Transcript Sports Medicine

Sports Injuries
Objectives
 Identify
signs and symptoms of common
sports injuries
 Describe
priority nursing interventions for
the major sports injury categories
Types of Athletic Injuries


Overuse or Chronic Injury
– Bursitis
– Tendinitis
– Stress Fracture
Acute Traumatic Injuries
– Laceration
– Abrasion
– Sprains / Strains
– Dislocations / Subluxations
– Fractures
P-RICE-MM Treatment
For Acute Sports Injuries

Protection
– Stabilize Area

Rest
– Stop All Activity

Ice
– 20 Min. Application

Compression
– Ace Wrap Under/Over Ice
P-RICE-MM Treatment
For Acute Sports Injuries

Elevation
– Above Heart

Medication
– NSAIDs/
Analgesics
– Muscle Relaxants

Modalities
– Diagnostic Testing
– Physical Therapy
Upper Body Injury
Head and Facial Injury

Protective Sports Equipment
– Blunt/Penetrating Eye
Injury
– Lacerations
– Fractures
– Spinal Cord Injury
– Closed Head Injury
 Acceleration/
Deceleration Forces
 Rotational Forces
 Coup-countercoup
Injury

Tetanus Immunization
Sports Injuries
of the Spine
Pinched Nerve Syndrome

Mechanism of Injury
– Sudden Direct Blow to One Side of Head

Clinical Presentation
– Paresthesia of Upper Extremity

Diagnostic Testing
– X-Rays / EMGs / NCS / Bone Scan

Conservative Treatment
– Initial Immobilization
– P-RICE-MM
– Protective Collars for Return to Play
Cervical Sprains / Strains

Mechanism of Injury
– Direct Trauma – Whiplash Effect
– Strain - Stretching or Tearing of Muscles
– Sprain – Stretching or Tearing of Ligaments

Clinical Presentation
– Immediate Onset of Pain & Muscle Spasms
– Decreased Active Range of Motion

Conservative Treatment
– P-RICE-MM
– Muscle Relaxants
Sports Injuries
of the
Upper Extremity
Shoulder Injuries
Impingement Syndrome  Rotator Cuff Injury

Multifactoral Mechanism of Injury
– Overuse Syndrome

Clinical Presentation
– Pain Over the Lateral and Anterior Shoulder Radiating Into
Deltoid
– Initially Pain Occurs With Activity Especially Overhead Motions
– Progressing to Pain at Rest
– Decreased and Painful Range of Motion
– May Feel Shoulder Catch
Normal Shoulder Anatomy
Shoulder Injuries


Rotator Cuff Musculature
– Four Distinct Muscles
– Supraspinatus Muscle Is
the First Damaged
Physical Examination
– + Impingement Sign
– Painful Arc Over 90
Degrees / ABD / ADD
– + Hawkins Test – Cross
Chest Adduction
– Tenderness With
Movement
– + Drop Arm Test With
Complete Rotator Cuff Tear
Rotator Cuff Tear
Shoulder Injuries

Diagnostic Testing
– X-rays to Rule Out Fracture
– MRI scan to Rule Out
Impingement Vs.
Tendinopathy Vs. Tear

Conservative Tx.
– P-RICE-MM
– NSAIDs
– Cortisone Injections

Surgical Intervention
– Arthroscopic Debridement &
Anterior Acromioplasty
Possible AC Joint Resection
– Open Acromioplasty
– Rotator Cuff Repair
– Mini Open Repair of the
Rotator Cuff
Question # 1
Injuries to the rotator cuff musculature
initially involve damage to the
1.
2.
3.
4.
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Answer # 1
Injuries to the rotator cuff
musculature initially involve damage
to the
1.
Supraspinatus
Shoulder Instability

Mechanism of Injury

Clinical Presentation
– Patient Reports a “Slipping” Within the Joint
– Can Be In One or Multiple Directions
– PE + Relocation Test + Sulcus Sign

Diagnostic Testing
– X-Rays / MRI Scan
Shoulder Instability

Conservative Management
– P-RICE-MM
– Essential to Stop
Overhead Activities

Surgical Treatment
– Capsulorrhaphy
– Post-Op Rehab to
Progress Slowly
– Return to Play
AC Joint Separation



Mechanism of Injury
– Direct Blow
Classifications
– 1st Degree - Stretching with
No Separation
– 2nd Degree Clavicle/Scapula
Attachments Intact
– 3rd Degree - Complete
Separation AC Joint and
Attachments
Clinical Presentation
– Pain / Swelling
– Deformity in Higher
Degrees
– Decrease Range of Motion
AC Joint Separation

