Orthopedic Injuries
Orthopedic injuries refer to a wide variety of conditions impacting the musculoskeletal system. The musculoskeletal system includes bones, joints, muscles, ligaments, tendons, and nerves. Injuries to these structures can result in loss of strength, mobility, and function through our Bodies.
Bones
Bones make up the body’s skeletal system. They are living tissue that consist of a hard outer layer and inner tunnels and canals that allow blood and lymphatic vessels to supply bones with nutrients and maintain health. Muscles, tendons, and ligaments attach onto bones. The average human body has 206 bones.
The most common bone injury is a fracture:
Joints
Joints (articulations) are where two or more bones meet and allow for movement. There are several types of joints that provide different degrees of movement:
Structures within a joint include articular cartilage, synovial fluid, tendons, ligaments, and bursae. These structures help to provide cushion, lubrication, and stability to the joint. Injury to one or more of these structures can disrupt the normal function of our joints and result in pain.
Common joint injuries include dislocation, osteoarthritis, and bursitis:
Muscles
Skeletal muscles assist with voluntary movement, maintaining posture, and circulation of blood and other nutrients. Muscles help to provide movement by crossing joints through our body. Muscles may cross one or two joints, allowing for multiple uses of the same muscle. Nerves originating from the spinal cord attach to muscles and give the signal to produce movement.
Common muscle injuries include strains and cramps/spasms:
Ligaments
Ligaments are connective tissue that serve to hold structures together and keep them stable. Within our musculoskeletal system they are found attaching bone to bone and are present around joints. Within our joints, ligaments allow joints to move in the proper directions, stabilize and strengthen joints, reduce rotation or twisting through joints, and prevent dislocations. Examples of ligaments include the ACL (anterior cruciate ligament) in the knee and the ATFL (anterior talofibular ligament) in the ankle.
The most common injuries to ligaments include sprains and tears:
Tendons
Tendons connect muscle to bone and allow movement through the musculoskeletal system. They act as levers and help transmit force produced by the muscles to move the bones. Tendons generally have a poor blood supply, which decreases with age. This may result in poor natural healing of tendons following an injury. Examples of tendons include the Achilles tendon (connects calf muscles to heel bone) and rotator cuff tendons (connect some shoulder muscles to upper arm bone).
Common tendon injuries include tendinopathy and tears or ruptures.
Nerves
Nerves within the musculoskeletal system connect the brain to our muscles and serve as messengers. They send electrical signals to the muscles to produce movement and relay feedback, such as pain, back to the brain. While movement of our skeletal muscles is voluntary, we often don’t consciously tell our muscles what to do, such as when walking. Nerves can be very long in order to reach all the muscles in the body. An example of a long nerve that serves many parts of the body is the sciatic nerve in the low back and legs.
Nerve compression is the most common injury to this structure:
Treatment of Orthopedic Injuries
All the above structures work together to allow movement in our bodies. Left untreated, the above injuries can result in chronic pain and significantly disrupt a person’s function. Physical therapy works to assess for orthopedic injuries and resulting impairments including weakness, tightness, instability, and decreased movement. It is not uncommon for an individual with an orthopedic injury to experience issues with two or more of the structures within the musculoskeletal system. Effective treatment includes a personalized assessment of the current condition, tailored exercises to restore function, and education regarding appropriate management and modifications.
Bones
Bones make up the body’s skeletal system. They are living tissue that consist of a hard outer layer and inner tunnels and canals that allow blood and lymphatic vessels to supply bones with nutrients and maintain health. Muscles, tendons, and ligaments attach onto bones. The average human body has 206 bones.
The most common bone injury is a fracture:
- A fracture is a crack or break in a bone and may be partial or complete. These injuries occur when excessive force is applied to a bone such as during a fall, direct hit to the body, or repetitive motions/overuse. Initial treatment of a fracture often includes stabilizing through a cast, splint, or sling. X-rays are most commonly used to diagnose fractures, however, additional imaging may be required for more complex injuries. Simple fractures take 6-8 weeks to heal, while more complex fractures can take 12 or more weeks to fully heal.
Joints
Joints (articulations) are where two or more bones meet and allow for movement. There are several types of joints that provide different degrees of movement:
- Immovable (fibrous) joints do not allow movement. Example: bones in the skull
- Partially moveable (cartilaginous) joints allow some movement. Example: spine
- Freely moveable (synovial) joints allow movement in many directions. Examples: hips, shoulders, knees, wrists
Structures within a joint include articular cartilage, synovial fluid, tendons, ligaments, and bursae. These structures help to provide cushion, lubrication, and stability to the joint. Injury to one or more of these structures can disrupt the normal function of our joints and result in pain.
Common joint injuries include dislocation, osteoarthritis, and bursitis:
- Dislocation occurs when excessive force is applied to a joint and it is forced out of its normal position. This is often the result of a fall, car accident, or direct hit to the joint. Initial treatment includes prompt medical attention to relocate the joint followed by several weeks of rest.
- Osteoarthritis is a degenerative joint disease where the cartilage and bone within the joint gradually break down. It is common in older adults and often occurs without a specific or known cause. A history of past trauma to a joint (including past surgeries) or other diseases (such as rheumatoid arthritis) can result in an increased risk of developing osteoarthritis.
