1. Topic #2
Injury Assessment

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

3. 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

5. 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

6. Synovial joint
Synovial Membrane

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

11. 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

12. Skeleton

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

14. 2) Appendicular Skeleton
Upper and Lower Limbs
26 bones

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

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

18. 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

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

20. 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

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

22. Compound FX
Simple FX

23. Types of Fractures Transverse Segmental Oblique Spiral Comminuted
Compacted
Greenstick

24. 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

25. 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

28. Special Types of Bone Fractures
Three types:
Epiphyseal
Avulsuion
Stress

29. Epiphyseal Fracture- Growth Plate

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

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

32. 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

33. 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

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

35. 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

36. HOPS
History
Observation
Palpation
Special Tests

37. 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.

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

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

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

41. 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

42. 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

43. 2) Neurological
a) Sensory testing
b) Reflex testing

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

45. 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