Chapter 13: Chapter 13: Recognizing Different Recognizing Different Sports InjuriesSports Injuries

Acute InjuriesAcute Injuries

FracturesFractures Dislocations and subluxationsDislocations and subluxations Ligament SPRAINSLigament SPRAINS ContusionsContusions Muscle STRAINSMuscle STRAINS Muscle crampsMuscle cramps Muscle sorenessMuscle soreness Nerve injuriesNerve injuries

FracturesFractures

Fractures (broken bones) occur because Fractures (broken bones) occur because of extreme stress placed on the boneof extreme stress placed on the bone

Parts of the boneParts of the bone Diaphysis- shaft (hollow)Diaphysis- shaft (hollow) Epiphysis- ends (place of growth)Epiphysis- ends (place of growth) Articular cartilage- covers joint surface Articular cartilage- covers joint surface

(provides protection and shock absorption)(provides protection and shock absorption) Periosteum- outer coveringPeriosteum- outer covering

FracturesFractures

Closed FractureClosed Fracture

Little or no Little or no movement or movement or displacement of displacement of broken bonesbroken bones

Open FractureOpen Fracture

Bone breaking Bone breaking through the through the surrounding surrounding tissues, tissues, including the including the skin, secondary skin, secondary to significant to significant displacement of displacement of the bonesthe bones

Forces Causing Forces Causing FracturesFractures

BendingBending

TorsionTorsion

CompressionCompression

Fracture HealingFracture Healing

Requires brief immobilizationRequires brief immobilization Long bones in the limbs (humerus, femur, Long bones in the limbs (humerus, femur,

tibia, fibula, radius, ulna)tibia, fibula, radius, ulna) 6 weeks of casting6 weeks of casting

Long bones in the feet and hands Long bones in the feet and hands (metacarpals, metatarsals, phalanges)(metacarpals, metatarsals, phalanges) 3 weeks of casting or splinting3 weeks of casting or splinting

Fracture HealingFracture Healing

OsteoblastsOsteoblasts Bone cells that build boneBone cells that build bone

OsteoclastsOsteoclasts Bone cells that reshape and break down Bone cells that reshape and break down

bonebone CallusCallus

Location of increased osteoblast activity Location of increased osteoblast activity following a fracture that is the initial sign of following a fracture that is the initial sign of bone healingbone healing

Fracture Fracture occursoccurs

Osteoblastic Osteoblastic activity beginsactivity begins

Callus Callus formationformation

Osteoclastic Osteoclastic activity beginsactivity begins

Bone healing Bone healing endsends

Greenstick FracturesGreenstick Fractures

Incomplete breaks in bones that have not Incomplete breaks in bones that have not completely ossifiedcompletely ossified

Tend to happen on the convex bone Tend to happen on the convex bone surfacesurface

Transverse FractureTransverse Fracture

Occurs in a straight Occurs in a straight line at right angle to line at right angle to the shaftthe shaft

Usually caused by Usually caused by a direct blowa direct blow

Spiral FracturesSpiral Fractures

S-shaped separation S-shaped separation of the boneof the bone

Common in football Common in football and skiingand skiing

Occurs when the foot Occurs when the foot is firmly planted and is firmly planted and body is suddenly body is suddenly rotatedrotated

Oblique FracturesOblique Fractures

Occurs when one Occurs when one end of the bone end of the bone receives sudden receives sudden torsion and the other torsion and the other end is fixed or end is fixed or stabilizedstabilized

Impacted FracturesImpacted Fractures

Commonly occurs Commonly occurs when falling from when falling from heightsheights

Causes the long Causes the long bone to become bone to become compressed along compressed along the long axisthe long axis

Requires immediate Requires immediate splinting and traction splinting and traction to ensure normal to ensure normal length of the injured length of the injured limblimb

Comminuted FracturesComminuted Fractures

Consists of three or more fragments at Consists of three or more fragments at the fracture sitethe fracture site

Caused by a hard blow or falling in an Caused by a hard blow or falling in an awkward positionawkward position

Difficult for healing because of the Difficult for healing because of the displacement of the fragmentsdisplacement of the fragments

Often requires surgical intervention Often requires surgical intervention because of involvement of soft tissuebecause of involvement of soft tissue

Longitudinal fracturesLongitudinal fractures Bone splits along its lengthBone splits along its length Result of jumping from a height and Result of jumping from a height and

landing applying a force along the long landing applying a force along the long axis of the boneaxis of the bone

Avulsion FracturesAvulsion Fractures

Separation of bone fragment from Separation of bone fragment from its cortex at an attachment of a its cortex at an attachment of a ligament or tendonligament or tendon

Result of sudden, powerful twist or Result of sudden, powerful twist or stretch of a body partstretch of a body part

