Transcript Lecture 2 Sports injuries and types of injuries

Sports Injury and
Types
Lecture 2
Definition of Sports Injury
Occurs as a result of participation in an
organized practice or game
 Requires medical attention by a therapist
or physician
 Results in restriction of the athlete’s
participation or performance for one or
more days.
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Mechanism or Injury
MOI
 What happened , how was the athlete
injured, main cause
 Provide clues as to acute or chronic
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Importance of MOI
Details how injury occurred
 Determines when it occurred
 Guides evaluation
 Determines levels of severity
 Leads to s differential diagnosis
 Guides treatment plans
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Questions to Determine MOI
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What is your primary complaint
What happened how did it happen where do you
hurt
What makes it feel better
Wha makes it feel worse
When did it happen
What can you do , what can’t you do
Was the pain sudden or did it gradually appear
Acute injury
a single force ( macrotrauma )
 definite moment of onset ( usually rapid
onset) followed by a relatively predictable
pattern of events
 Usually a single traumatic event
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Critical Force
tissues are said to have a limit that it is
able to withstand a force , this limit is the
critical force
 the critical force value varies for each type
of tissue
 The critical force may depend upon age,
temperature, skeletal maturity , sex, and
body weight
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Chronic Injury
repeated loading or stress ( microtrauma)
 develops and worsens over a period of
time, slow or insidious onset
 pain and inflammation - worsen with time
 may persist for months – years
 Often occur in activities with repeated,
 continuous movements
 Often called overuse injuries
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Catastrophic Injuries
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Involve damage to the brain and or spinal
cord and are potentially life threatening or
permanent
Soft tissue
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Includes muscle , fascia ,tendons, joint
capsules, ligaments , blood vessels and
nerves .
Soft tissue injuries
 Contusions, sprains, strains,
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Injury Classification
Sprains stretch or tear of stabilizing
connective tissue , ligaments
 History of acute onset
 MOI may be due to overstretch or overload
 Pain is localized over the injury site
 Discolouration in severe cases ( caused by
blood pooling distally to site of trauma)
Sprains
lst degree: mildest form of sprain , mild
pain, mild dysfunction , point tenderness,
little to no swelling
 2nd degree: more severe, imply more
damage to ligament involved, increased
amount pain and dysfunction , swelling
more pronounced with abnormal
movement
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Sprains
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3rd degree: most severe and imply a
complete rupture, severe pain, major loss
function, major instability, severe swelling
Sprain ankle
Strains
Injuries to muscles. Tendons or muscle
tendon junctions ( MTJ).
 Most common location for a strain is MTJ
 There is a tremendous variability in the
severity of strains
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Strains
1st degree: mildest form of strain with little
associated damage to muscle and tendon
structures, pain noticeable during use ,
with mild swelling
 2nd degree:more extensive damage to soft
tissue, pain , swelling are more
pronounced and functional loss is
moderate
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Strains
3 rd degree: most severe and imply a
complete tear or rupture of structure
involved
 Significant swelling and loss of function
 A defect may be apparent through the skin
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Hamstring strain
Contusions
a result of compressive force or a direct
blow to the body surface.
 Characterized with pain, stifness and
swelling as well as
 Ecchymosis - tissue discolouration if
haemorrhage is superficial
 Haematoma – pooling of blood
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Fractures
is a disruption in the continuity of a bone
a) simple
bone ends remain intact within surrounding
soft tissues
b) compound
one or both ends protrude from the skin
Associated with swelling , deformity , pain,
tenderness loss of use, grating sensation
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Types of fractures
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transverse - break occurs in straight line
across the bone
oblique - break occurs diagonally across the
bone
spiral - jagged bone ends are S- shaped
avulsion - bony fragment is pulled off by
attached tendon
stress - repeated low magnitude forces over
time
Types of fractures
comminuted - bone fragments into several
pieces
 greenstick - bone breaks incompletely
as with a green stick
 impacted - a bone impacts or is driven into
another bone
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Fracture dislocation
Dislocations
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Luxation
A temporary separation b/w articulating ends &
remains that way for extended period.
results in extreme damage to connective tissue.
common: fingers, G-H jt.
S/S --dysfunction , deformity, athlete will often
report a snapping or popping sound
Subluxation
incomplete separation b/w articulating
ends.
 less severe damage than luxation.
 common: patellafemoral jt.