Conservative Treatment
– 1st & 2nd Degree AC Joint
Separations
 P-RICE-MM

Surgical Intervention
– 3rd Degree and Higher
 Fixation
 Ligament
Reconstruction
 Resection of Distal
Clavicle
AC Joint Separation
Question # 2
A female high school swim team student presents with
anterior right shoulder pain and a slipping sensation.
As the nurse taking the history, the most important
piece of info would be:
1. Her overall grown and physical maturation in the
past six months
2. Her swim stroke specialization and training routine
3. Her weight loss or gain in the past six months
4. Her plans for a college swimming scholarship
Answer # 2
A female high school swim team student presents with
anterior right shoulder pain and a slipping sensation. As
the nurse taking the history, the most important piece of
info would be:
2. Her swim stroke specialization and training routine
Question # 3
A preliminary diagnosis of right shoulder instability is
made. On physical examination you would expect to find:
1. A positive McMurray test
2. Unilateral positive Relocation Test
3. Lack of tenderness over the affected joint
4. Unrestricted range of motion
Answer # 3
A preliminary diagnosis of right shoulder instability is
made. On physical examination you would expect to find:
2. Unilateral positive Relocation Test
Question # 4
The patient was placed on a conservative course of
treatment. A primary nursing consideration for this
patient is:
1. Allow her to continue to swim without any change in
training
2. Encourage her not to swim if pain is present
3. Order her to cease all swimming and overhead
activities
4. Tell her to swim per her coach and parents dictate
Answer # 4
The patient was placed on a conservative
course of treatment. A primary nursing
consideration for this patient is:
3. Order her to cease all swimming and
overhead activities
Clavicle Fractures

Direct Blow to Clavicle Region

Presentation
– Disfigure /Pain / Movement with Palpation

Diagnostic Testing
– Radiograph R/O SC Joint Derangement

Conservative Treatment
– Figure of 8 Harness

Surgical Intervention
– Plate & Screw Fixation
Clavicle Fracture
Epicondylitis

Location
– Medial - Golfers Elbow
– Lateral - Tennis / Pitchers / Swimmer / Little League

Mechanism of Injury
– Overuse Syndrome

Differential Diagnosis
– Obtain X-Rays to Rule Out
 Loose Bodies
 Fracture
 Occult Injury
 Exostosis
– Radial Nerve Entrapment
– Radiocapitellar Degeneration
Epicondylitis

Clinical Presentation
– Well Localized Pain & Swelling
– Difficulty / Pain w/ Supination & Pronation

Conservative Treatment
– P-RICE-MM
– Cock-Up Splint for Wrist
Lateral Epicondylitis
(Tennis Elbow)
Question # 5
Mr. Woods is a 38 year old tennis player who has developed lateral
epicondylitis and has begun conservative treatment to prevent
progression of this condition. If left untreated, a potential long term
effect of epicondylitis is:
1. Compartment syndrome
2. Osteomyelitis
3. Flexion contracture
4. Carpal Tunnel
Answer # 5
Mr. Woods is a 38 year old tennis player who has
developed lateral epicondylitis and has begun
conservative treatment to prevent progression of this
condition. If left untreated, a potential long term effect of
epicondylitis is:
3. Flexion contracture
Hand Injuries

Most Commonly Injured Body
Site
– Least Protected / Padded
Area
– Growth Plate Deformities

Mechanism of Injury
– Direct Trauma Most
Common
Hand Injuries

TRIGGER FINGER
- Locking of Digit in Flexion
- Often Self-Limiting
- Direct Trauma
- Stenosis of Tendon Sheath
- Conservative Treatment
-
P-RICE-MM
- Surgical Intervention
-
A1 Pulley Release

MALLET FINGER
- Extensor Tendon Injury at DIP
Joint – Extensor Lag
- Sudden Forced Flexion
- Conservative Treatment
-
P-RICE-MM
6-8 weeks immobilization
- Surgical Intervention
-
K Wire Fixation
Rare – Open Cases Only
Hand Injuries

GAMEKEEPER THUMB
- Stiff PIP Joint – Degenerative
Abduction Deformity MP UCL
Insufficiency
Possible Avulsion Fracture
- Conservative Treatment
-
P-RICE-MM
- Surgical Intervention
-
Early – UCL Reconstruction
Late – MP Fusion &
Arthroplasty

