Joint and Soft Tissue Pathologies Flashcards
Examples of ligamentous structures & their roles
- Lateral/collateral ligaments prevent joints from moving side to side
- Cruciate ligaments prevent forward/backward motion
- Volar plates prevent volar motion
- Wrist has complex ligamentous system that consists of volar, dorsal intrinsic, extrinsic, and inter-carpal ligaments
- Glenohumeral labrum
Ligament sprain and treatment
- Injury caused by overstretching and, in some cases, mild tearing of fibers of ligamentous tissue
- Treatment includes immobilization for 6-8 weeks, anti-inflammatory medication, and modalities as needed
Ligament tear and treatment
- Usually occurs from trauma
- May include a bone fracture known as an avulsion
- Surgical management can include pinning, screws, and suturing the ligamentous tissue
Dislocation of a joint
- A complete separation of the bone ends that normally articulate to form a joint
- Described according to direction of movement of the distal dislocating bone
- Glenohumeral joint most common, fingers 2nd most common
Recovery from joint dislocation
- When treated early, most don’t cause permanent injury
- Injuries to surrounding tissue take 6-12 weeks to heal
- Injuries to nerves and blood vessels may result in more long-term or permanent problems
Treatment for radial head dislocation
- Immobilization while healing for children:
- Sling if site is tender after re-setting
- Elbow splint if treatment is delayed more than 12 hours
- Cast if more than 3 recurrent episodes
- Adults wear sling for 1 week, then brace that allows movement but prevents full extension
Treatment for ulna dislocation at elbow
- Splint or case for 2-3 weeks, then placed in long-arm elbow splint or brace under protective motion protocols which gradually increase in extension
- Full extension not allowed until 4 weeks post-injury
Carpal kinematics & instability
- Scaphoid in slight flexion, triquetrum in slight extension, lunate with whichever one it’s connected to
- Since lunate is connected to both, everything stays in a neutral position (11-12 degrees flexion)
- Instabilities caused from motion between carpal bones from lax or torn ligaments
- Leads to arthritis and pain with weight-bearing and grip
DISI: Dorsal Intercalated Segment Instability
- Results from scapho-lunate tear
- Lunate stays connected to triquetrum and moves into slight extension
VISI: Volar Intercalated Segment Instability
- Results from luno-triquetral tear
- Lunate stays connected to scaphoid and moves into slight flexion
TFCC
Triangular fibrocartilage complex: includes ligamentous borders, ECU and its sheath, as well as the disc (TFC), which is like a meniscus in the knee
Jammed finger
- Sprained ligament in the finger, usually the PIP
- Painful, swollen, and stiff
- Collateral ligaments thicken
Finger dislocation
- Causes: accidents causing “jamming” force applied to end of finger or finger may be forcefully overextended or bent beyond limit of motion (more common for MCP joints)
- Most common in PIP of digits 2-5
Treatment for finger dislocation
- After joint reduction, individual wears protective splint or has finger taped to another finger for 3-6 weeks
- May take 4-6 months for pain to disappear
- Some cases result in permanent swelling around injured joint
Treatment for ulnar collateral ligament injury in thumb MP/skier’s thumb
- Splint for 6-8 weeks
- Activity modification (avoid pinching, esp. lateral key, and lateral forces)
- NSAIDs
- Modalities as needed
