Joint Mechanics & Joint Injuries

1. Joint Mechanics & Joint Injuries With Ms. Moonah

2. What’s a joint? • Joints are the points of contact between two connected bones • Types of joints • The three main types of joints are fibrous joints, cartilaginous joints and synovial joints • Joints are classified according to structure and function

3. Types of Joints • Fibrous joints – tightly bound together by connective tissue and allow no movement • synarthrosis • e.g. sutures of the skull which fuse after birth

4. Types of Joints • Cartilaginous joints –two bones connected by cartilage • Slight movement is possible • amphiarthrosis • E.g. the intervertebral discs

5. Types of Joints • Synovial joints –contain lubricating fluid and cartilage • diarthrosis • They are also joined by ligaments (tough elastic tissue) that enclose the ends of articulating bones • Allow movement between two or more bones

6. Characteristics of Synovial Joints HANDOUT – 10 minutes

7. Characteristics of Synovial Joints

8. Types of Joints Joints Fibrous Cartilaginous Synovial • Articulating cartilage • Joint Capsule • Joint cavity • Bursae • Intrinsic ligaments • Extrinsic ligaments

9. Types of Synovial Joints • Gliding Joints • Hinge Joints • Pivot Joints • Ellipsoid Joints • Saddle Joints • Ball-and-socket joints

10. Types of Synovial Joints • Gliding Joints • Connects flat bone surfaces • E.g. joints in the foot between tarsals

11. Types of Synovial Joints • Hinge Joints • Have a convex portion of one bone fitting into a concave portion of another • Allows movement in one plane • Name the convex and concave portions of the elbow

12. Types of Synovial Joints • Convex: trochlea of the humerus • Concave: trochlear notch of the ulna

13. Types of Synovial Joints • Pivot Joints • Allows rotation in one place • A rounded point of one bone fits into a groove of another

14. Types of Synovial Joints • E.g. Atlantoaxial articular joint between the first two vertebrae in the neck (this joint allows you to rotate your head when signifying “no”)

15. Types of Synovial Joints

16. Types of Synovial Joints • Ellipsoidal joints • Allow movement in two planes • E.g. flexion/extension, abduction and adduction • E.g. metacarpophalangeal joint and wrist • What are the two planes you can move your wrist in? • Sagittal and frontal/coronal

17. Types of Synovial Joints • Saddle Joints • Allow movement in two planes • E.g. carpo-metacarpal articulation of the thumb

18. Types of Synovial Joints • Ball-and-socket Joints • The “ball” at one bone fits into the “socket” of another • Allows movement around three axes • E.g. Hip joint and shoulder joint • What structures make up these joints? • Hip joint: The femur rests in the acetabulum • Shoulder joint: The humerus rests in the glenoid cavity

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

20. Joints Fibrous Cartilaginous Synovial • Characteristics • Articulating cartilage • Joint Capsule • Joint cavity • Bursae • Intrinsic ligaments • Extrinsic ligaments 6 Types Gliding Joints Hinge Joints Pivot Joints Ellipsoid Joints Saddle Joints Ball-and-socket joints

21. Sport Injuries

22. Welcome to the Chinguacousy Physiotherapy Clinic!

23. Chinguacousy Physiotherapy Clinic Day 1 • Meet your patient, Taylor! • Taylor has a swollen knee • When you touch it, the knee is warm • It’s also extremely painful for Taylor to move it • What’s wrong?

24. Proper Treatment of an Injury • S.H.A.R.P • Swelling • Heat (increased temperature of the injured area) • Altered (the tissue isn’t functioning properly) • Red (the injured area is red in color) • Painful

25. What Should You Do? • Treat Taylor’s knee immediately until you figure out what’s wrong

26. Proper Treatment of an Injury • The P.I.E.R. Principle • Pressure and Ice are used at the same time • While applying pressure and ice, the injured area should be Elevated • This will help to stop the swelling which will help us make a better diagnosis • What about “R?” • Last, advise Taylor to Rest the injured area

27. Chinguacousy Physiotherapy Clinic Day 2 • Taylor’s knee is still swollen • There is still a lot of pain • You start to wonder about the significance of the injury…

28. Tissue Properties • The tissues that attach bones to bones are called ligaments • Ligaments help to stabilize joints • What does stable mean? Do muscles stabilize joints? • Proper resistance and conditioning programs help to strengthen ligaments and therefore make the joint more resistant to injury • Ligaments can withstand large forces but will not stretch a lot…. instead they will TEAR!

