Transcript Injury Review PPT

INJURY REVIEW
ACHILLES TENDON RUPTURE
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Weekend warrior injury
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quick acceleration/jumping-type sports
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MOI
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forceful PF of foot while the knee is extended
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Unexpected rapid DF of the foot, stepping into a hole or stepping on a curb
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violent dorsiflexion when jumping from a height and landing on a plantar flexed foot
S/S
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report feeling a kick in the back of the calf and then severe sharp pain
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loud pop or snap sound and swelling.
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Limping, cant plantarflex
TX
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Immobilize
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PRICE, crutches
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Refer
GRADE 1 INVERSION ANKLE SPRAIN
MOI: Foot inversion, PF, with mild stretching of the ATF
S/S:
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Mild pain and disability
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Weight bearing is not impaired
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Mild point tenderness
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Mild/slight swelling over ligament
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No joint laxity (looseness)
TX:
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PRICE
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Progressive Resistance Exercises (PRE’s)
GRADE 2 INVERSION ANKLE SPRAIN
MOI:
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Moderate force in inversion, PF
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Complete tear of the ATF and stretch of the CF
S/S:
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c/o pop or snap
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Moderate pain and disability
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Weight bearing is difficult
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Tenderness and edema w/blood in the joint
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Ecchymosis
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+ talar tilt, + anterior drawer tests
TX:
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PRICE
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x-ray, crutches
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PF and DF exercises
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ROM, PRE’s
GRADE 3 INVERSION ANKLE SPRAIN
MOI:
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Severe force in inversion, PF
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Involving ATF, CF and PTF
S/S:
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c/o pain in region of lateral malleolus
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Swelling is diffused along w/ discoloration
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No possible weight bearing
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Major loss of function (LOF)
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Severe swelling
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+ talar tilt, + anterior drawer tests
TX:
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PRICE
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Crutches, refer for x-ray
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ROM, PRE’s
EVERSION ANKLE SPRAIN
MOI:
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Eversion, DF
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Avulsion fx of the medial malleolus in 15% of cases
S/S:
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c/o pain over the foot and lower leg
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Unable to bear weight on the foot
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Ab/adduction causes pain
TX:
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x-ray to rule out fx.
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PRICE
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NSAIDS
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PRE’s for posteromedial ankle muscle and for arch, could lead to pronation of the foot.
SYNDESMOTIC ANKLE SPRAIN (HIGH ANKLE SPRAIN)
Relatively common in football
MOI:
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Forceful external rotation of the ankle
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While lying on the field w/ ankle externally rotated, someone falls on the back of the leg and foot, forcing ER
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Lateral blow to knee/leg with foot planted, forcing ER
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External force can rupture ant. Tibiofibular lig., posterior tibiofibular lig., or fracture the posterior tibial tubercle.
S/S:
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c/o severe pain, loss of function
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When ankle is passively externally rotated, major pain in lower leg
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Pain along the antero-lateral leg
TX:
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Out of competition
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PRICE
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NSAIDS
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X-ray can reveal fracture or widening of the ankle mortise
MENISCUS TEAR
 Medial has higher incident of injury because medial meniscus attaches to the tibia and to the capsular ligament.
 MOI: firm Foot fixation with rotary force (Torsion) while the knee is extended of flexed, cutting motion,
squatting
 S/S: swelling, discoloration, pain along the joint line, loss of ROM, locking, clicking, knee is giving way, pain with
squatting and stairs.
 TX: MRI, if locked may have to be put under anesthesia to unlock it, surgery, strengthening and ROM exercises,
ice.
OTHER INJURIES
MCL SPRAIN
Most common injured ligament in knee
MOI: Valgus stress
Lateral blow w/ foot fixation, severe twist.
S/S: Swelling, limited ROM, pain, loss of function, instability
TX: PRICE, strengthening/ROM exercises, functional activities.
LCL SPRAIN
 MOI: Varus stress
 medial blow
 S/S: Pain, inflammation, instability, loss of function and ROM
 TX: PRICE, strengthening and ROM exercises, functional activities.
