Types of joint injuries and principles of treatment

Distortion (sprain)

Distortion (sprain) occurs through indirect action or direct violence when the physiological range of motion in a given joint is exceeded.

Ankle sprain

Clinical picture

• partial rupture or distension of the capsule or ligaments. It can also be hemarthroses
• the joint remains stable
• soreness, swelling, restriction of movement, hematoma

Therapy

• puncture a larger effusion, evacuate the hepatoma and flush the cavity with cold saline or mesocaine (in case of severe pain)
• immobilisation, according to disability, lighten the joint, give NOA, ice
• we can indicate arthroscopy for the knee

Subluxation

Subluxation position of the distal phalanx

A subluxation is an incomplete dislocation. It is caused by more violence than distortion. The bones are in a so-called subluxation position, when the joint surfaces only partially touch.

Clinical picture

• Injury to the capsule and ligaments is greater than with distortion.
• The joint is slightly unstable, but spontaneous reduction often occurs.

Therapy

• Rigid immobilisation is necessary for a period of 3–6 weeks.
• Relief, icing, NOA
• In more difficult cases – operative revision with ligament suture.

Luxation

Luxation (dislocation) occurs in case of significant force on the joint (possibly less force in case of predisposition), a serious disorder of congruence occurs . Reduction can be spontaneous, but usually the joint is dislocated.

X-ray of dislocation of the right hip (of a child)

X-ray of dislocated shoulder

According to the mechanism of formation, we distinguish sprains:

• Traumatic – caused by sudden and strong violence that breaks the stabilizing fibrous structures of the joint.
• Habitual – arises as a result of primary or secondary functional disorders or anatomical structure of the joint.
• Pathological – in case of long-term changes in the joint (damage of the joint surfaces during paralysis, loosening of the joint capsule during chronic inflammation).
• Congenital - basis in the presence of congenital dysplasia (hip).

Clinical picture

• swelling, hematoma, significant pain
• we monitor innervation, blood supply to the periphery, momentum
• we are investigating whether it is a dislocation fracture on the X-ray

Therapy

• perform under local or general anesthesia
• after repositioning, we check stability and detect damage to soft tissues
• immobilize the joint
• subsequent rehabilitation is important

Links

Related articles

• Injury
• Regional anesthesia, blockades
• [[General anesthesia]

Reference

• BENEŠ, Jiří. Studijní materiály [online]. [cit. 2009]. <http://jirben.wz.cz>.