Transcript Athletic Injuries

Athletic Injuries
John Hardin
MA, ATC, LAT, CSCS
SPHS Sports Medicine Class
Injuries
Acute
– Sudden onset
– traumatic
Chronic
– Overuse
– Repetitive activities
4/9/2016
Athletic injuries
2
Types of injuries
Closed Wounds
Skin
Musculoskeletal
Open Wounds
Skin
Musculoskeletal
4/9/2016
Athletic injuries
3
What you need to know
What is the injury?
What is the mechanism of injury?
How do you recognize the injury?
Signs?
Symptoms?
How do you care for the injury?
4/9/2016
Athletic injuries
4
Types of stress that cause injury
Tension
Stretching
Compression
Shearing
Bending
4/9/2016
Athletic injuries
5
Tension
A force that pulls or stretches tissue
– Example: sprain, strain
4/9/2016
Athletic injuries
6
Stretching
Going beyond the “yield” point
leading to a rupturing of soft tissue
or fracturing a bone
– Examples—sprain, strain, avulsion
fracture
4/9/2016
Athletic injuries
7
Compression
A force with enough energy to crush
tissue
– Example: arthritic changes, fracture,
contusion
4/9/2016
Athletic injuries
8
Shearing
A force that moves across the
parallel organization of tissue
– Example: blister, abrasion, vertebral
disk injury
4/9/2016
Athletic injuries
9
Bending
A force on the horizontal bone that
places stress within the structure
causing it to bend
– Example: fracture
– There can also be torsion or twisting
that causes compression and tension in
a spiral pattern.
4/9/2016
Athletic injuries
10
Closed Wounds
Contusions
Strains
Sprains
Dislocations
Fractures
4/9/2016
Athletic injuries
11
Contusions
Also known as bruise or charley
horse
Direct blow to the body part
Pain, temporary LOM, bruising or
discoloration, swelling
RICE, stretch
4/9/2016
Athletic injuries
12
Contusion
4/9/2016
Athletic injuries
13
Complications
If not treated properly can develop
myositis ossificans
– Bony formation within muscle
4/9/2016
Athletic injuries
14
Myositis Ossificans
4/9/2016
Athletic injuries
15
Myositis Ossificans
4/9/2016
Athletic injuries
16
Sprains
Injury to ligaments, also know as
“rolling” or “twisting”
Moving the joint beyond the normal
range of motion
Pain, swelling, discoloration, LOM
RICE, crutches, immobilization,
medical referral
4/9/2016
Athletic injuries
17
Degrees of Sprains
1st degree
overstretching
2nd degree
Partial tearing
3rd degree
Complete rupture
4/9/2016
Athletic injuries
18
1st degree sprain
Stretching of ligament
Minimal instability of joint
Mild to moderate pain
Localized swelling (minimal)
Joint stiffness
POT (point tenderness)
Discoloration
4/9/2016
Athletic injuries
19
2nd degree sprain
Partial tearing of ligament
Moderate joint instability
Moderate to severe pain
Swelling
Joint stiffness
POT
Discoloration
Inability to bear weight
4/9/2016
Athletic injuries
20
3rd degree sprain
Complete tearing of ligament
Joint instability
Severe pain initially followed by less
pain due to disruption of nerve fibers
Lots of swelling
Discoloration
Joint stiffness
POT
4/9/2016
Athletic injuries
21
Complications
Once a ligament is stretched/torn, it
heals with inelastic scar tissue which
prevents the ligament from regaining
its original tension
Ruptured/torn ligaments may require
surgery
4/9/2016
Athletic injuries
22
Strains
Injury to muscle or tendon—”pulling”
Stretching beyond a normal range or
strong muscle contraction
Pain, swelling, discoloration, “divot”,
LOM
RICE, crutches, medical referral
4/9/2016
Athletic injuries
23
Strains
Degrees of Strains
1st degree
Overstretching of muscle or tendon
no tearing of tissue
2nd degree
Partial tearing of muscle or tendon
3rd degree
Complete tearing or rupture of tissue
4/9/2016
Athletic injuries
25
Strains
Signs and symptoms are similar to
those of the sprains---it just occurs
within the muscle or tendon area
4/9/2016
Athletic injuries
26
Strains
4/9/2016
Athletic injuries
27
Complications
Scar tissue is not as elastic, may lose
some flexibility
Returning too soon can cause
reinjury to area
Rehab may take longer than for
sprains due to contractile properties
of muscles
4/9/2016
Athletic injuries
28
Dislocations
Bone ends at a joint are out of place
Joint is stressed beyond its normal
boundaries
Obvious deformity, pain, LOM at that
joint, shock
Immobilize joint, ice, treat for shock,
call 911 or send to ER for reduction
4/9/2016
Athletic injuries
29
Dislocations
4/9/2016
Athletic injuries
30
Subluxations
Partial or incomplete dislocation
Joint stretched beyond normal ROM
Pain, swelling, LOM
RICE, immobilize if necessary,
medical referral
4/9/2016
Athletic injuries
31
Fractures
Broken bone
Great force on the bone that moves
it or bends it beyond the “break”
point
Pain, possible deformity, crepitus,
unable or unwilling to move body
part, discoloration, swelling
RICE, immobilize, crutches, medical
referral
4/9/2016
Athletic injuries
32
Kinds of Fractures
Avulsion
Blowout
Comminuted
Compression
4/9/2016
Athletic injuries
33
Blowout fracture
Kinds of Fractures
Epiphyseal
Greenstick
Longitudinal
4/9/2016
Athletic injuries
35
Kinds of fractures cont’d
Oblique
Pathological
Serrated
Spiral
4/9/2016
Athletic injuries
36
Pathological fractures
4/9/2016
Athletic injuries
37
Kinds of Fractures
Stress
Transverse
4/9/2016
