Injuries to Skeletal System and Joints

Classification of Bones

• Long – femur, humerus

• Short– carpals, tarsals

• Flat– frontal, sternum

• Irregular– vertebral

Bones of the Cranium

Bones of the Rib Cage

Bones of the Vertebral Column

Bones of the Upper Extremity

Bones of the Lower Extremity

Anatomy of Long Bones

• Epiphysis– ends

• Metaphysis– “growth plate” area– epiphysis meets

diaphysis

• Diaphysis– Shaft or axis

Fractures

• Fractures (fx)– Break or crack in

bones

• 2 types– Compound

• Breaks the skin

– Simple• Does not break the skin• Most fx in sports are

simple

Types of FracturesOblique

- goes at angle to the axis

Comminuted - many relatively small fragments - “blow out” fx

Spiral - fracture which runs around axis of bone- “s” shaped

Types of Fractures

Greenstick - incomplete fracture where the bone bends

Transverse - goes across the bone's axis

Fractures

• Avulsion – fragment of bone is

pulled away where tendon attaches

– Common site• Superior pelvic bone

• Stress– small crack in bone

caused by repeated stress over time

– Common site• Tibia

• 5th metatarsal

Treatment of Fractures

• Compound1. Medical emergency

2. Control bleeding

3. Call EMS

4. Apply splint if can

5. Avoid any unnecessary movement

6. Will require surgery

Compound Fracture

Fracture of Forearm

Greenstick Fracture

Displaced Fracture

Transverse Fracture

Oblique Fracture

Stress Fracture

Avulsion Fracture

Treating a Fx

• Determine if EMS is needed– Compound fx ?– Severe deformity ?

• Splint fx– Type of splint based on

severity of fx

• Apply ice if can• Send to ER or Dr.

office for x-ray

Types of Splints

• Splints– Sam splints– Vacuum splints– Air splints– Traction splints

Joints / Articulations

• Articulations – a joint; the point at

which two bones meet– Over 230 articulations

in the body

Joints / Articulations

• 3 categories– Fibrous– Cartilaginous– Synovial

Categories of Joints

1. Fibrous – Immovable joints– Examples

• bones in the cranium (sutures)

• syndesmosis– connective tissue

between tibia and fibula AND radius and ulna

Categories of Joints

2. Cartilaginous – Slightly moveable– Examples

• Vertebrae• Joint between clavicle

and sternum• Ribs and sternum• Pubis Symphysis

– Between pelvic bones

Categories of Joints

3. Synovial– Freely movable– Most common joint in the

body– Examples

• elbow• knee• fingers• shoulder

Classification of Joints

• Classification of Joints

Motion Groups for Synovial Joints

• Ball and socket – Shoulder– Hip

• Pivot– Atlas & axis (1st & 2nd cervical

vertebra)

Motion Groups for Synovial Joints

• Hinge– Elbow– Knee– Phalangeal joints

• Saddle– Thumb

Motion Groups for Synovial Joints

• Condyloid– Wrist (carpal and radius)– Metacarpals and

proximal phalange

• Gliding– Carpals– Tarsals

Motion Groups of Synovial Joints• Synovial Joints

Anatomy of a Synovial JointAnatomy of a Synovial Joint

• Ligaments– connects bone to bone

• Synovial Membrane– encloses joint capsule

• Synovial Fluid– colorless fluid within the

joint capsule

• Meniscus – cartilaginous disc inside

the joint

Anatomy of a Synovial JointAnatomy of a Synovial Joint• Bursa

– sac of synovial fluid between tendons, bones, and ligaments

• Articular cartilage– on end of long bones

Synovial fluid, meniscus, and bursa sacs:1. reduce friction between joints

2. cushions3. acts as a shock absorber

• Anatomy of Synovial Joints

Bursa Sacs

Ligament or Capsular Sprains

• Sprain – overstretching and/or

tearing of ligaments or other connective tissue

• Mechanism of injury– traumatic twisting– can include joint capsule

or synovial membrane

Symptoms of Joint Sprain

1. Deformity

2. Crepitation – cracking or grating sound

3. Point Tenderness

4. Immediate Swelling

Degrees of Joint Sprains

1st degree – – minor tearing of

ligaments– mild point tenderness– mild loss of strength– no joint laxity – no decrease in range

of motion (ROM)

Range of Motion (ROM)– the max range through

which a joint can move

Degrees of Joint Sprains

• 2nd Degree – – partial tearing of ligaments– swelling and tenderness– decreased range of motion– moderate loss of strength– some joint laxity

Degrees of Joint Sprains

• 3rd Degree – complete tearing of

ligaments– complete loss of

function– severe swelling– increased laxity – immobilize and send

to physician– will be in walking boot

Degrees of Sprains

Treatment of SprainsPRICE

1. Protect– avoids further injury

2. Rest 3. Ice – 20 minutes on / 45

minutes off

4. Compression– use elastic wrap

5. Elevate – raise above level of

heart

Treatment of Sprains

Follow-up • strengthening exercises

– ROM exercises– Therabands– Wobble boards

• wrapping and bracing

Common Sites for Sprains

• Shoulder• Elbow• Wrist• Knee• Ankle

Dislocations and Subluxations

• Dislocation – separation of a joint

and malposition of an extremity

– joint goes beyond normal limits

• Subluxation – partial dislocation– “slipped out and went

back in”

Symptoms of Dislocation

1. Point tenderness

2. Loss of Strength

3. Complete loss of ROM

4. Swelling and Deformity

Treatment of Dislocations

1. Check area below for pulse2. If pulse impaired, call 9113. Splint injury in most

comfortable position4. Apply ice5. All cases have athlete see

physician

Follow-up - strengthening and flexibility exercises

MOI for Elbow Dislocations

Dislocated Humeral Head

Dislocated Thumb

Dislocated Tibia / Fx Fibula

Dislocated Ulna

Dislocated Thumb

Synovitis and Bursitis• Bursitis

– inflammation of bursa sac

• Synovitis– inflammation of synovial

membrane (lining of joint)

*** Both caused by repetitive motions (overuse injuries)

Treatment of Synovitis and Bursitis

1. If swelling is present -- ICE technique

2. No swelling – deep heating

Follow-up – stretching

ROM exercises

pain persists, see physician

Bursitis of the Elbow

Petallar and Calcaneal Brusitis

Calcaneal Bursitis

• Bursitis Health Byte• Elbow (Olecrenon)

Bursitis• Knee Bursitis (Prepatellar

bursitis)• Synovitis of the Shoulder