Chapter 7
JOINTS
JOINTS
"When your joints hurt you don't want to exercise. It's hard to get started. My best advise is to stay active regardless of your age or your excuse." Rosalinda dela Salazar
"Just losing a few pounds takes so much stress off your joints. Your body feels better."
Larry Fitzgerald
"Just losing a few pounds takes so much stress off your joints. Your body feels better."
Larry Fitzgerald
A frequent tactic used in aikido is joint immobilization. In this chapter we will discuss the joints, anatomy, function, potential injuries, focusing on the shoulder, elbow, wrist, hip, knee and ankle joints.
TERMS TO KNOW
Joint: Two or more bones connected together. The joints we will cover are synovial joints, the most common articular joint in the body. It is covered by cartilage filled with fluid that permit smoother and fuller movement. They are more prone to osteoarthritis.
Ligament: A ligament connects a bone to another bone at the joint. It is a thick connective tissue surrounded by a thin layer of tissue called fascia. A tear in a ligament is called a sprain.
Tendon: A tendon connects a muscle to the bone, It is a hard, thick connective tissue surrounded by a layer of fascia. A tear of the tendon or irritation to the surrounding fascia is called tendinitis.
THE SHOULDER
The shoulder is a ball and socket joint that allows an amazing amount of rotation.
TERMS TO KNOW
Joint: Two or more bones connected together. The joints we will cover are synovial joints, the most common articular joint in the body. It is covered by cartilage filled with fluid that permit smoother and fuller movement. They are more prone to osteoarthritis.
Ligament: A ligament connects a bone to another bone at the joint. It is a thick connective tissue surrounded by a thin layer of tissue called fascia. A tear in a ligament is called a sprain.
Tendon: A tendon connects a muscle to the bone, It is a hard, thick connective tissue surrounded by a layer of fascia. A tear of the tendon or irritation to the surrounding fascia is called tendinitis.
THE SHOULDER
The shoulder is a ball and socket joint that allows an amazing amount of rotation.
- The round head of the humerus is attached to the shallow cup of the glenoid cavity of the acromium. The joint capsule is surrounded by a thick capsule made of fascia connective tissue.
- A thin rubber band like tissue called the labrum surrounds the entrance to the glenoid cavity joint socket that prevents the head of the humerous from dislocating from the joint.
- The acromioclavicular joint (AC joint) connects the acromion to the clavicle, the collar bone. The clavicle is the most fractured bone in the body.
- Inside the joint capsule there are small fluid filled pockets of fluid called bursa. Inflammation of the bursa is called bursitis.
Bones to the shoulder bones are attached to four rotator cuff tendons, extensions of strong muscles that move the shoulder. The tendons are prone to injury, tears, and irritation from constant stretching. It gets worse with age when the tendons seem to dry out and are more fragile.
Impingement syndrome is a common condition where the inflamed rotator cuff tendons are compressed by the bones in the shoulder. This is caused with repeated activity of raising the arms above the head, or falling directly on the shoulder, such as in ukemi. It hurts to place your hands behind your back, raise your arms up or sleeping on the affected shoulder.
The problem is best treated with rest of the arm, physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and sometimes by steroid injection of the shoulder.
Impingement syndrome is a common condition where the inflamed rotator cuff tendons are compressed by the bones in the shoulder. This is caused with repeated activity of raising the arms above the head, or falling directly on the shoulder, such as in ukemi. It hurts to place your hands behind your back, raise your arms up or sleeping on the affected shoulder.
The problem is best treated with rest of the arm, physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and sometimes by steroid injection of the shoulder.
The most frequently torn rotator cuff is the supraspinatus tendon, atop the shoulder.
A rotator cuff tendonitis or tear is when the tendon, the hard tissue that attaches muscle to the bone, is frayed or torn. It can be caused by overuse, especially in older adults, as the tendon becomes worn and more fragile. Reaching above your head, chronic poor posture, or direct trauma to the shoulder, such as a fall, can injure the rotator cuff.
When the tendon is frayed or torn there is deep pain to the shoulder, pain with overhead activities, or any movement of the arm. You are unable to sleep on the shoulder. Dependent on the tear there is weakness and increasing loss of movement to the arm.