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Tissue Response to Injury
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tendons, ligaments , muscle , bones with
progressive training all structures gradually get
stronger and larger
injuries occur as a result of the bodies inability to
adapt to an increased load of training ( rapid
changes )
“Healing is a matter of time but sometimes
also a matter of opportunity” Hippocrates
Force Directions
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Compressive - an axial loading that produces a
squeezing or crushing effect on a structure (
bruises)
Tensile - axial force that is opposite to
compressive force ( longitudinal force) (muscle
stretch)
a pulling force that tends to stretch the structure
Bending –results in tension on one side and
compression on the other ( ankle sprains
damage to both sides)
Shear - a force that acts perpendicular to
the tissues involved (structures slide or
displace) (ligament tears , blisters)
 Rotational- combination of tension and
shears ( spiral fractures , acl tears)
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Soft Tissues
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Skin - tendons - ligaments
all made up of collagen
Collagen - is a protein strong in resisting tension
but stretches slightly under tensile loading as
fibres straighten
thus collagen provides both strength and
flexibility to tissues ( but are relatively inelastic)
Elastin another protein provides added elasticity
to some connective tissue structures.
Skin
3 layers
 largest organ of the human body
 loose multidirectional arrangement of
collagen fibres - enables the resistance of
multidirectional loads, including
compression, tension and shear
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Epidermis
outer sheath of the body
 acts as a barrier.
 Contains pigments
 hair, nail and glands
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Dermis
1 st layer under the epidermis
 blood vessels
 nerve endings
 glands ( sweat, sebaceous)
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Subcutis
subcutaneous fat
 primary area for fat storage
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producing internal temperature regulation
 mobility of skin over internal body core
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Skin Injury
Classification
Blister
Repeated application of a shear in multiple
directions
 excessive friction on skin
 results in a pocket of fluid accumulation
below epidermis.
 hot spot.
 open vs closed
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do not aspirate if blood filled … otherwise
 aspirate after 24 hours ,
 with a sterile needle ,
 clean and dress the wound ..
 leave the top layer of skin on …
 cover with donut pad and or second skin.
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Skin Bruise
Ecceymosis
a direct compressive force , from a blow or
trauma
 damage to underlying bloods vessels
causing accumulation of blood within the
skin
 ice and pad if necessary
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Abrasion
result of scraping or shear of skin on
rough surface.
 results in loss of epidermis or worse
depending on amount of force
 clean and remove any debris
 flush with saline solution
 dress with non stick adherent pad and
secure
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Punctures
direct penetration of skin by sharp object eg: T&F spike, javelin.
 CAUTION!! Tetanus Bacillis
 lockjaw - acute disease  booster shots if not had one in five years
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Lacerations
sharp object (skate blade)
 direct blow (squash racquet)
 stitches vs steri-strips
 1/2" length, 1/8" deep, need to be done
with in 10 hours
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Ligaments and Tendons
Injury
Classification
Tendons
connect muscles to bones
 dense connective tissue
 fibers parallel - enable resistance of high
unidirectional tensile loads
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Ligaments
connect bone to bone
 dense connective tissue
 fibers parallel and interwoven
 resistance along long axis and also small
resistance to loads of other directions
 more elastin in ligaments than tendons
thus more elastic in nature
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Tendon Injuries
stronger than muscle, so usually
damage to muscle belly or
musculotendinous junction.
 however, tendons can be weakened by
collagen re-absorption with:
> early conditioning.
> post - immobilization.
> repeated micro trauma.
 Note: also weakened with steroid use
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Tendonitis
S/S
 History of chronic onset
 MOI due to overuse, or repeated
overstretch or overload
 Pain exists through out the length of
tendon and increases with palpation
 Swelling may be minor to major and
thickening of tendon may be present
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Crepitus may be present
 Pain usually at the extremes of motion
 Pain increases during stretching and
resisted actions
 Strength decreases with pain
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Tenosynovitis
inflammation of synovial sheath around
tendon.
 occurs quickly
 crepitus - snapping sound
 acute or chronic
 if chronic a nodule is often formed
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Fascitis
inflammation of fascia which separates
muscle layers
 eg. - plantarfascia.
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Bursitis
may be acute or chronic
 direct trauma or repetitive forces
 fluid filled sac
 found in areas where friction might occur
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Joints Types
Fibrous
lack of synovial cavity.
 articulation held together by fibrous
connective tissue.
 little to no movement.
 eg.: distal tib fib joint.
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Cartilaginous
no synovial cavity.
 articulation held together by cartilage.
 little to slight movement.
 eg.: symphasis pubis, intervertebral discs.
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Synovial
-freely movable joints.
 -must process following criteria:
 space/potential b/w articulating ends.
 articular cartilage (hyaline cartilage).
 Articular Capsule:
i) Fibrous (outer).
ii) Synovial membrane (inner).
 secretes synovial fluid to lubricate joint
and provide nutrition.
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Types of Synovial Joints
Ball & Socket
 Hinge
 Pivot
 Saddle
 Gliding
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Bone
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like lig. & tendon connective tissue, except:
calcium carbonate , calcium phosphate, collagen
and water
some degree of flexibility and strength
progressive loss of collagen with age - which
increases the bones brittleness
Periosteum - contains blood supply to bone