© 2010 McGraw-Hill Higher Education. All rights reserved. Chapter 13: Recognizing Different Sports Injuries

© 2010 McGraw-Hill Higher Education. All rights reserved.

Chapter 13: Chapter 13: Recognizing Recognizing

Different Sports Different Sports InjuriesInjuries


InjuriesInjuries

No matter how much time is spent on No matter how much time is spent on injury prevention sooner or later an injury prevention sooner or later an injury occursinjury occurs

Either acute or chronic in natureEither acute or chronic in nature Acute injuriesAcute injuries

Result of macrotraumaResult of macrotrauma Athlete Athlete knowsknows when injury occurred when injury occurred

ChronicChronic Caused by repetitive, overuse activitiesCaused by repetitive, overuse activities Multiple microtraumasMultiple microtraumas


FracturesFractures

Result of extreme Result of extreme stress and strain on stress and strain on bonebone

Anatomical Anatomical CharacteristicsCharacteristics Dense connective Dense connective

tissue matrixtissue matrix Outer compact tissueOuter compact tissue Inner porous Inner porous

cancellous bone cancellous bone including Haversian including Haversian canalscanals


Bone StructureBone Structure Diaphysis Diaphysis

shaft - hollow and cylindrical shaft - hollow and cylindrical covered by compact bonecovered by compact bone

EpiphysisEpiphysis composed of cancellous bone composed of cancellous bone has hyaline cartilage covering has hyaline cartilage covering

PeriosteumPeriosteum dense, white fibrous covering which dense, white fibrous covering which

penetrates bone via Sharpey’s fiberspenetrates bone via Sharpey’s fibers contains blood vessels and osteoblastscontains blood vessels and osteoblasts


Acute FracturesAcute Fractures Partial or complete Partial or complete

disruption that can disruption that can be either closed or be either closed or open (through skin)open (through skin)

Serious Serious musculoskeletal musculoskeletal condition condition

Presents with Presents with deformity, point deformity, point tenderness, swelling tenderness, swelling and pain on active and pain on active and passive motionand passive motion


Load Characteristics of Load Characteristics of FracturesFractures

Bones can be stressed or loaded to fail by Bones can be stressed or loaded to fail by tension, compression, bending, twisting and tension, compression, bending, twisting and shearingshearing

Either occur singularly or in combinationEither occur singularly or in combination Amount of load also impacts the nature of the Amount of load also impacts the nature of the

fracturefracture More force results in a more complex fractureMore force results in a more complex fracture While force goes into fracturing the bone, While force goes into fracturing the bone,

energy and force is also absorbed by adjacent energy and force is also absorbed by adjacent soft tissuessoft tissues

Some bones will require more force than othersSome bones will require more force than others


Healing of FracturesHealing of Fractures Generally require immobilization for some Generally require immobilization for some

periodperiod Approx. 6 weeks for bones of arms and legsApprox. 6 weeks for bones of arms and legs 3 weeks for bones of hands and feet3 weeks for bones of hands and feet

Fracture healing requires osteoblast Fracture healing requires osteoblast activity to lay down bone and form callusactivity to lay down bone and form callus

Following cast removal, normal stresses Following cast removal, normal stresses and strains will aid in healing and and strains will aid in healing and remodeling processremodeling process Osteoclasts will be called on to assist in re-Osteoclasts will be called on to assist in re-

shaping of bone in response to normal stressshaping of bone in response to normal stress


Stress FracturesStress Fractures No specific cause but with a number of No specific cause but with a number of

possible causespossible causes Overload due to muscle contraction, altered Overload due to muscle contraction, altered

stress distribution due to muscle fatigue, stress distribution due to muscle fatigue, changes in surface, rhythmic repetitive stress changes in surface, rhythmic repetitive stress vibrationsvibrations

Begins with a dull ache and progressively Begins with a dull ache and progressively becomes worse over timebecomes worse over time Initially pain during activity and then Initially pain during activity and then

progresses to pain following activityprogresses to pain following activity Early detection is difficult, bone scan is Early detection is difficult, bone scan is

useful, x-ray is effective after several weeks useful, x-ray is effective after several weeks Due to osteoblastic activityDue to osteoblastic activity

