Boston Celtic Rajon Rondo really showed what kind of stuff he is made of yesterday during  a pivotal Game 3 of the NBA Eastern Conference semifinals.  In the 3rd quarter, Rondo was fouled by Miami Heat Dwayne Wade. The two got tangled up together and crashed onto the floor. Rondo landed awkwardly on his left arm, dislocating his left elbow in the process. Although he was taken off the court to be examined by team physician Dr. Brian McKeon, he returned at the end of the  quarter, with his left arm wrapped in a protective sleeve. Although he was obviously favoring his left arm, it didn’t stop him from landing 2 right-handed shots, and his return to the floor invigorated his teammates to beat the Heat 97-81.

The elbow is a joint where three bones come together. Your upper arm contains one long bone called the humerus and your lower arm contains two long bones called the radius and the ulna. The pointy tip of your elbow is actually part of the ulna and this part is called the olecranon. The close part of the radius bone that makes up part of the elbow joint is called the radial head. Three ligaments (sturdy connective tissue bands) help hold the bones together : the ulnar collateral ligament, radial collateral ligament, and annular ligament.

Elbow dislocations are not common,  constituting 10% to 25% of all injuries to the elbow, and typically occur when a person falls onto an outstretched hand. When the hand hits the ground, the force is transmitted to the elbow. This force causes a turning motion which can drive and rotate the elbow out of its socket. Elbow dislocations also happen in car accidents when the passengers reach forward to cushion the impact. Similar to a fall, the force is sent through the arm and can dislocate the elbow.

Depending on the severity, an elbow dislocation can injure not only the joint, but the bones, muscles and ligaments of the elbow as well. In the most severe cases, the blood vessels and nerves may also be involved. Symptoms include severe pain and the elbow may look deformed.

An elbow dislocation is considered a medical emergency and the dislocation should be realigned as soon as possible. This can often be done in an emergency department with the patient given sedation and pain medications. Afterwards, the arm is immobilized in a splint or sling for two to three weeks, followed by early motion exercises.

Boston Celtics center Kendrick Perkins left Game 6 of the NBA finals when he landed awkwardly when he went up for an offensive rebound about 10 minutes into the first quarter. He laid on the floor clutching his knee and had to helped off the court. Xrays revealed that he suffered sprains to both his medial collateral ligament and posterior cruciate ligament. It is unknown whether he will be able to play in Game 7 on Thursday.

“Perk brings rebounding and defense to the game, and toughness,” said Celtics captain Paul Pierce. “We lose that, but that’s not an excuse. We’re a mentally tough team. We’ve had injuries all year that we’ve dealt with. We know how to win when guys go down, so that’s no excuse for us.”

A sprain is an injury to the ligaments (thick bands of cartilage that connect bone to bone)caused by a fall or outside force that pulls the surrounding joint beyond its normal range of movement. The degree of sprain can range from a stretched ligament to a completely torn ligament.

The knee is essentially a modified hinge joint located where the end of the thigh bone (femur) meets the top of the shin bone(tibia). Four main ligaments connect these two bones:

• Medial collateral ligament (MCL) — runs along the inner part of the knee and prevents the knee from bending inward.
• Lateral collateral ligament (LCL) — runs along the outer part of the knee and prevents the knee from bending outward.
• Anterior cruciate ligament (ACL) — lies in the middle of the knee. It prevents the tibia from sliding out in front of the femur,and provides rotational stability to the knee.
• Posterior cruciate ligament (PCL) — works with the ACL. It prevents the tibia from sliding backwards under the femur.

The ACL and PCL cross each other inside the knee, forming an “X.”

Cruciate ligament injuries are sometimes referred to as sprains. They don’t necessarily cause pain, but they are disabling. The anterior cruciate ligament is most often stretched or torn (or both) by a sudden twisting motion (for example, when the feet are planted one way and the knees are turned another). The posterior cruciate ligament is most often injured by a direct impact, such as in an automobile accident or football tackle. If a cruciate ligament is injured, you may hear a popping sound, and the leg may buckle when you try to stand on it.

The medial collateral ligament is more easily injured than the lateral collateral ligament. The cause of collateral ligament injuries is most often a blow to the outer side of the knee that stretches and tears the ligament on the inner side of the knee. Such blows frequently occur in contact sports such as football or hockey. When injury to the medial collateral ligament occurs, you may feel a pop and the knee may buckle sideways. Pain and swelling are common.

As with most such injuries, care immediately after the injury consists of RICE therapy-
Rest, Ice, Compression, and Elevation). Medical attention should be sought to thoroughly evaluate the injury. If the injury is mild and not completely through the entire ligament, conservative management including immobilization with a knee brace and physical therapy may surfice. If the ligament is completely torn, it can not be repaired, but must be replaced, usually during arthroscopic surgery.

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Resounding Health(tm) Knee Problems

LA Lakers center Andrew Bynum played for 28 minutes in Game 1 of the NBA Finals last night, despite an ongoing knee injury. Bynum has been playing with torn cartridge in his right knee for more than a month. According to the LA Times, “Bynum had 2 1/2 ounces of fluid drained from his knee Monday, but the fluid returned about 12 hours later, causing his knee to swell up again.”

In 2008, Bynum has missed the NBA Finals because of a left knee injury. He wasn’t going to let that happen again. “It’s motivating for me,” Bynum said about playing through his injury. “I’m just going to keep going out there and playing as hard as I can, and whatever happens, happens.”

The knee joint is the largest joint in the body and is the junction of three bones: the femur (thigh bone or upper leg bone), the tibia (shin bone or larger bone of the lower leg), and the patella (kneecap). The patella is 2 to 3 inches wide and 3 to 4 inches long. It sits over the other bones at the front of the knee joint and slides when the knee moves. It protects the knee and gives leverage to muscles.

The ends of the three bones in the knee joint are covered with articular cartilage, a tough, elastic material that helps absorb shock and allows the knee joint to move smoothly.

A meniscus is a C-shaped piece of cartilage located in the knee joint. There are two in each knee joint. The menisci act as a buffer between the bones, protecting the joint. They serves as a shock-absorption system, assisting in lubricating the knee joint, and limiting the ability to  over flex or extend the leg at the joint.

Meniscal tears are most commonly caused by twisting or over-flexing the joint and frequently happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, may be involved.

The most common symptoms of meniscal tear are:

• Pain
• Clicking or popping (especially at the time of the injury)
• Stiffness and swelling
• Catching or locking of the knee
• The sensation of the knee “giving way”
• Decreased range of motion at the knee

Treatment depends on the severity of the tear. Small tears may only need “RICE” treatment (rest, ice, compression, elevation) to allow the cartilage to heal on its own. Non-steroidal anti-inflammatory medications like aspirin or ibuprofen may be added for pain relief. More serious tears usually require surgical treatment- usually done arthroscopically, where the torn cartilage is trimmed or repaired.

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Resounding Health(tm) Torn Knee Cartilage