NAIL BED INJURIES
- Disfigurement
- Avulsion of Nail
- Direct Trauma or Torsional
- Conservative Treatment
-
P-RICE-MM
Drilling of Nail
- Protective Padding for
Return to Sports
Hand / Wrist Fractures

Boxer’s Fracture
– Metacarpal Neck Fracture
– Palmer Angulation of
Fracture

Colles Fracture
– Distal Radial Fracture
– Silver Fork Deformity

Scaphoid Fracture
– Difficult Fracture to Heal
Sports Injuries
of the
Lower Extremity
Knee: Normal A & P
Knee – Ligamentous Injuries

Function
– Attaches Bone to Bone
– Stabilizes Knee

Mechanism of Injury
– Torsional Injury Often with
Direct Blow

Medial & Lateral Collateral
Ligaments
– Grade 1
– Grade 2
– Grade 3
ACL Substitution Surgery

AUTOGRAFT
– Patient Graft Harvested
Bone / Middle 1/3 Patella
Tendon / Bone Graft
– Arthrotomy
– Post-Op


2 Areas for Healing
Potential for Scarring /
Osteophyte Formation at
Patella

ALLOGRAFT
– Cadaver Bone / Patella
Tendon / Bone Graft
– Arthroscopically Assisted
– Post-Op


Fixation Site of Allograft
Patella / Patella Tendon
Complex Left Undisturbed
ACL Arthroscopy
Knee – Meniscal Injuries

Function
– Crescent Shaped Plates that Provide Stability
– Transmits Axial Loads
– Shock Absorbers / Joint Fillers

Mechanism of Injury
– Torsional / Rotational Injury
– “Pop” or “Snap” Frequently Heard at Impact

Incidence
– 3-7 X Incidence of Injury to Medial Meniscus
Meniscal Injuries



Clinical Presentation
– Exquisite Joint Line Pain
– Inability to Full Extend
Lower Extremity
– Buckling / Locking of
Affected Joint
– (+) McMurray Test
Diagnostic Testing
– X-Rays Rule Out Loose
Bodies
– MRI scan / Diagnostic
Arthroscopy
Conservative Treatment
– P-RICE-MM
Meniscal Injury Arthroscopic
Surgery

Meniscal Repair
– Smaller Vertical Tears
– Surgically Sutured

Partial / Total Removal
(Meniscectomy)
– Cut Out Tear – Back to a
Stable Rim
– Good For Large or Unstable
Tears
 Bucket Handle / Vertical

Allografting
Meniscal Injury Arthroscopic
Surgery
Question # 6
You respond to an on field injury during a football game.
The injured athlete reports hearing a “pop” in his knee.
He is now unable to fully extend his knee. You would
suspect an injury to the
1. Anterior Cruciate Ligament
2. Iliotibial Band
3. Articular Cartilage
4. Meniscus
Answer # 6
You respond to an on field injury during a football game.
The injured athlete reports hearing a “pop” in his knee.
He is now unable to fully extend his knee. You would
suspect an injury to the
4. Meniscus
ITB Friction Syndrome

Iliotibial Band
– Provides Lateral
Stabilization to Knee Joint

Overuse Syndrome From
Excess Friction

Conservative Treatment
– P-RICE-MM

Surgical Intervention
– Targeted to Remove
Impinging Posterior Fibers
– Rare
Iliotibial Band Stretch

Purpose: To gain flexibility in the
fibrous band of tissue that is
located along the outside of the
thigh and knee

Start Position: Lying on your
back with a rope looped around
the foot of the leg to be stretched

Action: Using the rope, pull the
leg across your body at an angle
approximately 20-30 degrees from
the floor

Parameters: Hold stretch for 30
seconds, Repeat 3-5 times

Tips: Stabilize the hip of the side
being stretched firmly to the
ground so no rotation of your trunk
occurs
PATELLA
SUBLUXATION
PATELLA
DISLOCATION

Medial Side Direct Blow

Medial Side Direct Blow

Clinical Presentation

Clinical Presentation
– May Spontaneously Reduce
– Unable to Extend
– Muscle Spasms

–
–
–
–
Buckling
Unable to Extend
Muscle Spasm
May Report “Pop”
Conservative Treatment
– P-RICE-MM
– Knee Immobilization in
Extension