Common sites of this type of Common sites of this type of fracture fracture Base of the 5Base of the 5thth metatarsal (peroneus metatarsal (peroneus

brevis)brevis) Anterior superior iliac spine (sartorius)Anterior superior iliac spine (sartorius) Medial malleolus (deltoid ligament) Medial malleolus (deltoid ligament)

DislocationDislocation

When one bone is When one bone is forced completely out forced completely out of its normal alignment of its normal alignment and must be manually and must be manually or surgically reducedor surgically reduced

Occur mostly at the Occur mostly at the shoulder, elbow, and shoulder, elbow, and fingersfingers

DislocationsDislocations

First dislocations First dislocations should be treated like should be treated like fracturesfractures

Should not be Should not be immediately reducedimmediately reduced

X-rays should be taken X-rays should be taken to rule out a fracture to rule out a fracture prior to reducing the prior to reducing the dislocationdislocation

SubluxationSubluxation

Similar to a dislocation except the bone Similar to a dislocation except the bone partially comes out of the joint and slides partially comes out of the joint and slides back into place on its own with out any back into place on its own with out any external force appliedexternal force applied

Occurs mostly at the shoulder and the Occurs mostly at the shoulder and the patellapatella

LigamentsLigaments

Tough, inelastic bands of tissue Tough, inelastic bands of tissue connecting bone to boneconnecting bone to bone

Synovial joints allow motion in one or Synovial joints allow motion in one or more planesmore planes Hyaline cartilage- cartilagenous covering over Hyaline cartilage- cartilagenous covering over

ends of bonesends of bones Joint capsule- thick ligamentous coveringJoint capsule- thick ligamentous covering Synovial membrane- thin lining of joint Synovial membrane- thin lining of joint

capsulecapsule Synovial fluid- provides lubrication, shock Synovial fluid- provides lubrication, shock

absorption, and joint nutritionabsorption, and joint nutrition

Synovial JointSynovial Joint

Ligament Ligament SprainSprain

Grade 1Grade 1 Some stretching of ligament fibers with minimal instabilitySome stretching of ligament fibers with minimal instability Mild to moderate pain, localized swelling, joint stiffnessMild to moderate pain, localized swelling, joint stiffness

Grade 2Grade 2 Some tearing of ligament fibers with moderate instabilitySome tearing of ligament fibers with moderate instability Moderate to severe swelling and joint stiffnessModerate to severe swelling and joint stiffness

Grade 3Grade 3 Total tearing of the ligament with major joint instabilityTotal tearing of the ligament with major joint instability Significant pain followed by no pain secondary to disruption of Significant pain followed by no pain secondary to disruption of

nerve fibersnerve fibers Significant swellingSignificant swelling Often require surgical repairOften require surgical repair

ContusionsContusions

““Bruise”Bruise” Caused by a direct blow to Caused by a direct blow to

soft tissuesoft tissue Capillaries are torn and Capillaries are torn and

bleeding into the tissues bleeding into the tissues occursoccurs

Causes discoloration that Causes discoloration that persists for dayspersists for days

Pain may be experienced Pain may be experienced with active movement or to with active movement or to the touchthe touch

ContusionsContusions

Repeated blows (Myositis ossificans)Repeated blows (Myositis ossificans) Small calcium deposits develop and Small calcium deposits develop and

accumulateaccumulate Found between several fibers in the muscle Found between several fibers in the muscle

belly or build up to form a spur projecting belly or build up to form a spur projecting into the underlying boneinto the underlying bone

When deposits cause impairments in When deposits cause impairments in movementmovement

Occur usually at the quadriceps and bicepsOccur usually at the quadriceps and biceps

Muscle StrainsMuscle Strains

Overstretched muscleOverstretched muscle Muscle forced to contract against too Muscle forced to contract against too

much resistancemuch resistance Results in separation or tearing of the Results in separation or tearing of the

muscle fibersmuscle fibers

Muscle StrainsMuscle Strains

Grade 1 Grade 1 Some muscle fibers stretched or tornSome muscle fibers stretched or torn Tenderness and pain with active motionTenderness and pain with active motion Painful but full range of motionPainful but full range of motion

Grade 2Grade 2 Muscle fibers tornMuscle fibers torn Active contraction of the muscle is painfulActive contraction of the muscle is painful Palpable deformityPalpable deformity Some swelling and discolorationSome swelling and discoloration

Grade 3Grade 3 Complete rupture of the muscleComplete rupture of the muscle Significant loss of movementSignificant loss of movement Pain is intense, but often subsides due to nerve tissue damagePain is intense, but often subsides due to nerve tissue damage

Muscle CrampingMuscle Cramping

Extremely painful involuntary Extremely painful involuntary muscle contractionsmuscle contractions

Occur most commonly in the Occur most commonly in the calf, abdomen, hamstringscalf, abdomen, hamstrings