If suspected – stop activity for 14 daysIf suspected – stop activity for 14 days Generally do not require castingGenerally do not require casting


Dislocations and Dislocations and SubluxationsSubluxations

DislocationDislocation At least one bone in a joint is forced At least one bone in a joint is forced

completely out of normal and proper completely out of normal and proper alignmentalignment

High level of incidence in fingers, elbow High level of incidence in fingers, elbow and shoulder and shoulder

Subluxation Subluxation Partial dislocations causing incomplete Partial dislocations causing incomplete

separation of two bonesseparation of two bones Often occur in shoulder and patellaOften occur in shoulder and patella


Dislocations and Dislocations and Subluxations (cont’d.)Subluxations (cont’d.)

S&S of dislocationsS&S of dislocations Deformity – almost always presentDeformity – almost always present

Occasionally obscured by heavy musculature = requires Occasionally obscured by heavy musculature = requires palpation to determine normal contourspalpation to determine normal contours

Other factors associated with dislocations - 1) loss of Other factors associated with dislocations - 1) loss of limb function, 2) swelling and point tendernesslimb function, 2) swelling and point tenderness

Additional concernsAdditional concerns Avulsion fracturesAvulsion fractures Growth plate separationGrowth plate separation ““Once a dislocation, always a dislocation”Once a dislocation, always a dislocation”

TreatmentTreatment Dislocations (particularly first time) should always be Dislocations (particularly first time) should always be

considered and treated as a fracture until ruled outconsidered and treated as a fracture until ruled out X-ray is the only absolute diagnostic techniqueX-ray is the only absolute diagnostic technique Return to play often determined by extent of soft Return to play often determined by extent of soft

tissue damagetissue damage


SprainsSprains Damage to a ligament Damage to a ligament

Ligaments provide support to a joint (connect Ligaments provide support to a joint (connect bone to bone)bone to bone)

Synovial joint characteristicsSynovial joint characteristics 2 or more bones2 or more bones Capsule or ligamentsCapsule or ligaments Capsule is lined with synovial membraneCapsule is lined with synovial membrane Hyaline cartilageHyaline cartilage Joint cavity with synovial fluidJoint cavity with synovial fluid Blood and nerve supply with muscles crossing Blood and nerve supply with muscles crossing

jointjoint Mechanoreceptors within joint structures Mechanoreceptors within joint structures

provide feedback relative to positionprovide feedback relative to position


Sprains (cont’d.)Sprains (cont’d.)

Some joints will Some joints will have meniscus have meniscus (thick fibrocartilage) (thick fibrocartilage) for shock absorption for shock absorption and stabilityand stability

LigamentsLigaments Thickened portions of Thickened portions of

the capsule or totally the capsule or totally separate bandsseparate bands

Plays some role in Plays some role in the motions the jointthe motions the joint


Sprains (cont’d.)Sprains (cont’d.) Result of traumatic joint twist that causes Result of traumatic joint twist that causes

stretching or tearing of connective tissuestretching or tearing of connective tissue Graded based on the severity of injuryGraded based on the severity of injury Grading SystemGrading System

Grade I - some pain, minimal loss of function, Grade I - some pain, minimal loss of function, no abnormal motion, and mild point no abnormal motion, and mild point tenderness, slight swelling and joint stiffnesstenderness, slight swelling and joint stiffness

Grade II - pain, moderate loss of function, Grade II - pain, moderate loss of function, swelling, and instability, some tearing of swelling, and instability, some tearing of ligament fibers and joint instabilityligament fibers and joint instability

Grade III - extremely painful, inevitable loss of Grade III - extremely painful, inevitable loss of function, severe instability and swelling, and function, severe instability and swelling, and may also represent subluxationmay also represent subluxation



Sprains (cont’d.)Sprains (cont’d.)