If injured the shoulder should be rested, NSAIDs and ice may help. An MRI, a Magnetic Resonance Imaging test, is sometimes ordered by orthopedists, bone specialists, to determine the damage to the tendon. Sometimes physical therapy can rehabilitate the shoulder, sometimes surgery is needed. It takes at least six months after the surgery and intense physical therapy to return the shoulder to normal.
LABRAL TEAR AC SEPARATION
- The labrum, the rubber band like tissue surrounding the entrance - The clavicle collar bone is attached to the acromion, the shoulder
to the shoulder socket prevents the humoral head from displacing girdle. This connection is called the acromioclavicular AC joint.
from the joint. - It is usually damaged by a direct fall and graded 1-3. 3 is a complete
- It can be damaged if the shoulder is dislocated, lifting overhead or separation of the joint and may need surgery to repair.
falling directly on the shoulder. - AC separation causes pain with movement of the arm and a bony
- There is usually pain and a popping, crackling feeling to the joint with bump to the joint that may be permanent.
movement. The shoulder becomes weak with movement. - The injury can lead to long term problems with the shoulder.
- The tear can be treated with rest, NSAIDs, and therapy. Sometimes a - It can be treated with rest, NSAIDS, and therapy. Surgery is rare.
steroid injection can help.
- If surgery is required it can take 9-12 months for the labrum to heal
with PT. The arm will be totally immobilized the first 4 weeks after surgery.
- The labrum, the rubber band like tissue surrounding the entrance - The clavicle collar bone is attached to the acromion, the shoulder
to the shoulder socket prevents the humoral head from displacing girdle. This connection is called the acromioclavicular AC joint.
from the joint. - It is usually damaged by a direct fall and graded 1-3. 3 is a complete
- It can be damaged if the shoulder is dislocated, lifting overhead or separation of the joint and may need surgery to repair.
falling directly on the shoulder. - AC separation causes pain with movement of the arm and a bony
- There is usually pain and a popping, crackling feeling to the joint with bump to the joint that may be permanent.
movement. The shoulder becomes weak with movement. - The injury can lead to long term problems with the shoulder.
- The tear can be treated with rest, NSAIDs, and therapy. Sometimes a - It can be treated with rest, NSAIDS, and therapy. Surgery is rare.
steroid injection can help.
- If surgery is required it can take 9-12 months for the labrum to heal
with PT. The arm will be totally immobilized the first 4 weeks after surgery.
Osteoarthritis is to wear and tear of the synovial joint. This can happen to most joints, especially those which are weight bearing or are frequently overused, such as the shoulders, hands and knees. The protective lining of the joint is eroded away and bone rubs against bone. In time ligaments and tendons stretch. All this causes pain with movement and overuse of the joint involved.
The arthritis can be treated with rest, NSAIDs, steroid injection of the joint and therapy. Glucosamine-chondroitin is a supplement that may help the joints, but it is expensive. With new technology there are more knee and shoulder replacements due to worn out joints.
The arthritis can be treated with rest, NSAIDs, steroid injection of the joint and therapy. Glucosamine-chondroitin is a supplement that may help the joints, but it is expensive. With new technology there are more knee and shoulder replacements due to worn out joints.
THE ELBOW
The elbow is a synovial hinge joint connecting the humerus of the upper arm to the radius and ulna of the lower arm. It allows flexion and extension, the forearm to bend and extend. It allows internal and external rotation, the elbow at your side and the arm moving in and out like a gate. It allows supination and pronation, the palm up and down.
The bicep muscle tendon attaches to the anticubital front of the elbow, the tricep muscle tendon to the rear. The forearm muscle tendons attach to either the lateral or medial epicondyle, bony prominence on each side of the distal humerus.
The elbow is a synovial hinge joint connecting the humerus of the upper arm to the radius and ulna of the lower arm. It allows flexion and extension, the forearm to bend and extend. It allows internal and external rotation, the elbow at your side and the arm moving in and out like a gate. It allows supination and pronation, the palm up and down.
The bicep muscle tendon attaches to the anticubital front of the elbow, the tricep muscle tendon to the rear. The forearm muscle tendons attach to either the lateral or medial epicondyle, bony prominence on each side of the distal humerus.
Lateral epicondylitis, irritation to the lateral (outside) epicondyle is a common problem caused from constant over rotation of the forearm. This is called Tennis Elbow.
Medial epicondylitis, irritation to the medial (inside) epicondyle, is called Tennis Elbow.
