Transcript Athletic Injuries(Chapter 23) - Dr Antoine I Jabbour | Tulsa Sports

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Dislocations
Subluxations
Cuff tears
Osteolysis of distal clavicle (power lifters)
Fractures
TONY JABBOUR, MD
SPORTS MEDICINE
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Elbow – high stress during throwing.
MCL stretching leads to valgus instability.
Radial head osteochondritis dissecans (younger
pitchers).
Lateral epicondylitis (tennis elbow, injury to
extensor tendons of the wrist).
TONY JABBOUR, MD
SPORTS MEDICINE
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Mallet finger – extensor tendon rupture from the
distal phalanx, splinting usually.
Jersey finger – Football. Flexor digitorum
profundus (FDP) of tackling player. Flexor tendon
avulses from distal phalanx. Surgery is usual
treatment.
Skiers thumb – ulnar collateral ligament sprain of
the thumb.
TONY JABBOUR, MD
SPORTS MEDICINE
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Avulsion injuries from anterior superior iliac spine
or ischial tuberosity. Younger athletes, usually
around 14 years of age.
Hamstring strains – usually older athletes.
Femoral neck stress fractures (rare but require
pinning).
TONY JABBOUR, MD
SPORTS MEDICINE
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Second most frequently injured in regard to soft
tissue injuries.
Overuse injuries lead to tendinitis.
Traumatic – Patellar dislocations, ACL tear,
cartilage damage (articular cartilage or meniscus).
MCL – Soccer, hockey.
ACL – Non-contact, high speed, change of
direction. Tibia subluxes onto femur.
TONY JABBOUR, MD
SPORTS MEDICINE
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Shin splints – Non-specific term, should be
avoided.
Stress fracture of tibia.
Exertional compartment syndrome – different
from post-traumatic compartment syndrome in
that pressure never gets high enough to cause
permanent damage.
Increased pressure leads to increased lactic acid,
which leads to increased pain which leads to
athlete having to stop activity.
TONY JABBOUR, MD
SPORTS MEDICINE
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Most common of all soft tissue athletic injuries.
Ligaments prone to injury.
Complete ligament tears can heal non-operatively.
Achilles rupture – middle-aged athletes.
Thompson test.
TONY JABBOUR, MD
SPORTS MEDICINE
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Plantar fasciitis and stress fracture of calcaneus,
common causes of heel pain.
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Stress fracture of metatarsals and sesamoid bone.
TONY JABBOUR, MD
SPORTS MEDICINE
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Cervical injuries – spearing in football is illegal
which can lead to quadriplegia.
TONY JABBOUR, MD
SPORTS MEDICINE
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Keep helmet and shoulder pads on during
transport to ER by ambulance.
Stingers/Burners – painful sensations radiating
down arm and possibly numbness and weakness
secondary to forceful shoulder depression or
lateral bending of neck during tackling.
Low back pain common with gymnastics and
football.
TONY JABBOUR, MD
SPORTS MEDICINE
•Stress fracture of pars interarticularis
(spondylolysis).
•Axial loads on spine in extension.
•MRI/bone scan.
•Treatment – Rest and bracing.
•Spondylolisthesis – progressive instability of one
vertebral body onto the one below – “rare
complication in athletes”.
•Contusions.
•Fractures.
•Sprains.
•Dislocations.
•Turf toe hyperextension injury.
TONY JABBOUR, MD
SPORTS MEDICINE
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Especially pitchers:
 Shoulder instability with secondary
impingement.
 Valgus overload of elbow (younger
athletes).
 Osteochondritis dissecans of elbow.
 Hook of hamate fracture, batting.
TONY JABBOUR, MD
SPORTS MEDICINE
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High risk of knee and ankle injuries.
TONY JABBOUR, MD
SPORTS MEDICINE
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ACL injuries
Ankle injuries with landing.
Hyperextension of spine leads to spondylolysis.
Eating disorders – Female triad:
 Eating disorder
 Abnormal menses
 Stress Fracture
TONY JABBOUR, MD
SPORTS MEDICINE
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Shoulder instability (younger athletes).
Rotator cuff tears (older athletes).
Low back pain.
Lateral epicondylitis (older athletes).
TONY JABBOUR, MD
SPORTS MEDICINE
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Finger injuries.
Jumper’s knee (chronic tendinosis of patellar
tendon, usually at distal pole of patella.
Treatment – hamstring stretches and quadriceps
strengthening.
Knee/ankle injuries most common.
TONY JABBOUR, MD
SPORTS MEDICINE
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Year-round Sport.
Overuse injuries.
Low back pain.
High number of catastrophic injuries (neck and
head injuries) secondary to basket tosses and
pyramids.
TONY JABBOUR, MD
SPORTS MEDICINE
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Knee/ankle injuries most common.
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Osteitis pubis – Repetitive stress on symphysis
pubis from high kicking.
TONY JABBOUR, MD
SPORTS MEDICINE
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Lacerations from skates and fighting.
AC joint clavicle fracture because of body
checking.
Catastrophic neck injuries.
MCL injuries.
TONY JABBOUR, MD
SPORTS MEDICINE
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AC joint injuries secondary to landing on point of
shoulder.
TONY JABBOUR, MD
SPORTS MEDICINE
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Jumper’s knee.
ACL meniscal injury.
Shoulder instability in younger patients.
Finger tip injuries.
TONY JABBOUR, MD
SPORTS MEDICINE
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Shoulder injuries.
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Breaststroker’s knee ( MCL strain).
TONY JABBOUR, MD
SPORTS MEDICINE
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Inferior shoulder instability.
TONY JABBOUR, MD
SPORTS MEDICINE
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Stress fractures of metatarsals and tibia.
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Exertional compartment syndrome.
TONY JABBOUR, MD
SPORTS MEDICINE
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Lower center of gravity.
Wider pelvis which leads to high valgus angle at
knee (knock-kneed).
Wider pelvis also leads to high patellofemoral
tracking problems.
Smaller notch in knee leads to high ACL tears.
Monthly fluctuation of Estrogen levels.
If Estrogen is down, this leads to osteoporosis
which leads to decreased repair of stress fractures.
TONY JABBOUR, MD
SPORTS MEDICINE
•FEMALE TRIAD:
•Eating disorders
•Osteoporosis
•Abnormal menses
TONY JABBOUR, MD
SPORTS MEDICINE
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Definition of aging?
More sprains and strains.
Increased risk of stress fractures.
Vascular claudication (peripheral vascular
disease).
Neurogenic claudication (spinal stenosis).
TONY JABBOUR, MD
SPORTS MEDICINE
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Open physes (growth plates).
Physis tends to fail before ligament fails.
All sprains in children/adolescents – think
physis fracture.
Apophysitis – inflammation at attachment of
tendons. (Osgood-Schlatter’s disease).
Avulsion fracture (ischial tuberosity).
Osteochondritis dissecans (elbows of pitchers).
Tarsal coalition in 11-15 year olds.
TONY JABBOUR, MD
SPORTS MEDICINE
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Special Olympics.
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Down’s Syndrome – Cervical spine C1-2
instability.
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Wheelchair athletes – rotator cuff tears.
TONY JABBOUR, MD
SPORTS MEDICINE