Transcript What`s wrong?

Injury Classification
What’s wrong?
Trauma
• An injury or wound created by a force applied to any body part
– Direct trauma: impact from a blow or fall
– Indirect trauma: forcing a joint beyond its normal range of motion
• Results in a harmful disturbance in
– Function
– Structure
Injury Classification
Fracture
– Break or crack in bone
– Simple, compound or stress fracture
• Emergency Splinting
– Splint all suspected fracture before moving the athlete or body part
– Use proper immobilization to decrease risk of
• Secondary tissue damage
• Hemorrhage
• Potential for death (if handled improperly)
– Splint the fracture where the athlete lies
– Avoid moving the athlete before splinting
– Splint one joint above and one joint below the fracture
– Assess neurovascular status before and after splinting
– Monitor vital signs
– Rapid form immobilizer
– Air splints
• Clear plastic splint inflated with air around affected part
• Do not use with fracture deformity
• Provides moderate pressure and can be x-rayed through
– Cardboard splints
– Lower Limb Splinting
• Foot and ankle require splinting of foot and knee
• Knee, thigh, or hip require splinting of whole leg and one side of trunk
– Upper Limb Splinting
• Shoulder splinting is difficult
– Use sling and swathe with upper limb bound to body
• Upper arm and elbow
– Splint with arm straight to lessen bone override
• Lower arm and wrist
– splint in position of forearm flexion and support with sling
• Hand and finger
• splint with tongue depressors, roller gauze and/or aluminum splints
Sprains
– Injury to the following structures
• Joint Capsule
• Ligaments
Synovial Joint
•
Fibrous (Joint) Capsule
•
Ligaments
•
Synovial Membrane
•
Synovial Fluid
•
Articular Cavity
– Contains synovial fluid
•
Articular Cartilage
•
In some cases
– meniscus/I
– labrum
Synovial Joints
• Synovial fluid
– Shock absorber
• Function
– Cushions bone ends
– Allows movement in one or more
directions
– Prevents irritation
– Low friction articulation
• Meniscus/Labrum
– In some synovial joints
– Cartilagenous disc
– Surrounded by synovial fluid
– Reduces friction
– Increases joint stability
– Allows movement with minimal
effort
Synovial Joint Injury
Trauma - Sprains
• Pathology
– Ligaments
– Joint capsule
– Synovial membrane
Synovial Joint
Trauma - Sprains
• Mechanism of injury
– Forcing of joint into abnormal position
as in traumatic twist
– Overstretch or tearing of structures
– Degrees of sprains
• 1st over stretch
• 2nd partial tear
• 3rd complete tear
1st Degree Sprain
Signs & Symptoms
• Ligament Damage
•Mild tearing or overstretch
• Point Tenderness
•Yes
• Loss of Function
•Mild
• ROM
•Not effected
• Edema (swelling)
•Mild
• Stress test results
•No Laxity
2nd Degree Sprain
Signs & Symptoms
• Ligament Damage
•Moderate tearing
• Point Tenderness
•Yes
• Loss of Function
•Moderate to severe
• ROM
•Decreased
• Edema (swelling)
•Moderate
• Stress test results
•Some laxity with end point
3rd Degree Sprain
Signs & Symptoms
• Ligament Damage
•Complete tear
• Point Tenderness
•Yes
• Loss of Function
•Severe w/instability
• ROM
•Decreased or increased
• Edema (swelling)
•Moderate to severe
• Stress test results
•Laxity with no end point
• Subluxation
– Bone comes partially out of joint(<50%)
– Usually goes back in place by itself
• Dislocation
– The separation of the bones of a joint more than
50% of articulation surfaces
– Mechanism of injury
• A force that causes a joint to go beyond its
normal anatomical limits
– Requires outside force to put bone back in
place (reduction of dislocation)
Sprains
Assessment
•
Joint stability or ligamentous laxity tests
•
Positive test indicated by
– Abnormal translation of one bone in relation to
another bone
– Indicates laxity
•
Grade
1+ 0-5mm
2+ 5-10 mm
3+ >10mm
Normal End Points
• Soft tissue approximation
– Soft and spongy
– Gradual painless stop
– ie. Knee flexion
• Capsular
– Abrupt, hard, firm end point
– Only a little give
– ie. Hip rotation
• Bone to bone
– Distinct and abrupt
– Two hard surfaces contact
– ie. Elbow extension
• Muscular
– Springy
– Some discomfort
– ie. Shoulder abduction
Abnormal End Points
• Empty
– Movement beyond anatomical limit
– Pain before end range
– ie. ligament rupture
• Spasm
– Involuntary muscle contraction
– Muscle guarding prevents motion
• Loose
– Occurs w/extreme hypermobiltiy
– ie. Previously sprained joint
• Springy block
– Rebound at end point
– Meniscus tear
Muscles, Tendons and Strains
• Muscles
– Origin
– Belly
– Insertion
• Tendons
– Connect muscle to bones
• Musculotendinous Junction
– Area where muscle and tendon connect
1st Degree Strain
• Muscle damage: Mild tearing
• Pain w/contraction: Mild
• Pain w/stretching: Yes
• Muscle spasm: Possible
• Loss of function: Mild
• ROM: decreased
• Edema: Mild
• Palpable defect: None
2nd degree Strain
• Muscle damage: Moderate tearing
• Pain w/contraction: Moderate to severe
• Pain w/stretching: Yes
• Muscle spasm: Possible
• Loss of function: Moderate to severe
• ROM: Decreased
• Edema: Moderate
• Palpable defect: None
• Hamstring 2 º Strain
3rd Degree Strain
• Muscle damage: Complete tear
• Pain w/contraction: None to mild
• Pain w/stretching: No
• Muscle spasm: Possible
• Loss of function: Severe
• ROM: Decreased or increased
• Edema: Moderate to severe
• Palpable defect: Yes
Manual Muscle Testing
• Grading strength on 5/5 basis
•
Classification
ROM
Gravity
•
5/5
Full
Yes
Yes
=/> than other side
•
4/5
Full
Yes
Yes
< then other side
•
3/5
Full
Yes
No
< then other side
•
2/5
Full
No
No
< then other side
•
1/5
No
No
No
Palpable contraction
•
0/5
No
No
No
No Palpable contraction
Added Resistance
Strength
Injury Classification
Tendinopathy
•Tendinitis
–No longer considered inflammatory condition
•Mechanism of Injury
–Tendon is overloaded due to extensive stress
–Degenerative changes in the tendon
–Gradual onset
–Worsens with continued use
–Decreased flexibility exacerbates condition
Injury Classification
Leg Cramps
Muscle Spasms
•Involuntary muscle contractions
–Sudden
–Violent
–Fatigue
–Loss of fluids
–Electrolyte imbalance
–Nerve Irritation
Contusions - Bruises
•Skin
•Muscles
•Tendons
•Ligaments
•Bone
•Nerves
“Charleyhorse”