Chapter 9
 Acute
Injuries
 New injuries
 Caused by trauma
• Physical injury or wound produced by internal
or external force
 Chronic
Injuries
 Result from overuse
 Happen over a period of time
Hinge
• Movement in 1 plane:
flexion/extension
• Elbow and
interphalangeal (fingers)
Ellipsoidal
• Reduced ball and socket;
• Knee and wrists
Ball and
Socket
• Movements in all
directions
• Shoulder and hip
Gliding
Pivot
Saddle
• Flat surfaces that glide past
each other
• AC joint
• Ring of 1 bone rotates on
another
• Atlas pivots on the axis in
the neck
• 2 concave surfaces
• thumb
 Long
• Longer than wide
• Help with movement
 Short
• Short and cube shaped
• Carpals and tarsals
 Flat
• Flat and wide
• protection
 Irregular
• Different sizes and functions
Provide shape and support
Allow movement
1.
2.
•
Protection
3.
•
Protect internal organs
Store minerals
4.
•
5.
Give the muscles a place to attach
Calcium and phosphorus
Hematapoiesis (produce blood cells)
 Diaphysis
– main shaft of a bone
• Hollow, cylindrical, covered by compact bone
 Epiphysis
– ends of a bone
• Growth area; “growth plate”
 Articular
cartilage – covers the end or
epiphysis
• Protection during movement, and cushions joint
 Periosteum
– dense, white membrane
that covers diaphysis
• Interlaced with muscle tendons, blood vessels,
and osteoblasts (bone-forming cells)
 Acute
injuries
 Result of extreme stress and strains
placed on the bone
Open
Fracture
• Goes through skin
• Increased chance of
infection
Closed
Fracture
• Little/no movement
• Does not go through
skin
 Partial
or complete tissue disruption that
can be closed or open
 Serious musculoskeletal injury
 Signs/Symptoms:
• Possible deformity, point tenderness, swelling,
pain with both active and passive ROM
 Forces
• Tension, compression, bending, twisting, and
shearing
 Greenstick
Fx:
• Incomplete break
• Bone that have not ossified
• Bones bend
 Transverse
Fx:
• Straight line across bone
• direct blow from the side
 Spiral
Fx:
• “S” shaped
• Foot is planted and body gets twisted
 Comminuted
Fx:
• Broken into 3 or more fragments
• Hard blow or fall
• Difficult to heal
 Linear
Fx:
• Bone splints length wise
• Landing from tall height or landing
• Force applied to ends of bone
 Oblique
•
•
Fx:
Break is at an angle; similar to spiral
One end stabilized and the other twists
 Types
 How
of Fractures - 2 min
X-rays work - 2 min
 Chronic
or overuse Fx
 Begins as dull ache and progressively gets
worse; becomes very point tender
 Early on – pain during activity
 Late stages – pain after activity
 Common sites: tibia (shin) and metatarsals
 Requires
immobilization
• Arms/legs: 6 weeks
• Hands/feet: 3 weeks
 Osteoblasts
in the periostium form new
bone cells as a callus on the fracture site
 After
immobilization normal stresses will
help the bone re-model and heal
 When
at least 1 bone of a joint is forced
completely out of alignment or place
 Common: fingers, elbow, and shoulder
 Once dislocated = greater chance of
dislocating again
 Shoulders most commonly dislocate in the
anterior direction
 Sling and swathe – best way to immobilize
 “Seperated shoulder” is an AC joint sprain
not a dislocation
 At
least 1 bone comes partially out of its
normal alignment or articulation and then
goes back into place
 Common: shoulder and patella (kneecap)
 Need
x-ray to rule out fx for dislocation
and subluxation
 Return to play determined by soft tissue
damage
1.
2.
3.
4.
5.
6.
7.
What is the difference in acute and chronic
injuries?
Draw a long bone and label the 4 parts.
What are the 4 types of bones (classified by
shape) and give an example of each?
List the 5 functions of bones.
What are the types of acute fractures?
What is a stress fracture?
What is the difference in a dislocation and
subluxation?
