Joint Injuries: Specialists & Information

Depending on their range of motion, joints have a very complex structure and are therefore susceptible to a wide variety of injuries.

The bones that form a joint have thin layers of articular cartilage at their respective ends. Between these two articular surfaces lies a narrow space that allows for movement—the so-called joint space. To prevent the articular cartilage surfaces from rubbing dry against each other, the joint space is filled with synovial fluid. This “joint lubricant” nourishes the cartilage and ensures that the joint remains mobile. 

Joints are enclosed by a joint capsule that supports and protects the joint. Together with the joint ligaments and capsular ligaments, this forms a complex capsular-ligamentous apparatus that stabilizes the joint and supports its function.

However, these highly complex systems are also susceptible to a wide variety of injuries.

Depending on the severity of the injury, the following four main types of joint injuries are distinguished:

• Joint contusion,
• joint sprain,
• joint dislocation, and 
• joint fracture.

A special type of joint injury is a joint cartilage injury. This can occur with contusions, dislocations, or sprains. For example, in knee joint injuries, small cartilage fragments are often observed on the kneecap.

Such cartilage fragments can lead to increased wear and tear on the cartilage surfaces within the joint even later on. This can result in conditions such as osteoarthritis.

Joint injuries are usually the result of external force, such as

• twisting,
• blows, or
• falls.

In cases of very severe force, such as in an accident, fractures or bleeding often occur as well.

Joint injuries are usually immediately recognizable by a sudden, severe pain. This is accompanied by swelling and increasing difficulty moving the joint. In severe cases, joint dislocation may also be observed following the accident.

The easy-to-remember PECH formula was developed for first aid in cases of joint injuries:

• Rest: The injured joint must be immobilized immediately. Support the affected person in any position they find comfortable. In this position, they will experience the least amount of pain.
• Ice: Cooling the injured joint should begin very soon after the injury. To do this, apply cold cloths or ice packs for about 30–45 minutes.
• Compression: The injured joint can also be supported with a compression bandage. This helps alleviate some of the pain. Additionally, the bandage can be used to secure an ice pack or similar item in place.
• Elevation: To reduce potential bleeding and the formation of hematomas at the injured joint, the affected limb should be elevated.

For minor injuries, consult a doctor afterward. After accidents or serious injuries involving bleeding, among other things, call 112 for emergency assistance. 

Children can also quickly injure their joints from falls © famveldman | AdobeStock

The diagnostic process for joint injuries also begins with a medical history and a clinical examination. The examination includes an assessment of joint mobility and reflexes to rule out neurological damage following an accident.

Imaging techniques are used to assess the extent of the injury, e.g.,

• ultrasound,
• X-rays,
• magnetic resonance imaging (MRI), or
• computed tomography (CT).

Minimally invasive diagnostic procedures also include joint aspiration and arthroscopy. During arthroscopy, instruments and a miniature camera are inserted directly into the injured joint through a small surgical incision.

In addition to first aid, pain-relieving medications and immobilization of the affected joint usually play a major role in the initial stages.

If the joint is dislocated—which is common with the knee or shoulder joints—the doctor will attempt to “put the joint back in place” (repositioning).

Fluid buildup resulting from a joint injury often leads to painful swelling around the joint. In this case, the joint is punctured to drain the excess fluid and thereby reduce the pressure on the joint.

In most cases, joint injuries are also treated with physical therapy. The goal of physical therapy is to improve joint mobility. After a prolonged period of immobilization, it is intended to gradually strengthen the muscles and joints again.

After severe joint injuries, such as those resulting from an accident or torn ligaments, surgical treatment is usually required:

• Torn ligaments in the joint’s ligamentous apparatus are sutured.
• In cases of bone fractures, some bone and cartilage fragments may require plates, screws, or pins for fixation and stabilization. In these cases, a longer recovery period for the joint injuries and an extended rehabilitation process are to be expected.

The more severe the joint injury was and the more often a joint has been damaged over the course of a person’s life, the higher the risk of developing one of the long-term consequences. For example, this can lead to

• affected individuals may develop secondary osteoarthritis,
• bone healing defects may occur,
• the joint becomes unstable because the ligaments have “stretched out” or the supporting muscles are too weak,
• the damaged joint stiffens and thus becomes immobile.