Restoration of joint stability is difficult Restoration of joint stability is difficult with grade I and II injurieswith grade I and II injuries Must rely on other structures around the Must rely on other structures around the

joint joint Rely heavily on muscles surrounding jointRely heavily on muscles surrounding joint

Ligament has been stretched/partially Ligament has been stretched/partially torn causing development of inelastic scar torn causing development of inelastic scar

Ligament will not regain original tensionLigament will not regain original tension Increased muscle tension due to strength Increased muscle tension due to strength

training will improve joint stabilitytraining will improve joint stability


ContusionsContusions Often referred to as “bruise”Often referred to as “bruise” Result of sudden blow to bodyResult of sudden blow to body Can be deep or superficialCan be deep or superficial Hematoma results from blood and lymph flow Hematoma results from blood and lymph flow

into surrounding tissueinto surrounding tissue Minor bleeding results in discoloration of skinMinor bleeding results in discoloration of skin

May be painful to the touch and with active May be painful to the touch and with active movementmovement

Must be cautious and aware of more severe Must be cautious and aware of more severe injuries associated with repeated blowsinjuries associated with repeated blows Calcium deposits may form with fibers of soft Calcium deposits may form with fibers of soft

tissuetissue Myositis ossificans Myositis ossificans


Contusions (cont’d.)Contusions (cont’d.)

Prevention relies on protection and Prevention relies on protection and paddingpadding Particularly when dealing with myositis Particularly when dealing with myositis

ossificansossificans Protection and rest may allow for Protection and rest may allow for

calcium re-absorption calcium re-absorption Surgery would not be necessary to removeSurgery would not be necessary to remove

Quadriceps and biceps are very Quadriceps and biceps are very susceptible to developing myositis susceptible to developing myositis ossificansossificans


Muscle Strains and Muscle Strains and InjuriesInjuries

CausesCauses Stretch, tear or rip to muscle or adjacent tissue Stretch, tear or rip to muscle or adjacent tissue

(tendon)(tendon) Muscle Strain GradesMuscle Strain Grades

Grade I - some fibers have been stretched or actually Grade I - some fibers have been stretched or actually torn resulting in tenderness and pain on active ROM, torn resulting in tenderness and pain on active ROM, movement painful but full range presentmovement painful but full range present

Grade II - number of fibers have been torn and active Grade II - number of fibers have been torn and active contraction is painful, usually a depression or divot is contraction is painful, usually a depression or divot is palpable, some swelling and discoloration resultpalpable, some swelling and discoloration result

Grade III- Complete rupture of muscle or Grade III- Complete rupture of muscle or musculotendinous junction, significant impairment, musculotendinous junction, significant impairment, with initially a great deal of pain that diminishes due with initially a great deal of pain that diminishes due to nerve damageto nerve damage


Treatment/Rehab of Treatment/Rehab of StrainsStrains

Large tendon ruptures will require Large tendon ruptures will require surgerysurgery

RehabilitationRehabilitation Lengthy process regardless of severityLengthy process regardless of severity Will generally require 6-8 weeksWill generally require 6-8 weeks Return to activity too soon may result in Return to activity too soon may result in

re-injury re-injury


Muscle Guarding and Muscle Guarding and CrampsCramps

Muscle GuardingMuscle Guarding Following injury, muscles within an effected Following injury, muscles within an effected

area contract to splint the area in an effort to area contract to splint the area in an effort to minimize pain through limitation of motionminimize pain through limitation of motion

Involuntary muscle contraction in response to Involuntary muscle contraction in response to pain following injurypain following injury

Not spasm which would indicate increased tone due Not spasm which would indicate increased tone due to upper motor neuron lesion in the brainto upper motor neuron lesion in the brain

Muscle Cramps Muscle Cramps Painful involuntary contractionPainful involuntary contraction Attributed to dehydration/electrolyte Attributed to dehydration/electrolyte

imbalanceimbalance May lead to muscle or tendon injuriesMay lead to muscle or tendon injuries


Muscle SorenessMuscle Soreness Overexertion in strenuous exercise results in muscular Overexertion in strenuous exercise results in muscular

painpain Generally occurs following participation in activity to Generally occurs following participation in activity to

which individual is unaccustomed which individual is unaccustomed Two types of sorenessTwo types of soreness

Acute-onset muscle soreness - accompanies fatigue, and is Acute-onset muscle soreness - accompanies fatigue, and is transient muscle pain experienced immediately after exercisetransient muscle pain experienced immediately after exercise

Delayed-onset muscle soreness (DOMS) - pain that occurs 24-48 Delayed-onset muscle soreness (DOMS) - pain that occurs 24-48 hours following activity that gradually subsides (pain free 3-4 hours following activity that gradually subsides (pain free 3-4 days later)days later)