Both type of epicondylitis injuries, aching pain to the elbow and forearm, worse with movement, is from overuse and is difficult to treat. The radial and ulnar nerves rung along the bone here. Rest, ice, NSAIDs can help, but it can take time to resolve.
THE WRIST
The wrist is the most complex joint in the body and most prone to injury. Diligent stretching of the wrist helps prevent injury. In aikido the wrist is frequently grabbed and twisted in procedures like nikkyo, sankyo, kote gashi and yonkyo.
- From the elbow is the forearm, made up of the radius and ulna. the radius connects to the thumb.
- There are 27 bones to the hand and wrist, connected to the radius and ulna
- 8 irregular shaped carpal bones which allows the wrist its amazing movement..
- 5 metacarpal bones to the palm of the hand.
- 14 bones of the phalanges, the fingers connected to each other by synovial joints.
- Ligaments connect the bones together.
- Tendons connect the muscles of the forearm to the bones in the wrist and hands.
- The entire complex is covered with fasica connective tissue. Lubricated fascia covering the tendons allow them to slide over each other with smooth movement.
The most common injury to the wrist is tendinitis. Continued abuse to the tendon due to overuse can form scar tissue which interferes with it moving smoothly beneath the fascia.
Adjacent to the tip of the ulna (the pinky side of the wrist) is a small round piece of cartilage called the TFC. The triangular fibrocartilage can be damage with severe twisting of the wrist. If torn the individual can not hold objects with their hand. It may require surgery.
The large medial nerve travels through the middle of the wrist and palm passing through the carpal bones. Surrounded in a fascia sheath this nerve can be compressed by chronic pressure or blunt trauma. This is called Carpal Tunnel Syndrome.
CTS causes numbness, pain to the 2,3,4th fingers, and is worse at night. Limited use of the hand, wrist brace and therapy, sometimes a steroid injection or surgical release of the tendon and fascia is needed.
Adjacent to the tip of the ulna (the pinky side of the wrist) is a small round piece of cartilage called the TFC. The triangular fibrocartilage can be damage with severe twisting of the wrist. If torn the individual can not hold objects with their hand. It may require surgery.
The large medial nerve travels through the middle of the wrist and palm passing through the carpal bones. Surrounded in a fascia sheath this nerve can be compressed by chronic pressure or blunt trauma. This is called Carpal Tunnel Syndrome.
CTS causes numbness, pain to the 2,3,4th fingers, and is worse at night. Limited use of the hand, wrist brace and therapy, sometimes a steroid injection or surgical release of the tendon and fascia is needed.
THE HIP
The hip is a ball and socket synovial joint that connects the head of the femur, the long bone of the thigh, into the acetabulum of the pelvis. It is surrounded by strong musculature that we will discuss in future chapters. The joint is designed so the leg can be extended forward and back, side to side, and externally and internally rotated.
The hip is a ball and socket synovial joint that connects the head of the femur, the long bone of the thigh, into the acetabulum of the pelvis. It is surrounded by strong musculature that we will discuss in future chapters. The joint is designed so the leg can be extended forward and back, side to side, and externally and internally rotated.
- The hip includes tenon insertions from the groin, hip flexors, glutes,
muscles and hamstrings. Repetitive motion and strain can cause
inflammation to the tendon. Tendinitis causes gradual onset of pain to the hip with movement, decreased pain with rest. Treat with rest, ice, NSAIDs and stretching.
- Bursitis of the hip is caused by inflammation to the trochanter or
ishial bursa. It causes an dull burning pain and is worse with weight-
bearing and when sleeping. It is found to the outer buttock and is caused by overuse or strain to the joint, especially by a direct fall. Treat with rest, ice, NSADIs. Infected, the bursitis requires antibiotics.
- A fractured hip is when he neck of the femur, the angulated bone between the long bone of the femur and the joint itself, fractures. It is from a fall or direct trauma. Most often it requires a hip replacement. This includes a steel ball and femur neck inserted into the femur shaft. There are frequent complications with this type of fracture.
muscles and hamstrings. Repetitive motion and strain can cause
inflammation to the tendon. Tendinitis causes gradual onset of pain to the hip with movement, decreased pain with rest. Treat with rest, ice, NSAIDs and stretching.
