Transcript Chapter 13: Recognizing Different Sports Injuries

Chapter 13: Recognizing
Different Sports Injuries
McGraw-Hill/Irwin
© 2013 McGraw-Hill Companies. All Rights Reserved.
• No matter how much time is spent on
injury prevention sooner or later an injury
occurs
• Either acute or chronic in nature
• Acute injuries
– Result of trauma
• Chronic
– Caused by repetitive, overuse activities
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Acute Traumatic Injuries
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Fractures
• Result of extreme
stress and strain on
bone
• Anatomical
Characteristics
– Dense connective
tissue matrix
– Outer compact tissue
– Inner porous
cancellous bone
including Haversian
canals
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– Gross Structures
• Diaphysis -shaft - hollow and cylindrical
- covered by compact bone
• Epiphysis - composed of cancellous bone and
has hyaline cartilage covering
• Periosteum - dense, white fibrous covering
which penetrates bone via
Sharpey’ fibers
- contains blood vessels and
osteoblasts
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• Acute bone
fractures –
– Partial or complete
disruption that can be
either closed or open
(through skin)
– Serious
musculoskeletal
condition
– Presents with
deformity, point
tenderness, swelling
and pain on active and
passive motion
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– Load Characteristics
• Bones can be stressed or loaded to fail by
tension, compression, bending, twisting and
shearing
• Either occur singularly or in combination
• Amount of load also impacts the nature of the
fracture
• More force results in a more complex fracture
• While force goes into fracturing the bone,
energy and force is also absorbed by adjacent
soft tissues
• Some bones will require more force than others
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• Healing of a Fracture
– Generally require immobilization for some
period
• Approx. 6 weeks for bones of arms and legs
• 3 weeks for bones of hands and feet
– Fracture healing requires osteoblast activity to
lay down bone and form callus
– Following cast removal, normal stresses and
strains will aid in healing and remodeling
process
• Osteoclasts will be called on to assist in re-shaping
of bone in response to normal stress
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• Stress fractures
– Number of possible causes
•
•
•
•
Overload due to muscle contraction
Altered stress distribution due to muscle fatigue
Changes in surface
Rhythmic repetitive stress vibrations
– Progressively becomes worse over time
• Initially pain during activity and then progresses to
pain following activity
– Early detection is difficult, bone scan is useful,
x-ray is effective after several weeks
– If suspected – stop activity for 14 days
– Generally does not require casting
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• Dislocations and Subluxations
– Dislocation
• At least one bone in a joint is forced completely out
of normal and proper alignment
• High level of incidence in fingers, elbow and
shoulder
– Subluxation
• Partial dislocations causing incomplete separation
of two bones
• Often occur in shoulder and females (patella)
– S&S of dislocations
• Deformity – almost always present
• Loss of function
• Swelling, point tenderness
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– Additional concerns
• Avulsion fractures
• Growth plate separation
• “Once a dislocation, always a dislocation”
– Treatment
• Dislocations (particularly first time) should always
be considered and treated as a fracture until ruled
out
• X-ray is the only absolute diagnostic technique
• Return to play often determined by extent of soft
tissue damage
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Ligament Sprains
• Sprain
– Damage to a ligament
• Ligaments provide support to a joint
• Synovial joint characteristics
•
•
•
•
•
•
2 or more bones
Capsule or ligaments
Capsule is lined with synovial membrane
Hyaline cartilage
Joint cavity with synovial fluid
Blood and nerve supply with muscles crossing
joint
• Mechanoreceptors within joint structures provide
feedback relative to position
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• Some joint will have
meniscus (thick
fibrocartilage) for
shock absorption
and stability
• Ligaments
– Thickened portions of
the capsule or totally
separate bands
– Dictates partially the
motions the joint
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• Sprains
• Result of traumatic joint twist that causes stretching
or tearing of connective tissue
• Graded based on the severity of injury
– Grading System
• Grade I - some pain, minimal loss of function, no
abnormal motion, and mild point tenderness, slight
swelling and joint stiffness
• Grade II - pain, moderate loss of function, swelling,
and instability, some tearing of ligament fibers and
joint instability
• Grade III - extremely painful, inevitable loss of
function, severe instability and swelling, and may
also represent subluxation
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– Restoration of joint stability is difficult with
grade I and II injuries
• Must rely on other structures around the joint
– Rely heavily on muscles surrounding joint
• Ligament has been stretched/partially torn causing
development of inelastic scar
– Ligament will not regain original tension
• Increased muscle tension due to strength training
will improve joint stability
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• Contusions
– Result of sudden blow to body
– Can be both deep and superficial
– Hematoma results from blood and lymph flow
into surrounding tissue
• Minor bleeding results in discoloration of skin
– May be painful to the touch and with active
movement
– Must be cautious and aware of more severe
injuries associated with repeated blows
• Calcium deposits may form with fibers of soft
tissue
• Myositis ossificans
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– Prevention relies on protection and padding
• Particularly when dealing with myositis ossificans
– Protection and rest may allow for calcium reabsorption
• Surgery would not be necessary to remove
– Quadriceps and biceps are very susceptible
to developing myositis ossificans
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Muscle Strains and Injuries
• Causes
– Stretch, tear or rip to muscle or adjacent
tissue
• Muscle Strain Grades
• Grade I - some fibers have been stretched or
actually torn resulting in tenderness and pain
on active ROM, movement painful but full range
present
• Grade II - number of fibers have been torn and
active contraction is painful, usually a
depression or divot is palpable, some swelling
and discoloration result
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• Grade III- Complete rupture of
muscle or musculotendinous
junction, significant impairment,
with initially a great deal of pain
that diminishes due to nerve
damage
– Tendon ruptures
• Large tendon ruptures will require
surgery
• Rehabilitation
– Lengthy process regardless of
severity
– Will generally require 6-8 wks.
