tendon as a result of a small tear in the tendon Tendonitis Excessive , repetitive motion Improper technique Age (loss in elasticity) Symptoms Pain (aggravated by movement) Tenderness Stiffness near joint

Tennis Elbow Lateral epicondylitis Affect forearm extensors
Attach to lateral epicondyle Extend wrist and fingers Contributing factors Excessive forearm pronation and wrist flexion Gripping racquet too tightly Improperly sized grip Excessive string tension Excessive racquet weight Topspins Hitting ball off-centre

Golfer’s and Little League Elbow
Medial epicondylitis Affects tendons of forearm flexors Attach to medial epicondyle Flex wrist and fingers May result in collateral ligament and ulnar nerve injury May affect medial humeral growth plate in young children (little league elbow)

Tennis & Golfer’s Elbow

Inflammation of the bursae
BURSITIS Inflammation of the bursae Tiny fluid-filled sacs Lubricate and cushion pressure points between bone and tendons Results from overuse and stress Age is also a factor Most common Shoulder, elbow and hip Inflammation and pain aggravated by movement and direct pressure

Excess movement of the humeral head + lack of space
SHOULDER IMPINGEMENT Excess movement of the humeral head + lack of space Inflammation of bursae or rotator cuff tendon Result of muscle imbalances in shoulder muscles Weak shoulder depressors Strong shoulder elevators Balanced strength training

DISLOCATIONS

DISLOCATIONS Forces are great enough to push the joint beyond its normal anatomical limits Joint surfaces come apart Subluxation When supporting structures (e.g. ligaments) are stretched or torn enough Bony surfaces partially separate Most common = fingers Can become chronic

Patellar Dislocation

OVERUSE INJURIES Due to Results from
Repeated and accumulated microtrauma Non-sufficient recovery Results from Poor technique Poor equipment Too much training Type of training

Stress fracture Results from repeated low-magnitude forces Small disruption of the outer bone layer Weakened bone Cortical bone fracture NOT a shin splint Shin splints Pain along inside tibial surface Involve pain and inflammation NO disruption of cortical bone

FRACTURES

Fractures Simple fracture Compound fracture
Stays within the surrounding soft tissue Compound fracture Protrudes from the skin

Fractures Stress fracture Avulsion fracture
Results from repeated low magnitude loads Avulsion fracture Involves tendon or ligament pulling small chip of bone

Fractures Anderson silva

Fractures David Busst, had to wait 12 minutes to clean blood off field, and needed 26 operations just to make sure he didn’t need to be amputated. Never played again.

No such thing as “minor concussion and “shaking off”
CONCUSSIONS: Injury to the brain Mechanism: Violent shaking or jarring action of the head Brain bounces against the inside of the skull Symptoms Confusion Temporary loss of normal brain function REST No such thing as “minor concussion and “shaking off”

Concussions

Signs of an Injury Whenever an injury occurs, one or more of the following signs will appear, as noted by the acronym S.H.A.R.P. Swelling – instantly or over time Heat – increased temperature of area Altered – tissue will not function properly Red – in colour Painful – to touch or move

Proper Treatment of an Injury
When you or one of your fellow players sustains an injury, you should immediately follow the P.I.E.R. principle: Pressure Ice Elevation Restriction

Proper Treatment of an Injury
S.H.A.R.P P.I.E.R. Principle Swelling: instantly or over time Pressure: tensor wrap Heat: increased temperature in the area Ice: placed on affected area Altered: tissue will not function properly Elevate: to reduce swelling Red: in colour Restrict: tensors, slings, or crutches Painful: to touch or move

Treatment Rehabilitation
Received by patient from a health care professional Promotes healing Improves quality of injured tissue Allows quicker return to activity Rehabilitation Therapist’s restoration of injured tissue +patient's participation Individualized for each athlete

Shoulder Joint Injuries
Biceps tendinitis Caused by overuse of the biceps brachii muscle Shoulder separation Tearing of the acromioclavicular ligament Shoulder dislocation Occurs when the humerus “pops out” of the glenoid fossa Rotator cuff tears An injury to one of the rotator cuff tendons Shoulder separation

Dislocation of the Shoulder

Most mobile  most unstable joint Categories of dislocation:
Partial (subluxation) Complete Most common Head of humerus slips anteriorly Falling backwards on extended arm Symptoms Swelling, numbness, pain, weakness, bruising Capsule and/or rotator cuff tears Brachial plexus injury Require medical treatment to relocate head of humerus back to glenoid fossa

Shoulder Dislocation

Knee Joint Injuries Knee ligament tears
Q-angle may contribute to the predisposition of ACL tears Osgood-Schlatter syndrome Affects the epiphyseal plate of the tibial tuberosity Patellofemoral Syndrome (PFS) Gradual onset of anterior knee pain/pain around the patella Osgood-Schlatter syndrome

Growing Pains: Osgood-Schlatter Syndrome
Causes: When the epiphyseal plate gets overused Symptoms: Pain, swelling, and tenderness Pain gets worse from jumping, running, and doing deep knee bends Limping after physical activity Pain is relieved during rest Treatment: Apply the principles of PIER See your physician Rest and anti-inflammatory drugs 67 67

Osgood-Schlatter Syndrome

Anterior Cruciate Ligament
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Ankle Joint Injuries Inversion sprains “twisted ankle”
Eversion sprains Occurs to the deltoid ligament Pott’s Fracture A force on the medial side of ankle causing the deltoid ligament to rip off the tip of the medial malleolus; and a break of the fibula Inversion sprain

Inversion Sprain

Eversion Sprains Pott’s Fracture Eversion Sprain

Healing Phases

Inflammatory Response Phase
Inflammation begins at the time of injury Signs Redness Swelling Pain Increased temperature Loss of function Protect Rest Cryotherapy (extreme cold) Decreases swelling, bleeding, pain and spasms Compression Decreases swelling Elevation

Fibroplastic Repair Phase
Repair and scar formation Granulation tissue fills the gap Collagen fibres are deposited by fibroblasts Signs seen in the phase1 subside Rehab-specific exercises Restore range of motion and strength Manual massage therapy and ultrasound Help break down scar Protective taping and bracing

Maturation-Remodeling Phase
Remodeling or realigning of the scar tissue More aggressive stretching and strengthening To organize the scar tissue along the lines of tensile stress Include sport-specific skills and activities

Pain Nature’s way of telling us something is wrong
One of the best indicator of when it is best to resume play

Problem with Ignoring Pain
Masking with medications Continued participation Pushing injured tissue closer to yield-level point Gastrointestinal complications Addiction

INJURY PREVENTION: Protective Equipment

Warm Up and Cool Down

Keeping Fit and Flexible
“Use it or lose it” Especially important during the off-season Preparing the muscle for placing demands

In order to function effectively body must receive
Eating and Resting In order to function effectively body must receive Proper nutrient Adequate rest Avoid over-training and lack of sleeping

JOINT MECHANICS AND SPORT INJURIES

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