Athletic injuries
38
Kinds of Fractures
A few more photos
4/9/2016
Athletic injuries
39
Open Fractures & Dislocations
A break in the bone or the bone ends
come out of place
The bone (end) is exposed, may be
bleeding, pain, LOM, shock
Cover the exposed bone
Immobilize
Treat for shock
Transport or send to ER
4/9/2016
Athletic injuries
40
Fixing the Fracture
Casting
Internal fixation
External Fixation
4/9/2016
Athletic injuries
41
Open wounds
Abrasions
Incisions
Lacerations
Avulsions
Amputations
Puncture
4/9/2016
Athletic injuries
42
Abrasions
Road rash, strawberry, traumatic
tattoo
Top layer(s) of skin are rubbed off
Pain, some bleeding, oozing,
dirt/debris in the wound
Clean the wound with soap and
water, apply antibacterial ointment,
cover, watch for infection
4/9/2016
Athletic injuries
43
Incisions & Lacerations
Open cut with either smooth
or jagged edges
Cut by blunt trauma
or sharp object
Bleeding, open wound,
pain, shock
Control bleeding, clean wound,
pull ends of skin together,
send for stitches if necessary
4/9/2016
Athletic injuries
44
Lacerations
4/9/2016
Athletic injuries
45
Avulsions & Amputations
Body part or skin partially or
completely torn away from body
Trauma
May be profuse or little bleeding,
body part missing (or partly), shock
Get the missing body part in plastic
bag, control bleeding, treat for
shock, call 911, ER
4/9/2016
Athletic injuries
46
Avulsions
4/9/2016
Athletic injuries
47
Puncture
Object is imbedded or impaled in the
person
Force to push the object into the
body
Little bleeding, object impaled, shock
Leave the object in if in more than ¼
in., control bleeding, Call 911 or
send to ER
4/9/2016
Athletic injuries
48
Punctures
Very small or large object
Leave in place to prevent further
trauma and control bleeding
4/9/2016
Athletic injuries
49
Tendinitis
Inflammation of a tendon
Due to overuse
Common sites
– Achilles tendon
– Biceps tendon
– Peroneal tendon
Tendinitis
Signs/symptoms
– Pain with movement
– Swelling
– Warmth
– crepitus
Tendinitis
Treatment
– Rest
– Ice
– Heat
– Anti-inflammatory drugs
Tenosynovitis
Inflammation of tendon surrounded
by a synovial sheath
Signs/symptoms are similar to
tendinitis
Treatment is similar
Bursitis
Bursae
– Fluid filled (synovial) sac found at joints
– Decrease friction during movement
Inflammation of bursa
Subacromial bursa, olecranon bursa,
prepatellar bursa
Bursitis
Acute or chronic
Produce large amounts of synovial
fluid
More irritation, more fluid
More fluid, more pain
Restricts movement
Nerve injuries
Acute or chronic
Stretched, compressed, torn/severed
Produce variety of sensations
– Hypoesthesia, hyperesthesia,
paresthesia
Nerves damaged in periphery can
regenerate, but spinal nerves cannot
(rate of 3-4 mm per day)
Tissue healing
Injury must occur
Inflammation must occur for healing
to begin
Soft tissue healing
3 stages
– Inflammatory response stage
– Fibroblastic Repair stage
– Maturation-Remodeling stage
Inflammatory Response stage
Begins immediately after injury
Last 2-4 days
Cells die due to injury, lack of O2, &
nutrients
Phagocytes come in to eat the dead
cells
Leukocytes (WBC) come in to help
fight infection
Inflammatory Response Phase
Platelets are blood clotting cells
Come in to help control bleeding
Area will have redness, swelling,
tenderness, discoloration, loss of
function
Fibroblastic Repair phase
Fibroplasia-period of scar formation
Begins within first few hours
Lasts 4-6 weeks
Fibroblasts are fiber building cells
that lay fibers across injured area
Form the scar tissue for healing
Maturation-Remodeling Phase
Long term process
Can take a year or longer
Realigns the scar tissue when
subjected to stresses applied
Realigns in a parallel form to become
normal in appearance and function
Must use strengthening exercises to
provide stress needed to remodel
Bone Fracture healing
3 stages
Acute fracture stage
Repair stage
Remodeling stage
Acute fracture stage
Get bleeding in area due to fracture
of bone
Osteoclasts come in to “eat” the
debris and help resorb it into the
body
Osteoblasts add new layers of “bone”
to the outside of bone
Repair stage
Osteoclasts and osteoblasts continue
to regenerate bone
Bony splint (callus) forms both
internally & externally to hold ends
of bone together
Transformation of “callus” to bone
starts at about 3rd week & continues
to 3rd month
Remodeling
Can take years
Usually return to activity within 6-16
weeks
Callus is resorbed and replaced with
fibrous bone around fracture site.
Stress must be applied to help
remodel/reorganize the site
Summary
Any injury can cause shock
Treat the signs and symptoms you
find
If in doubt as to the severity of the
injury, be conservative
Call 911 and let EMS take over
4/9/2016
Athletic injuries
67
Terms/prefixes/suffixes
Hyper-to increase
Hypo- to decrease
Itis- inflammation
Cardio- heart
Heme- blood
Edema- swelling
Arthro- joint
Terms
Myo- muscle
Oss/osteo- bone
Rhino- nose
Oto- ear
Laryngo- larynx & throat
Neuro- nerve
Gastro- stomach
Terms
Algia- pain
Sub- below
Ab- away
Add- towards
Dys- bad
Eu- good
Inter- between
Terms
Intra- within or inside
Supra- above
Infra- below
Cyan/o- blue
Erythr/o-red
Leuk/o-white
Melan/o- black
Poli/o-gray