Return to activity too soon may
result in re-injury
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• Muscle Guarding
– Muscles within an effected area contract to
splint the area in an effort to minimize pain
through limitation of motion
– Involuntary muscle contraction in response
to pain following injury
• Not spasm which would indicate increased tone
due to upper motor neuron lesion in the brain
• Muscle Cramps
– Painful involuntary contraction
– Attributed to dehydration/electrolyte
imbalance
– May lead to muscle or tendon injuries
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• Muscle Soreness
– Overexertion in strenuous exercise resulting
in muscular pain
– Generally occurs following participation in
activity that individual is unaccustomed
– Two types of soreness
• Acute-onset muscle soreness - accompanies
fatigue, and is transient muscle pain experienced
immediately after exercise
• Delayed-onset muscle soreness (DOMS) - pain
that occurs 24-48 hours following activity that
gradually subsides (pain free 3-4 days later)
– Potentially caused by slight microtrauma to muscle or
connective tissue structures
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– Prevent muscle soreness through gradual
build-up of intensity
– Treat with static or PNF stretching and ice
application within 48-72 hours of insult
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Nerve Injuries
• Two main causes of injury
– Compression and tension
– Resulting in radiating pain & muscle
weakness
• Stinger or burner
• May be acute or chronic
– Causes pain and can result in a host of
sensory responses
• Hypoesthesia
• Hyperesthesia
• Paresthesia
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• Injuries can range from minor to severe
and life altering
– Neuritis
• Chronic nerve problem caused by overuse or a
variety of forces
• Results in minor to severe problems
– Crushing or severed nerve injury
• Life long implications
• Paraplegia/quadriplegia could result
• Healing process is very slow and long
term
– Optimal environment is critical
– CNS vs. PNS repair
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Chronic Overuse Injuries
• Importance of Inflammation in Healing
– Essential part of healing process
• Must occur following tissue damage to initiate
healing
– Signs and Symptoms
• Pain, redness, swelling, loss of function and
warmth
– If source of irritation is not removed then
inflammatory process becomes chronic
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• Tendinosis
– Tendinosis refers to a chronic tendon injury
without inflammation
– Most common overuse problem in sports
– Likely that pain occurred with initial stages of
injury without proper tendon healing
• Tendinitis
– Inflammation of the tendon
– Crepitus
• Crackling sound caused by “sticking” of tendon
when sliding
• Sticking occurs due to chemical products of
inflammation
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• Management
– Key for treatment
is rest and
removal of causal
factors
– Work to maintain
cardiovascular
fitness using
means that don’t
irritate inflamed
tendon
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• Tenosynovitis
– Inflammation of synovial sheath
– In acute case - rapid onset, crepitus, and
diffuse swelling
– Chronic cases result in thickening of tendon
with pain and crepitus
– Often develops in long flexor tendons of
fingers
– Treatment is similar to that of tendinitis
– NSAID’s may also be of some assistance
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• Bursitis
– Bursa
• Fluid filled sac that develops in area of friction
– Sudden irritation can cause acute bursitis,
while overuse and constant external
compression can cause chronic bursitis
• Results in increased fluid production, causing
increases in pressure due to limited space around
anatomical structures
– Signs and symptoms include swelling, pain,
and some loss of function
– Three most commonly irritated
• Subacromial, olecranon, and prepatellar bursa
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• Osteoarthritis
– Wearing away of hyaline cartilage as a
result of normal use
• Changes in joint mechanics lead joint
degeneration (the result of repeated trauma to
tissue involved)
• May be the result of direct blow, pressure of
carrying and lifting heavy loads, or repeated
trauma from an activity such as running or
cycling
– Commonly affects weight bearing joints but
can also impact shoulders and cervical
spine
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– Symptoms include pain (as the result of
friction), stiffness, localized tenderness,
creaking, grating, and often is localized to one
side of the joint or generalized joint pain
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• Myofascial Trigger Points
– Develop due to mechanical stress
• Either acute strain or static postural positions
producing constant tension in muscle
– Typically occur in neck, upper and lower
back
– Signs and Symptoms
• Pain with palpation, with predictable pattern of
referred pain which may also limit motion
• Pain may increase with active and passive motion
of involved muscle
– While stretching may increase pain, it can be
incorporated into the treatment process
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Importance of the Healing
Process Following Injury
• Essential to possess understanding of
both sequence and time frame for various
phases of healing process
• Interference with healing process will
delay return to full activity
• Work to create optimal healing
environment
– Little can be done to speed the process, while
much can be done to impede it
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• Inflammatory Response Phase
– Begins immediately following injury – critically
important
• Without the inflammatory phase the other phases
will not occur
– Phagocytosis occurs to clean the injured area
– Chemical mediators are released to facilitate
healing
– Symptomatically presents with the following
• Redness, swelling, warmth, tenderness and loss of
function
– Stage lasts 2-4 days following injury
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• Fibroblastic Repair Phase
– Proliferative and regenerative activity occurs
resulting in scar formation (fibroplasia)
• Occurs within initial hours of injury and continues
up to 4-6 weeks
– S&S of inflammatory phase subside
• Athlete will still experience some tenderness and
pain with motion
• With increasing development of the scar
complaints of pain and tenderness will decrease
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• Maturation-Remodeling Phase
– Long-term process
– Re-alignment of scar tissue according to
tensile forces acting on tissue
• Re-align to position of maximum efficiency (parallel
to lines of tension)
– Tissue gradually resumes normal appearance
and function
– After 3 weeks
• Firm, strong, contracted, nonvascular scar exists
– Maturation may take several years to be
totally complete
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