- Bursitis of the hip is caused by inflammation to the trochanter or
ishial bursa. It causes an dull burning pain and is worse with weight-
bearing and when sleeping. It is found to the outer buttock and is caused by overuse or strain to the joint, especially by a direct fall. Treat with rest, ice, NSADIs. Infected, the bursitis requires antibiotics.
- A fractured hip is when he neck of the femur, the angulated bone between the long bone of the femur and the joint itself, fractures. It is from a fall or direct trauma. Most often it requires a hip replacement. This includes a steel ball and femur neck inserted into the femur shaft. There are frequent complications with this type of fracture.
THE KNEE
The knee is a complicated, fragile synovial hinge joint that must carry the body's weight in different dynamic situations. It is capable of extension forward and back, and slight internal and external rotation. The femur connects with the tibia and fibula of the lower leg. The ligaments and tendons allow locomotion, twisting and pivoting.
The knee is a complicated, fragile synovial hinge joint that must carry the body's weight in different dynamic situations. It is capable of extension forward and back, and slight internal and external rotation. The femur connects with the tibia and fibula of the lower leg. The ligaments and tendons allow locomotion, twisting and pivoting.
Jumper's Knee Runner's Knee
Tendonitis is inflammation to the patella tendon. It is caused by The generic term for chondromalacia, anterior pain syndrome and
jumping, kneeling, squatting, and chronic problems to the knee. illiotibial band syndrome (pain to the lateral knee).
There is pain to the bottom of the patella and hurts with any There is pain to the knee cap and can be caused by poor tracking of
movement. the patellar tendon, weak hamstrings (behind the upper leg), and
poor footwear.
It is treated with ice, rest, NSAIDs and stretching.
Symptoms is aching pain after climbing, running, jumping or
kneeling. Treat with rest, ice, NSAIDs and stretching.
Osgood Schlatter Disease is caused by constant jumping and running, especially in adolescent teens. The patellar tendon tears away from the tibia below. Calcium builds up and a painful bony lump can develop. There is no treatment for it, but ice and NSAIDs. It can also occur in adults.
The meniscus is cartilage covering the tibial plateau of the knee, the larger bone to the lower leg. It acts like a shock absorber for the ends of the two large bones, the femur and tibia.
The cartilage is thick, tough connective tissue that dries out over time and can be worn thin. Overuse, running, quick abrupt turns and squatting can tear or erode the meniscus so the bone rubs against bone.
- The cartilage is thick, tough connective tissue that dries out over time and can be worn thin.
- It can be torn by abrupt trauma or eroded from overuse, especially jumping, running and quick abrupt turns.
- Symptoms include popping to the knee, pain, stiffness and swelling. The knee feels weak and like it may give way.
- A person can function with a meniscus tear to the knee, though at times it is painful.
- Treatment includes ice (avoid heat that increases swelling), NSAIDs, steroid injection or surgery. Knee pads or braces may or may not help.
Degeneration of the knee results from osteoarthritis leading to chronic pain. The knee is a common joint for artificial knee replacement. An artificial joint can last about 10 years with normal use.
- It can be torn by abrupt trauma or eroded from overuse, especially jumping, running and quick abrupt turns.
- Symptoms include popping to the knee, pain, stiffness and swelling. The knee feels weak and like it may give way.
- A person can function with a meniscus tear to the knee, though at times it is painful.
- Treatment includes ice (avoid heat that increases swelling), NSAIDs, steroid injection or surgery. Knee pads or braces may or may not help.
Degeneration of the knee results from osteoarthritis leading to chronic pain. The knee is a common joint for artificial knee replacement. An artificial joint can last about 10 years with normal use.
THE ANKLE
The ankle supports a person's weight and is synovial hinge joint that permits the the foot to go up and down, with a certain amount of rotation.
The tibia and fibula of the lower leg connects to the talus, one of 7 bones to the foot. The foot also contains 5 metatarsals and 14 bone of the toe phalanges. The bones are connected to each other by tendons. Muscles attach to the bones with ligaments.
The ankle supports a person's weight and is synovial hinge joint that permits the the foot to go up and down, with a certain amount of rotation.
The tibia and fibula of the lower leg connects to the talus, one of 7 bones to the foot. The foot also contains 5 metatarsals and 14 bone of the toe phalanges. The bones are connected to each other by tendons. Muscles attach to the bones with ligaments.
- A sprain is a tear to the ligament. 90% sprain ankle injures occur in inversion of the foot; the ankle rolls out, the foot inward.