 Ligaments
– connect bone to bone
• Gives support to a joint
 Sprain
– damage to a ligament
 3 grades of sprains
• Grade 1 – some pain, no loss of function, mild pt.
tenderness, mild swelling
• Grade 2 – partial tearing of fibers and joint
instability, pain, moderate loss of function
• Grade 3 – complete tear, severe instability and
swelling, extreme pain, and full loss of function
 Ligaments
connect bone to bone
 Try to restore joint stability after a
ligament injury
 Inelastic scar tissue forms, so ligament
never regains the original tension it had
 Must increase strength around the joint
 Contusion
= Bruise
 From a direct blow
• Tissue is compressed against object and the bone
 Causes
bleeding under the skin
 Calcium
deposits form in the muscle
 Tissue often compressed between object
and bone
 From repeated blows
• When a muscle is bruised repeatedly
• Quadriceps and biceps
 Extremely
painful and decreases ROM
 Pad an area to prevent more bruising
 Strain
– stretch or tear of a muscle or
tendon
 Tendon – connects muscle to bone
 3 grades of strains
• Grade 1 – some fibers stretched or torn.
Movement it painful, but have full ROM
• Grade 2 – more fibers torn; AROM extremely
painful; feel depression or divot at tear; swelling
and discoloration
• Grade 3 – complete tear; possible total loss of
AROM; extremely painful but goes away because
nerves are severed or cut
 Grade
3 strain (rupture)
 Any muscle strain
requires lengthy rehab
 Returning too early will
re-injure the muscle
 Involuntary
muscle contractions that
occur in response to a musculoskeletal
injury
 Body’s way to splint the injury
 Painful
involuntary contraction
• Calf, hamstring, and abdomen
 Often
result of dehydration
 Loss of water and electrolytes
 Treatment
• Stretch, replace water and electrolytes
 Muscular
pain that is caused by
overexertion during exercise
 As a person gets older muscle soreness
is more common
 2 Types
1. Acute-onset muscle soreness
 Happens with muscle fatigue
 During and just after exercise
2. Delayed-onset muscle soreness (DOMS)
 Most intense 24-48 hours after exercise
 Goes away 3-4 days later
 Stretch and ice
 Usually
thought of as bad, but is an
essential part of the healing process
 Once an structure is damaged,
inflammation must occur to start the
healing process
 Signs and Symptoms
• Pain, swelling, warmth, redness, loss of function
 -itis
means inflammation
 Inflammation
of a tendon
 Most common overuse injury
 Pain, swelling, maybe warmth and crepitus
 Crepitus
– crackling feeling or sound
 Treatment
• REST or at least change activities to decrease stress
• Tendon sticks to surrounding structures when
moving
 Inflammation
of a tendon and the synovial
sheath (or covering) it slides through
 Sheath is present to reduce friction and
help movement
 Tendinitis makes the tendon “sticky” so it
becomes difficult to move through the
sheath
 REST, change activities, medications, ice
 Inflammation
 Bursae
of a bursae
– fluid filled sac at joints that help
with movement and provide protection
 When inflammed the bursae produces
more fluid which makes the space
crowded and produces pain
 REST, change activities, medications, ice
 Inflammation
of a nerve
 S&S of a nerve injury

Numbness, tingling, loss of sensation, burning
 Common
Nerve injuries
• “Stinger” – brachial plexus is stretched in shoulder
• “funny bone” – ulnar nerve is hit in elbow
 Occurs
after all injuries
 Can’t speed up the healing process, but
things can be done to slow it down
 Consists
of 3 phases:
1. Inflammatory response phase
2. Fibroblastic repair phase
3. Maturation-remodeling phase
 The
phases overlap - continuum
 Begins
as soon as injury occurs
 Inflammation must occur or other phases
won’t
 Most critical part
 The damaged cells are “cleaned up”
 Damaged cells release chemicals that
will help healing later
 Lasts approximately 2-4 days following
the injury
 Regenerative
activity leads scar
formation
 Scar formation begins a few hours after
the injury and lasts for 4-6 weeks
 Signs and symptoms of inflammation go
away
 As scar formation progresses tenderness
and pain go away
 Long
term process
 The scar remodels and becomes stronger
as it changes shape
 Collagen fibers of scar are parallel to
forces
 Tissue has normal appearance, but scar
is not as strong as uninjured tissue
 Strong scar is present in about 3 weeks
 Begins 2-3 weeks after injury and lasts
for several years