ACL SPRAIN
 MOI: Torsion (Foot fixation w/twisting), or a blow. (EX: athlete running then turns suddenly.)
 Highest incidence of tear = Female soccer players, then female basketball players
 S/S: pop, followed by disability, “feels like my knee is coming apart” rapid swelling, pain.
 TX: PRICE, surgery…then strengthening, ROM exercises, functional activities.
 Prevention: no single exercise can prevent ACL tears, but the chances of ACL injury can be lowered by
performing training drills emphasizing power and agility and by improving muscular reactions with jumping and
balance drills
PCL SPRAIN
 MOI: severe hyperextension, OR a fall w/knee flexed to 90 degrees.
 S/S: feeling a pop in back of knee, tenderness, little swelling, instability, pain.
 TX: PRICE, non-operative, strengthening quads, ROM exercises.
TROCHANTERIC BURSITIS
 MOI:
 Common at the greater trochanter, high in women w/ increased Q angle, or leg length discrepancy
 Inflammation of bursa, or insertion of gluteus medius, or IT band
 S/S:
 c/o pain on lateral hip
 Radiating pain down to the knee
 Tenderness over greater trochanter
 TX:
 PRICE, NSAIDS, ROM, PREs, no inclined running
 Special Tests: Obers,
HIP POINTER (CONTUSION)
 MOI
 blow to inadequately protected iliac crest
 Most handicapping injury in sports, difficult to manage
 S/S
 Immediate pain, spasms, transitory paralysis of soft structures
 Unable to rotate the trunk or to flex the thigh with out pn
 TX
 RICE, referral, x-ray, ice massage, ultrasound, injection
 Doughnut pad for return to play
HIP DISLOCATION
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MOI
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Rarely occur during sports
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Femur is adducted and flexed
S/S
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Flexed, adducted, and internally rotated thigh
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Deformity, nerve damage
TX
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Immobilization, ice, analgesics
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Direct blow to the thigh
TX: flx w/ice pack
,PRICE,NSAIDS, crutches
• deeper
• Pain, swelling,
cannot flex
knee more
then 90
degrees
• Moderate
pain and
swelling,
limping,
cannot flex
knee
Severe/Grade 4
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• Superficial
bruise
• Mild
hemorrhage,
mild pain, no
swelling, mild
pt tenderness
• No game
restrictions
Grade 3
MOI
Grade 2
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Grade 1
QUAD CONTUSION
• Disability, may
split the
fasciae
• Severe pain,
limited ROM,
limp
AVULSION FRACTURE
 MOI:
 Most common: 1) ischial tuberosity (hamstrings), 2)AIIS(rectus femoris), ASIS (sartorius)
 Sudden acceleration/deceleration
 S/S:
 Sudden local pain
 Limited movement
 TX:
 X ray, PRICE, crutches, ROM, PREs
 Special Tests: Hip MMTs
SACROILIAC JOINT SPRAIN (S.I. JOINT)
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MOI
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Twists with both feet on the ground
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Stumbles forward, falls backward, steps in hole
S/S
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Pain over joint, muscle guarding, radiating pain down back of gluteus and hamstring
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Asymmetrical ASIS/PSIS or leg length difference
TX
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Modalities, brace, stability exercises
Special Test: FABERS/Patricks
GROIN STRAIN (ADDUCTOR/HIP FLEXOR STRAIN)
 MOI
 The groin is the area between the thigh and the abdominals
 Torn during twist or pull while running or jumping
 S/S
 Felt as sudden twinge or feeling of tearing during an AROM, or may feel it the next day
 Pain, weakness, internal bleeding
 TX
 PRICE, analgesics, ROM and strengthening exercises
 Rest has been the best treatment, protective spica
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Special Tests: MMTs
HAMSTRING STRAIN
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MOI
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Most common injury to thigh, exact cause is not known
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Possible MOI: muscle fatigue, faulty posture, leg length discrepancy, tight hamstrings
S/S
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Hemorrhage, pain, loss of function.