- Typically the lateral talar-fibular ligament is injured. Medial injures are less frequent and may be more serious.
- Sprains are graded 1st, 2nd, and 3rd. 1st degree is a mild sprain. 3rd degree sprains the ligament is completely torn.
- An avulsion fracture, the ligament pulls away from the bone with a small chip. The chip fracture can easily heal if the ankle is immobilized.
Sprains should be treated with respect. If not healed properly scar tissue can fill in the tear and is more easily re-torn in the future. If sprained avoid weight bearing, immobolize the ankle, apply ice and NSAIDs can be used for pain. Xrays are routinely taken, sometimes an MRI and surgery is needed.
The tissue attached to the heel is the Achilles Tendon which attaches the gastrocnemus calf muscle to the calcaneus heel. The tendon is very touch. Inflammation of the fascia covering the tendon is called Achilles tendonitis. The tendon or the heel is very tender. It takes sufficient force to tear the Achilles tendon, there is an audible pop. If torn the tenon will usually require surgery with a significant recovery time.
A fractured ankle is more often to the fibula, the smaller, non-weight bearing bone to the outside of ankle. If the fracture is displaced higher up the fibula,causing the fracture to be unstable, surgery may be needed to connect the broken bone.
More complicated is a fracture to the tibia,the weight bearing bone of the ankle. These often require surgical ORIF, open reduction and internal fixation, metal screws and maybe application of a metal plate to hold the fracture in place. Once healed the screws may or may not be removed.
- Typically the lateral talar-fibular ligament is injured. Medial injures are less frequent and may be more serious.
- Sprains are graded 1st, 2nd, and 3rd. 1st degree is a mild sprain. 3rd degree sprains the ligament is completely torn.
- An avulsion fracture, the ligament pulls away from the bone with a small chip. The chip fracture can easily heal if the ankle is immobilized.
Sprains should be treated with respect. If not healed properly scar tissue can fill in the tear and is more easily re-torn in the future. If sprained avoid weight bearing, immobolize the ankle, apply ice and NSAIDs can be used for pain. Xrays are routinely taken, sometimes an MRI and surgery is needed.
The tissue attached to the heel is the Achilles Tendon which attaches the gastrocnemus calf muscle to the calcaneus heel. The tendon is very touch. Inflammation of the fascia covering the tendon is called Achilles tendonitis. The tendon or the heel is very tender. It takes sufficient force to tear the Achilles tendon, there is an audible pop. If torn the tenon will usually require surgery with a significant recovery time.
A fractured ankle is more often to the fibula, the smaller, non-weight bearing bone to the outside of ankle. If the fracture is displaced higher up the fibula,causing the fracture to be unstable, surgery may be needed to connect the broken bone.
More complicated is a fracture to the tibia,the weight bearing bone of the ankle. These often require surgical ORIF, open reduction and internal fixation, metal screws and maybe application of a metal plate to hold the fracture in place. Once healed the screws may or may not be removed.
Inflammation to the fascia covering the bottom of the foot is called plantar fasciitis. It is usually caused by walking or running on the toes or improper footwear. there is pain with walking and bending the toes. Rest,, NSAIDs and inserts for the shoes may help.
HYGIENE NOTE:
Traditionally aikidokas train barefooted on mats. The mats are routinely cleaned after every training session but caution should be taken. Proper care of one's feet and cleanliness is appreciated. Wear clean socks with your shoes. Wash your feet. Trim your toenails.
Tinea pedis, Athlete's Foot, is a fungus to the foot and toes and is very contagious. It can be identified by red, inflamed skin that itches and can be treated with anti-fungal cream from the pharmacy.
POINTS TO REMEMBER:
- Joints connect bones to other bones with ligaments. Most are synovial joints that are prone to osteoarthritis.
- The ulnar nerve runs against the bone to the wrist very close to the skin. That is why nikkyo in aikido can be so painful.
- Ice is best with joints when injured. Heat is better with muscles.
- Non-steroidal anti-inflammatory (NSAIDs) are effective for pain and inflammation, but caution should be taken. These drugs are hard on the stomach and should not be taken if allergic to the same. If any questions, contact your medical professional.
- This chapter provides information about injuries. This is not meant to be a definitive diagnosis and treatment guide for orthopedic injuries. If there is any problem, the individual should see their medical provider.