Conservative Treatment
– P-RICE-MM
– Knee Immobilization in
Extension
Patellar Tendinopathies
Patellar Tendinitis
 AKA Jumper’s Knee
 Overuse Syndrome
 Pain at Tibial Insertion
 Localized Swelling
 Conservative Treatment
 P-RICE-MM
 Chopat Brace
Patellar Tendinopathies
Osgood Schlatter’s Disease

Tibial Tubercle Apophysitis

Point Tenderness

Elevated Tibial Tubercle

Conservative Treatment
– P-RICE-MM
– Protective Padding

Surgical Intervention
– Rare
– Excision of Ossicle
Shin Splints / Stress Fractures

Overuse Syndrome

Micro Fractures Develop in
Tibia

Diagnostic Testing
– X-Rays Rule Out Fracture
– Bone Scan Differential
Diagnosis of Stress
Fracture

Conservative Treatment
– P-RICE-MM
– Orthotics
– Prevention
Question # 7
What diagnostic examination patient teaching would an
office nurse need to conduct for a client having a workup for shin splints?
1. NPO for an arthroscopy
2. Explanation of an orthotic evaluation
3. Determine potential allergies to arthrogram dye
4. Radioisotope injection for a bone scan
Answer # 7
What diagnostic examination patient teaching would an
office nurse need to conduct for a client having a workup for shin splints?
4. Radioisotope injection for a bone scan
Ankle Injuries

Anatomy
– The Ankle is a Hinged Joint
– Distal Tibia/Fibula/ Medial
& Lateral Malleolus/Talus
– 3 Planes of Motion
 Dorsiflexion-Plantar
Flexion
 Inversion-Eversion
 Abduction-Adduction
Ankle Sprain – Severity Guide
GRADE I
GRADE II
GRADE III
Mild
Moderate
Severe
Some
Tearing of
Ligamentous
Fibers
Some
Tearing of
Ligamentous
Fibers & Loss
of Function
Complete
Rupture of
Ligaments.
Loss of
Function &
Instability of
the Joint
Ankle Sprain – Severity Guide
Ankle Sprains

Mechanism of Injury
– Direct Trauma

Clinical Presentation
– Athlete Report Tearing at
Moment of Impact
– Unable to Bear Weight on
Affected Ankle
– Swelling/Stiffness (early)
Ecchymosis (later)
– Instability Medial
 + Anterior Drawer
 Medial Lateral
Question # 8
Nursing assessment of a suspected ankle injury would
include:
1. Neurovascular assessment
2. Physical manipulation of the joint
3. Tetanus immunization status
4. Application of heat for comfort
Answer # 8
Nursing assessment of a suspected ankle injury
would include:
1. Neurovascular assessment
Ankle Sprains

Diagnostic Testing
– X-Rays Rule Out Fracture
or Avulsion Fracture
– MRI / Arthrogram Ligamentous Injury

Conservative Treatment
– P-RICE-MM
– Initial Immobilization
 Posterior Splint with
Ace Wrap
 Casting
 Ace Wrap and Air Cast
Question # 9
After applying a posterior splint and ace wrap to a patient
with an ankle sprain, the nurse explains that they are
used to allow:
1. for bruising which will occur
2. for early mobilization
3. for swelling which will occur
4. to allow weight bearing on affected ankle
Answer # 9
After applying a posterior splint and ace wrap to a patient
with an ankle sprain, the nurse explains that they are
used to allow:
3. for swelling which will occur
Ankle Sprains


Surgical Intervention
– Indicated for Complete
Ruptures
– Debridement of Joint /
Suturing Torn Ligaments
and Anterior Capsule For
Instability
 Crisman Snook
Procedure
Complications of Ankle Sprains
Scar Tissue Builds   Risk
of Recurrent Sprains 
Leads to Instability 
Requiring Surgical
Stabilization
Achilles Tendinitis

Achilles Tendon - Poor
Capacity to Repair

Common Overuse Syndrome

Direct Trauma Can Lead to
Rupture

Clinical Presentation
– Pain Stiffness

Conservative Treatment
– P-RICE-MM
– Daily Stretching
– Orthotics / Heel Lifts
Imaging of Sports Injuries

For the Purpose of:
– Differential Diagnosis
 R/O Fracture / Loose Bodies
– Gradation of Injury
 G2-G2 Sprain/Separation
– Treatment Protocols
 Reductions
 Conserv Vs. Surg. Intervention
– Post-Treatment Status
 Reductions
 Healing Status