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3 grades of strain
TX
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PRICE, NSAIDS, very conservative, PREs
Special test: MMTs
SNAPPING HIP
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Excessive repetitive movement in dancers, gymnasts, hurdlers, sprinters
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MOI:
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Imbalance in muscle
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IT band moves over the greater trochanter
S/S:
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c/o of snapping with pain
TX:
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Ice, NSAIDS, ultrasound, then stretching
QUAD STRAIN
 MOI: sudden stretch/contraction EX; jumping, kicking
 S/S: pain, spasm, loss of function,
 TX: PRICE, analgesics, pain free ROM, strengthening, crutches, neoprene sleeve
HAMSTRING STRAIN
 MOI: muscle fatigue, faulty posture, leg length discrepancy, tight hamstrings, improper form
 S/S: discoloration, pain, loss of function, swelling.
 TX: Extremely conservative, PRICE, analgesics, reduced activity. Move towards, pain free stretching, pain free
exercises, jogging, stationary bike.
SHOULDER IMPINGEMENT
MOI:
- acute: direct blow
- Chronic:
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Impingement
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Tendonitis
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Degeneration
* Mostly supraspinatus
S/S:
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complains of diffuse pain
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Overhead activities increase pain
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Painful arc
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Pain on insertion of supraspinatus
TX: PRICE, Strength, ROM, NSAIDS
Special tests: Neer, Hawkins Kennedy empty can test, drop arm
CLAVICLE FRACTURE
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Most frequent fx.
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In young athletes = greenstick fx.
MOI: FOOSHA, direct impact, occurs in middle 3rd
S/S: athlete supports arm, swelling, deformity, point tenderness. tilts head to the injured side w/ chin toward opposite
side.
TX: sling and swathe, refer for x-ray.
Special tests: piano key
HUMERUS FRACTURE
 Humeral Shaft: comminuted or transverse.
MOI: direct blow or fall on arm
 Proximal Humerus: great danger to nerve and vessels
MOI: direct blow,
 Most likely at the neck
 Can be mistaken for dislocation
 Epiphyseal fx: young athlete 10 years and younger
MOI: direct blow, or indirect force applied to the length of the axis.
S/S:, pain, inability to move arm, swelling, point tenderness, discoloration
TX: splint, treat for shock, refer
SHOULDER SUBLUXATION
MOI: brief translation of the humeral head without separation of the joint surfaces.
Can occur: anteriorly, posteriorly, or inferiorly.
SHOULDER ANTERIOR DISLOCATION
MOI: Forced abduction, external rotation and extension. direct impact to the posterior or posterorlateral aspect
Arm is held in abduction & ER
S/S: Anterior
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flat deltoid
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Feel humeral head
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Athlete carries the affected arm in slight abduction and ER
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Unable to touch opposite shoulder
TX:
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immediate immobilization
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PRICE
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Refer
SHOULDER POSTERIOR DISLOCATION
MOI:
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forced adduction and IR,
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or fall on an extended and internally rotated arm
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Labrum damage
S/S: posterior
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severe pain and disablitity
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Held in adduction and IR
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Flat anterior deltoid
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Acromion and coracoid processes
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Limited ER & elevation
TX:
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immediate immobilization
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PRICE
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Refer
AC SPRAIN
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Grade 1:
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point tenderness
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Grade 3:
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Discomfort during movement
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rupture of the AC &coracoclavicular lig
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No deformity
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Dislx of the clavicle
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Mild stretching of AC lig.