Potentially caused by slight microtraumas to muscle or connective Potentially caused by slight microtraumas to muscle or connective tissue structurestissue structures

Also associated with lactic acid build upAlso associated with lactic acid build up Prevent muscle soreness through gradual build-up of Prevent muscle soreness through gradual build-up of

intensityintensity Treat with static or PNF stretching and ice application Treat with static or PNF stretching and ice application

within 48-72 hours of insultwithin 48-72 hours of insult


Nerve InjuriesNerve Injuries

Two main causes of injuryTwo main causes of injury CompressionCompression TensionTension

Resulting in radiating pain & muscle Resulting in radiating pain & muscle weaknessweakness

Stinger or burnerStinger or burner May be acute or chronicMay be acute or chronic

Causes pain and can result in a host of sensory Causes pain and can result in a host of sensory responses (pinch, burn, tingle, muscle weakness, responses (pinch, burn, tingle, muscle weakness, radiating pain)radiating pain)


Nerve Injuries (cont’d.)Nerve Injuries (cont’d.) Injuries can range from minor to severe and Injuries can range from minor to severe and

life alteringlife altering NeuritisNeuritis

Chronic nerve problem caused by overuse or a Chronic nerve problem caused by overuse or a variety of forcesvariety of forces

Results in minor to severe problemsResults in minor to severe problems Crushing or severed nerve injuryCrushing or severed nerve injury

Life long implicationsLife long implications Paraplegia/quadriplegia could resultParaplegia/quadriplegia could result

Healing process is very slow and long termHealing process is very slow and long term Optimal environment is criticalOptimal environment is critical CNS vs. PNS repairCNS vs. PNS repair


Chronic Overuse InjuriesChronic Overuse Injuries

Inflammation is an essential part of Inflammation is an essential part of healing processhealing process Must occur following tissue damage to Must occur following tissue damage to

initiate healinginitiate healing Signs and SymptomsSigns and Symptoms

Pain, redness, swelling, loss of Pain, redness, swelling, loss of function and warmthfunction and warmth

If source of irritation is not If source of irritation is not removed then inflammatory process removed then inflammatory process becomes chronicbecomes chronic


TendinitisTendinitis Most common overuse problem in sportsMost common overuse problem in sports Gradual onset, with diffuse tenderness Gradual onset, with diffuse tenderness

due to repeated microtrauma and due to repeated microtrauma and degenerative changesdegenerative changes

Obvious signs of swelling and painObvious signs of swelling and pain May also experience crepitus (due to May also experience crepitus (due to

chemical products of inflammation)chemical products of inflammation) Key for treatment is rest and removal of Key for treatment is rest and removal of

causal factorscausal factors Work to maintain fitness but avoid activities Work to maintain fitness but avoid activities

that aggravate conditionthat aggravate condition


TenosynovitisTenosynovitis Inflammation of synovial Inflammation of synovial

sheathsheath In acute case - rapid In acute case - rapid

onset, crepitus, and onset, crepitus, and diffuse swellingdiffuse swelling

Chronic cases result in Chronic cases result in thickening of tendon with thickening of tendon with pain and crepituspain and crepitus

Often develops in long Often develops in long flexor tendons of fingersflexor tendons of fingers

Treatment is similar to Treatment is similar to that of tendinitisthat of tendinitis

NSAID’s may also be of NSAID’s may also be of some assistancesome assistance


BursitisBursitis BursaBursa

Fluid filled sac that develops in area of frictionFluid filled sac that develops in area of friction Sudden irritation can cause acute bursitis, Sudden irritation can cause acute bursitis,

while overuse and constant external while overuse and constant external compression can cause chronic bursitiscompression can cause chronic bursitis Results in increased fluid production, causing Results in increased fluid production, causing

increases in pressure due to limited space increases in pressure due to limited space around anatomical structuresaround anatomical structures

Signs and symptoms include swelling, Signs and symptoms include swelling, pain, and some loss of functionpain, and some loss of function

Three most commonly irritatedThree most commonly irritated Subacromial, olecranon, and prepatellar bursaSubacromial, olecranon, and prepatellar bursa


