Musculo-skeletal   [back to the Category]

General comments on articular illnesses linked to ballet   [read the french version]

Author :   Docteur Anne Thiescé

Articular affections unite all acute or chronic affections of the various structures that make up an articulation: osseous and cartilaginous parts, ligaments, the articular capsule and its synovial membrane which can form intra-articular synovial folds, meniscal fibrocartilages and marginal dropsical swellings.

Articular stability comes from the combination of muscular coaptation and passive articular elements: especially ligaments. Ligaments have insufficient mechanical resistance to be the sole factors of articular stability.

Acute trauma affections

Sprains with elongation or rupture of the ligaments due to a sudden distortion of the articulation but without permanent displacement of the articular surfaces.

The benign sprain corresponds to a stretching of the ligaments with micro ruptures, passive stability is maintained. The serious sprain corresponds to a complete rupture of the ligament, there is bruising and a pathological articular gap. Fig.1.
The treatment for benign sprains is functional, with ice, drainage, physiotherapy and gentle movements followed by isometric, then proprioceptive, muscular strengthening sometimes using a light support strapping.
The treatment for medium strains is orthopedic: immobilisation in plaster or strapping followed by re-education.
The treatment for serious sprains is plaster or surgical.

The luxation or dislocation of an articulation is the total or partial, permanent displacement of the articular surfaces. A partial displacement is called a subluxation.

The reduction of the displacement is urgent but must not be carried out without X-rays. In actual fact, these different lesions can be accompanied by peri-articular lesion fractures with tendinous ruptures or osseous avulsions. These acute trauma affections can result in chronic pathologies with, in particular, chronic laxities.

Chronic laxity, articular instability

Articular instability covers two different concepts: objective laxity or a subjective feeling of insecurity.
Laxity or excessive joint mobility, can be constitutional or acquired as a result of a trauma with, at least partial, rupture of a ligament. This laxity is not obligatorily accompanied by a feeling of instability.
Subjective instability is the lack of proprioceptive information, sometimes even after the ligament is completely mended. Treatment must take proprioception recovery into account.
There is a risk that the sprain will reoccur with subjective instability as with pathological laxity.


Dropsical swellings and semilunar cartilages come under intra-articular foreign body pathology.

The semilunar cartilages and dropsical swellings are fibrocartilages interposed between the articular surfaces which allow a better articular congruence or better articular jointing. They absorb stress and provide better distribution over facing articular surfaces. They promote articular lubrication.
Semilunar cartilages are attached by the articular capsule, dropsical swellings are attached by the articular capsule and by the periphery of the articular surfaces.
These fibrocartilages can be disinserted, torn or crushed with thwarted articulation. These different injuries will produce an articular inflammation with recurring effusion, articular jamming – a piece of this fibrocartilage becoming stuck between the articular parts (knee, hip) -, or feelings of dislocation, articular jointing impairment (shoulder). The attitude, depending on the symptomatology and the frequency experienced by the patient, can be to wait and see or surgical using arthroscopy. Always try to maintain as many of the semilunar cartilages as possible when jamming is rare because of their predominant role in articular protection against arthrosis or degenerative pathology.


Arthrosis or degenerative articular pathology

Whatever their way of life, no population is spared the ubiquitous process of Arthrosis. Arthrosis corresponds to a deterioration of the cartilages, to a peripheral osseous construction and to a hyper-pressure of the bone. X-rays will show that these lesions respectively correspond to the pinching of the articular spacing, to osteophytes or "lipping of vertebra", and to hyper-pressure geodes of the sub-chondral bone. Fig.2.

It is a result of age, articular overexertion, obesity and sex.

Clinically, arthrosis can develop from an articulation that becomes progressively stiff either with shooting pains or with a seat of chronic pain.