Gross deformity
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Grade 2:
tearing or rupture of AC lig
Stretching or tearing of coracoclavicular lig
Displacement of distal end of clavicle
Moderate pain
Unable to abduct arm through full ROM
Can’t bring arm across chest horizontally
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Severe pain
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LOF
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instability
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TX: Price, refer for x-rays
Special tests: Piano Key, Compression
SHOULDER SPRAIN
MOI: forced abduction, external rotation, direct blow
S/S: pain with movement and palpation, decreased ROM
TX: PRICE,
Special tests:
load and shift, Sulcus,
Apprehension Crank
BICIPITAL TENOSYNOVITIS
 MOI
 Overuse in overhead activity
 S/S
 Pain in the anterior upper arm over bicipital groove while performing overhead activity
 Some swelling, crepitus
 TX
 Complete rest for a few days, NSAIDS, gradual PRE program
 Special Tests: Yergasons, Speeds
SHOULDER BURSITIS
MOI: build up of fluid
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chronic inflammation
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Overuse
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Direct impact
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Fall on tip of shoulder
* Subacromial bursa is most inflamed.
S/S:
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pain with movement ( ab, add, IR)
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Pain, tenderness
TX:
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RICE
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NSAIDS
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Strengthening, ROM
Special tests: Neer, Hawkins-Kennedy
THORACIC OUTLET COMPRESSION SYNDROME (TOCS)
 “Stingers”
Nerve damage by impingement or compression.
UCL SPRAIN
 MOI
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Valgus force from repetitive trauma
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Tennis, golfing, throwing
 S/S
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Pn. On medial aspect of elbow
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Parasthesia, and laxity
 TX
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Rest, NSAIDs, strengthening, correct form
EPICONDYLITIS
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MOI
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Lateral (tennis elbow)
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Tennis, baseball, swimming, golfing
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Repeated forearm flexion and extension
Medial (pitchers or golfers elbow)
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Repetitive wrist flexion, valgus stress on elbow
S/S
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Aching pn. During and after activity
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decreased ROM
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hand weakness
TX
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RICE, NSAIDS
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ROM, PRE, Deep friction massage
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Elbow sleeve or band just below the bend of the elbow
OLECRANON BURSITIS
 MOI
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Direct blow
 S/S
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Pain, severe swelling, point tenderness
 TX
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Acute= ice, compression
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Chronic = compression, modalities, aspiration
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Padding for play
VOLKMANN’S CONTRACTURE
 MOI
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Complication of serious elbow injury
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Muscle spasm, swelling, or bone pressure on the brachial artery
 S/S
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Pn. In the forearm that is worse when fingers are passively extended
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Decreased or absent brachial and radial pulses
 TX
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Removal of constricting casts, wraps or braces, elevation
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Can become permanent
SKULL FRACTURE
 MOI
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Blunt trauma to head ie ball to head
 S/S
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Sever headache, nausea, skin indentation
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Blood in ear or nose
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CSF (cerebrospinal fluid) may seep from ears and nose
 TX
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911!!
CONCUSSION
 MOI
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Direct or indirect trauma to head
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Impulsive force transmitted to head
 S/S
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Confusion, headache, dizziness, nausea, nystagmus, trouble concentrating, abnormal pupil response
 TX
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Take out of practice/game, determine LOC, watch for symptoms to worsen, assess memory
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*no longer grading concussions, or classifying as simple or complex*
INTRACRANIAL HEMORRHAGE
 MOI
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Blow to head
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May be a slow bleed
 S/S
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Show signs of mild headache but then has severe head pains, dizziness, nausea, unequal pupils
 TX
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Referral to ER
EPIDURAL BLEEDING
 MOI
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Blow to head
 S/S
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Extremely fast bleeding
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In 10-20 min. athlete will go from fine to having major symptoms!
 TX
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ER, surgery
SUBDURAL BLEEDING
 MOI
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Veins are torn that bridge the dura
matter to the brain
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contrecoup
 S/S
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Bleeding is slow, s/s may not appear for many hours
 TX
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911 after s/s appear
INTRACEREBRAL BLEEDING
 MOI
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Force trauma to brain
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Bleeding within the brain
 S/S
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Deterioration of neurological function
 TX
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ER, 911
SECOND IMPACT SYNDROME
 MOI
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Second head injury before s/s of initial injury go away
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Caused 30-40 deaths over the last decade
 S/S
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Appear stunned, within short time athlete may collapse, dilated pupils, loss of eye movement, respiratory failure
 TX
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Prevention