OsteoarthritisOsteoarthritis

Wearing away of hyaline cartilage as a Wearing away of hyaline cartilage as a result of normal useresult of normal use Changes in joint mechanics lead joint Changes in joint mechanics lead joint

degeneration (the result of repeated trauma to degeneration (the result of repeated trauma to tissue involved)tissue involved)

May be the result of direct blow, pressure of May be the result of direct blow, pressure of carrying and lifting heavy loads, or repeated carrying and lifting heavy loads, or repeated trauma from an activity such as running or trauma from an activity such as running or cyclingcycling

Commonly affects weight bearing joints but Commonly affects weight bearing joints but can also impact shoulders and cervical spinecan also impact shoulders and cervical spine


Osteoarthritis (cont’d.)Osteoarthritis (cont’d.)

Symptoms include Symptoms include pain (as the result of pain (as the result of friction), stiffness, friction), stiffness, prominent uprising in prominent uprising in the morning, localized the morning, localized tenderness, creaking, tenderness, creaking, grating, and often is grating, and often is localized to one side localized to one side of the joint or of the joint or generalized joint paingeneralized joint pain


Myofascial Trigger Myofascial Trigger PointsPoints

Develop due to mechanical stressDevelop due to mechanical stress Either acute strain or static postural positions Either acute strain or static postural positions

producing constant tension in muscleproducing constant tension in muscle Typically occur in neck, upper and lower Typically occur in neck, upper and lower

backback Signs and Symptoms Signs and Symptoms

Pain with palpation, with predictable pattern Pain with palpation, with predictable pattern of referred pain which may also limit motionof referred pain which may also limit motion

Pain may increase with active and passive Pain may increase with active and passive motion of involved musclemotion of involved muscle


Importance of the Importance of the Healing Process Healing Process Following Injury Following Injury

Essential to possess understanding Essential to possess understanding of both sequence and time frame for of both sequence and time frame for various phases of healing processvarious phases of healing process

Interference with healing process Interference with healing process will delay return to full activitywill delay return to full activity

Work to create optimal healing Work to create optimal healing environmentenvironment Little can be done to speed the process, Little can be done to speed the process,

while much can be done to impede itwhile much can be done to impede it



Inflammatory Response Inflammatory Response PhasePhase

Begins immediately following injury – critically Begins immediately following injury – critically importantimportant Without the inflammatory phase the other phases Without the inflammatory phase the other phases

will not occurwill not occur Phagocytosis occurs to clean the injured areaPhagocytosis occurs to clean the injured area Chemical mediators are released to facilitate Chemical mediators are released to facilitate

healinghealing Symptomatically presents with redness, Symptomatically presents with redness,

swelling, warmth, tenderness and loss of swelling, warmth, tenderness and loss of functionfunction

Stage lasts 2-4 days following injuryStage lasts 2-4 days following injury


Fibroblastic Repair Fibroblastic Repair PhasePhase

Proliferative and regenerative activity Proliferative and regenerative activity occurs resulting in scar formation occurs resulting in scar formation (fibroplasia)(fibroplasia) Occurs within initial hours of injury and Occurs within initial hours of injury and

continues up to 4-6 weekscontinues up to 4-6 weeks S&S of inflammatory phase subsideS&S of inflammatory phase subside

Athlete will still experience some tenderness Athlete will still experience some tenderness and pain with motionand pain with motion

With increasing development of the scar With increasing development of the scar complaints of pain and tenderness will complaints of pain and tenderness will decreasedecrease


Maturation-Remodeling Maturation-Remodeling PhasePhase

Long-term processLong-term process Re-alignment of scar tissue according to Re-alignment of scar tissue according to

tensile forces acting on tissuetensile forces acting on tissue Re-align to position of maximum efficiency Re-align to position of maximum efficiency

(parallel to lines of tension)(parallel to lines of tension) Tissue gradually resumes normal Tissue gradually resumes normal

appearance and functionappearance and function After 3 weeks, firm, strong, contracted, After 3 weeks, firm, strong, contracted,

nonvascular scar existsnonvascular scar exists Maturation may take several years to be Maturation may take several years to be

totally completetotally complete


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© 2010 McGraw-Hill Higher Education. All rights reserved. Chapter 13: Recognizing Different Sports Injuries