29. Tissue Properties • The tissues that attach muscles to bones are called tendons • While tendons possess a greater stretching range than ligaments, tendons can TEAR as well!

30. Tissue Properties

31. Chinguacousy Physiotherapy Clinic Day 2 Cont’d • So Taylor may have torn a ligament or a tendon…

32. First- to Third-Degree Tears, Sprains, and Pulls • After doing some assessments on Taylor’s knee, you find that the joint is loose • What does loose mean? • The muscles are fine…there must be a torn ligament or tendon in the knee joint

33. First- to Third-Degree Tears, Sprains, and Pulls • Tears, sprains and pulls are usually used to describe injuries to joints • Sprains are associated with ligaments & tendons • Pulls and strains are associated with muscles Does Taylor have a sprain or strain?...or pull?!

34. Chinguacousy Physiotherapy Clinic Day 2 • A Sprain! • Since you can’t see inside the joint to determine what’s wrong, you send Taylor for an MRI (magnetic resonance imaging) • A technique used to see internal structures

35. Turns out there’s a FULL tear of a ligament!

36. First- to Third-Degree Tears, Sprains, and Pulls • Tears, Sprains, and Pulls are classified into 3 categories of severity • First-degree injuries: mild and considered least severe (usually take a few days to heal) • Second-degree injuries: moderate to more severe (require treatment of a physiotherapist) • Third-degree injuries: move severe (May require surgery and rehabilitation. May take 6-12 months to fully repair)

37. How Would You Classify Taylor’s Injury? • Second-degree injuries: moderate to more severe (require treatment of a physiotherapist) OR • Third-degree injuries: move severe (May require surgery and rehabilitation. May take 6-12 months to fully repair)

38. How Bad is it??? • Turns out Taylor has a Third-degree Sprain! • Why isn’t it a second degree injury? • Taylor requires surgery because ligaments are avasuclar • this means ligaments do not have a large blood supply and therefore, cannot heal in some cases • Taylor must receive a donor ligament or use a tendon from his/her own body to replace the torn ligament…is Taylor a male or female?!

39. Taylor is Ms. Moonah! • October 14th, 2011  Game Day • November 16th, 2011  MRI • December 20th, 2011  Surgery Day: ACL RE-Construction • 6-month recovery

40. Why Do Injuries Happen?

41. Why Injuries Happen • Playing conditions: wet, dry, temperature • Playing surface: artificial vs natural • Poor officiating • Improper warm ups/preparations • Size mismatches • Rules and rule changes • Poor equipment • Lack of conditioning/training • Poor Technique • Poor Coaching

42. Sports Classifications • Collision • Use bodies to deter opponents i.e.: football, ice hockey, rugby, wrestling 2) Contact • Make “incidental” body contact i.e.: soccer, basketball, filed hockey, baseball 3) Non-Contact – no physical contact - rowing, archery, tennis

43. Common Sport Injuries • 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

44. Bring out your workbooks! • Label the diagrams on pp. 72-74 • 10 minutes

45. 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

46. 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

47. Joint Mechanics & Joint Injuries With Ms. Moonah

48. Opening Activity – 10 minutes In pairs, brainstorm on a sheet of paper everything you remember about the different types of joints

49. Joints Fibrous Cartilaginous Synovial • Characteristics • Articulating cartilage • Joint Capsule • Joint cavity • Bursae • Intrinsic ligaments • Extrinsic ligaments 6 Types Gliding Joints Hinge Joints Pivot Joints Ellipsoid Joints Saddle Joints Ball-and-socket joints

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