Heat crampsHeat cramps Secondary to significant loss of Secondary to significant loss of

waterwater

Muscle SorenessMuscle Soreness

Acute onset muscle sorenessAcute onset muscle soreness Accompanies fatigueAccompanies fatigue Transient and occurs immediately following exerciseTransient and occurs immediately following exercise

Delayed onset muscle soreness (DOMS)Delayed onset muscle soreness (DOMS) Appears approximately 12 hours following exerciseAppears approximately 12 hours following exercise Becomes more intense at 24-48 hours then Becomes more intense at 24-48 hours then

subsidessubsides Delayed muscle pain leading to increased muscle Delayed muscle pain leading to increased muscle

tension, swelling, and resistance to stretchingtension, swelling, and resistance to stretching

Nerve InjuriesNerve Injuries

Compression or tension injuriesCompression or tension injuries HypoesthesiaHypoesthesia

Diminished feelingDiminished feeling

HyperesthesiaHyperesthesia Increased sensation of pain or touchIncreased sensation of pain or touch

Paresthesia Paresthesia Numbness, tingling, pricklingNumbness, tingling, prickling

Stingers of BurnersStingers of Burners

Chronic InjuriesChronic Injuries

TendonitisTendonitis TenosynovitisTenosynovitis BursitisBursitis OsteoarthritisOsteoarthritis

TendonitisTendonitis Inflammation of a tendonInflammation of a tendon Tendon can become irritated or Tendon can become irritated or

inflamed with repetitive movementinflamed with repetitive movement Causes pain on movement, swelling, Causes pain on movement, swelling,

some warmth, and crepitus (cracking some warmth, and crepitus (cracking or crunching upon palpation)or crunching upon palpation)

Rest is most important aspect to Rest is most important aspect to treatment (2 weeks)treatment (2 weeks)

Most common types of tendonitis are Most common types of tendonitis are at the Achilles and patellaat the Achilles and patella

TenosynovitisTenosynovitis

Tendons are surrounded by synovial Tendons are surrounded by synovial sheaths providing a tight space for the sheaths providing a tight space for the tendon to movetendon to move

Tendon adheres to the sheath causing Tendon adheres to the sheath causing inflammationinflammation

Treatment involves rest and anti-Treatment involves rest and anti-inflammatory medicationsinflammatory medications

BursitisBursitis Bursa is a synovial membrane Bursa is a synovial membrane

filled with synovial fluid and filled with synovial fluid and located at areas of high frictionlocated at areas of high friction Between bone and tendonBetween bone and tendon Between skin and boneBetween skin and bone Between musclesBetween muscles

Direct trauma or overuse can Direct trauma or overuse can cause irritation and increased cause irritation and increased synovial fluid synovial fluid

Pressure increases, pain Pressure increases, pain increases, movement is restrictedincreases, movement is restricted

OsteoarthritisOsteoarthritis

Degeneration of the of the articular or Degeneration of the of the articular or hyaline cartilagehyaline cartilage

Cartilage wears away to the underlying Cartilage wears away to the underlying bonebone

Most often affects weight-bearing jointsMost often affects weight-bearing joints KneesKnees HipsHips Lumbar spineLumbar spine

Role of InflammationRole of Inflammation

Inflammation must occur for the healing process to Inflammation must occur for the healing process to beginbegin Should be acute and end when its role in the healing Should be acute and end when its role in the healing

process is completedprocess is completed When inflammation persists it is considered chronic and When inflammation persists it is considered chronic and

prevents further healingprevents further healing SYMPTOMS (KNOW THESE)SYMPTOMS (KNOW THESE)

PainPain SwellingSwelling WarmthWarmth Loss of functionLoss of function RednessRedness

Healing ProcessHealing Process(KNOW THIS SLIDE)(KNOW THIS SLIDE)

Inflammatory response (first 2 to 4 days)Inflammatory response (first 2 to 4 days) Direct injury to cellsDirect injury to cells Phagocytic cells clean up dead cellsPhagocytic cells clean up dead cells Injured cells release chemicalsInjured cells release chemicals Symptoms of redness, swelling, tenderness, heat, loss of Symptoms of redness, swelling, tenderness, heat, loss of

functionfunction Fibroblastic repair (2 days to 4-6 weeks)Fibroblastic repair (2 days to 4-6 weeks)

Proliferative and regenerative activity leads to scar formationProliferative and regenerative activity leads to scar formation Symptoms subside including tenderness and pain with Symptoms subside including tenderness and pain with

movementmovement Maturation-remodeling (3 week to several years)Maturation-remodeling (3 week to several years)

Realignment or remodeling of the scar tissueRealignment or remodeling of the scar tissue Stress realigns collagen parallel to lines of tensionStress realigns collagen parallel to lines of tension