Joint Trauma: Perspectives of a Chiropractic Family Physician

Joint Trauma:
Perspectives of a Chiropractic Family Physician

Clinical Monograph 8

By R. C. Schafer, DC, PhD, FICC

INTRODUCTION

The general stability of synovial joints is established by action of surrounding muscles. Excessive joint stress results in strained muscles and tendons and sprained or ruptured ligaments and capsules. When stress is chronic, degenerative changes occur.

The lining of synovial joints is slightly phagocytic, is regenerative if damaged, and secretes synovial fluid that is a nutritive lubricant having bacteriostatic and anticoagulant characteristics. This anticoagulant effect may result in poor callus formation in intra-articular fractures where the fracture line is exposed to synovial fluid. Synovial versus mechanical causes of joint pain are shown in Table 1.

Table 1. Synovial vs Mechanical Causes of Joint Pain

Feature	Synovitic Lesions	Mechanical Lesions
Onset	Symptoms fairly consistent, during use and at rest.	Symptoms arise chiefly during use
Location	Any joint may be involved.	Primarily involves weight-bearing joints.
Course	Usually fluctuates. Episodic flares are common.	Persistently worsening progression. No acute exacerbations.
Stiffness	Prolonged in the morning.	Little morning stiffness.
Anti-inflammatory effect	Aided by cold and other anti-inflammatory therapies.	Anti-inflammatory therapy of only minimum value.
Major pathologic features	Negative radiographic signs or diffuse cartilage loss, marginal bony erosions, but no osteophytes.	Radiographic signs of cartilage loss and osteophyte developments