- Bursitis occurs when a bursa, a fluid-filled sac providing cushion to joints, becomes inflamed and/or enlarged. Bursae are located throughout the entire body, but bursitis is most common in the shoulders, elbows, and hips. Bursitis often resolves within a few weeks.
Muscles
Skeletal muscles assist with voluntary movement, maintaining posture, and circulation of blood and other nutrients. Muscles help to provide movement by crossing joints through our body. Muscles may cross one or two joints, allowing for multiple uses of the same muscle. Nerves originating from the spinal cord attach to muscles and give the signal to produce movement.
Common muscle injuries include strains and cramps/spasms:
- Strains, or pulled muscles, occur when a sudden or excessive force is applied to a muscle, resulting in an overstretch or a tear. Rest, ice, and progressive exercise is the most common treatment for muscle strains. Mild to moderate strains take 6-10 weeks to heal, while severe strains may take 12 weeks or, in extreme cases, require surgery to repair.
- Muscle cramps or spasms are sudden and involuntary contractions of muscles that result in intense pain. They can last from a few seconds to a few minutes. Some causes for muscle cramps include overuse of a muscle, excessive sweating, maintaining a position for a long period of time, poor blood flow, nerve compression, or low mineral levels. Most muscle cramps are not harmful. Treatment and prevention of muscle cramps includes proper hydration, limiting caffeine and alcohol intake, and regular stretching and exercise of the muscles.
Ligaments
Ligaments are connective tissue that serve to hold structures together and keep them stable. Within our musculoskeletal system they are found attaching bone to bone and are present around joints. Within our joints, ligaments allow joints to move in the proper directions, stabilize and strengthen joints, reduce rotation or twisting through joints, and prevent dislocations. Examples of ligaments include the ACL (anterior cruciate ligament) in the knee and the ATFL (anterior talofibular ligament) in the ankle.
The most common injuries to ligaments include sprains and tears:
- Sprains occur when a ligament is forced outside of its normal range of motion, resulting in an overstretch or tear. Initial treatment includes rest, ice, compression (often with a brace or splint), and activity modification. Sprains most commonly occur at the ankle, knee, and wrist. Sprains typically heal within 6-12 weeks.
- Ligament tears occur with a similar mechanism to a sprain, however the ligament is pushed to the point of failure. An ACL tear in the knee is one of the most common and well known ligament tears. Initial treatment for a ligament tear is similar to a sprain. Additional imaging, such as an MRI, is often performed to determine the extent of damage and determine appropriate treatment. Surgery is often used to repair a ligament and appropriateness depends on an individual’s location of injury and activity level.
Tendons
Tendons connect muscle to bone and allow movement through the musculoskeletal system. They act as levers and help transmit force produced by the muscles to move the bones. Tendons generally have a poor blood supply, which decreases with age. This may result in poor natural healing of tendons following an injury. Examples of tendons include the Achilles tendon (connects calf muscles to heel bone) and rotator cuff tendons (connect some shoulder muscles to upper arm bone).
Common tendon injuries include tendinopathy and tears or ruptures.
- Tendinopathy refers to conditions that cause pain at the tendons, including tendinitis or tendinosis. Tendinitis refers to inflammation around a tendon and is typically due to repetitive strain and overuse. This can result in microtears within a tendon. Tendinosis occurs with overuse and is a breakdown of collagen within a tendon. Both conditions can lead to chronic pain and steroid injections are a common treatment. Tendinopathy can heal within a few weeks or last for months.
- Tendon tears occur when there is a partial or full (rupture) break in a tendon. Many tendon tears occur with overuse and increased age. They can also result from a direct injury, such as a fall. Repeated steroid injections increase an individual’s risk of a tendon tear, as the medication gradually weakens connective tissue. Tendon tears can be visualized with an MRI and may be treated with conservative or surgical measures. Exact treatment depends on the location and extent of the tear, as well as the individual’s activity level and needs.
Nerves
Nerves within the musculoskeletal system connect the brain to our muscles and serve as messengers. They send electrical signals to the muscles to produce movement and relay feedback, such as pain, back to the brain. While movement of our skeletal muscles is voluntary, we often don’t consciously tell our muscles what to do, such as when walking. Nerves can be very long in order to reach all the muscles in the body. An example of a long nerve that serves many parts of the body is the sciatic nerve in the low back and legs.
Nerve compression is the most common injury to this structure:
- Nerve compression occurs when pressure is placed along the nerve. It can be difficult to identify an exact cause for nerve compression, as it can be due to spinal discs, bones (including osteoarthritis), muscles, or connective tissues. Common symptoms include numbness or tingling, pain, and muscle weakness. Effective treatment includes accurately identifying the cause of compression and reducing pressure on the nerve. Imaging (MRI) or other diagnostic tests (nerve conduction studies) can help with identification of causes. Nerve compression may improve within a few weeks or last months.
Treatment of Orthopedic Injuries
All the above structures work together to allow movement in our bodies. Left untreated, the above injuries can result in chronic pain and significantly disrupt a person’s function. Physical therapy works to assess for orthopedic injuries and resulting impairments including weakness, tightness, instability, and decreased movement. It is not uncommon for an individual with an orthopedic injury to experience issues with two or more of the structures within the musculoskeletal system. Effective treatment includes a personalized assessment of the current condition, tailored exercises to restore function, and education regarding appropriate management and modifications.