Chap. 9
Mechanism of Characteristics of Sports TraumaChap. 9 Mechanical
injuryTrauma is defined as physical injury or wound sustained in
sport, produced by internal or external forceMechanical injury
results from force or mechanical energy that changes state of rest
or uniform motion of matter
Tissue PropertiesP 239 in or forces acting on internal
tissueLoad- external force or forces acting on internal
issueStiffness- ability of a tissue to resist a loadStress-
internal resistance to an external loadStrain- extent of
deformation of tissue under loadingDeformation- change in shape of
a tissueElasticity- property that allows a tissue to return to
normal following deformationYield point- elastic limit of
tissuePlastic- deformation of tissues that exists after the load is
removedCreep- deformation of tissues that occurs with application
of a constant load over timeMechanical failure- exceeding the
ability to withstand stress and strain, causing tissue to break
down.Tissue StressesP 240Types of loadingCompression
TensionShearingBendingTorsion
Soft tissue TraumaSoft tissue or non bony tissue is categorized
as inert (nonconrtactile and contractile tissueInert tissues-
include ligaments, skin cartilage, capsules, fascia, dura mater and
nerve roots. Dont heal wellContractile issue involves muscles and
tendons. Heal wellSkin Injuries
Break in the continuity of skin as a result of traumaAnatomical
considerationsSkin or integument represent the largest organ of the
bogy and consists of 2 layersEpidermis Dermis
Wound ClassificationFriction Blister-Continuous rubbing over
skin surface that causes a collection of fluid below or within
epidermal layer.Abrasion -Skin is scraped against rough surface
resulting in capillary exposure due to skin removalSkin Bruise
(contusion)- Compression or crush injury of skin surface that
produces bleeding under the skinWound Class cont.Laceration- Wound
in which skin has been irregularly torn Skin Avulsion- Skin that is
torn by same mechanism as laceration to the extent that tissue is
completely ripped from sourceIncision- Wound in which skin has been
sharply cutPuncture- Penetration of the skin by a sharp
object.Skeletal Muscle InjuriesHigh incidence in
athleticsAnatomical characteristicsComposed of contractile cells
that produce movementPossess following
characteristicsIrritabilityContractility ConductivityElasticity
Three types of musclesCardiacSmoothskeletalAcute Muscle
InjuriesContusionResults from sudden blow to bodyCan be both deep
and superficialHematoma results from blood and lymph flow into
surrounding tissue
StrainsStretch, tear or rip to MUSCLE or TENDONCausesAbnormal
muscle contraction failure in reciprocal coordination of agonist
and antagonist 2) electrolyte imbalance due to profuse sweating 3)
strength imbalance.
Muscle strains contGradesGrade 1- some fibers have been
stretched or actually torn resulting in tenderness and pain on
active ROM, movement painful but ROM= WNLGrade 2-number of fibers
have been torn and active contraction is painful, usually a
depression or divot is palpable, some swelling and
discolorationGrade 3- complete rupture of muscles significant
impairment with initially a great deal of pain that diminishes due
to nerve damageTendon InjuriesTendon- connects muscle to bone.Tears
generally occur in muscle and not tendonRepetitive stress on tendon
will result in microtrauma and elongation, causing fibroblasts in
flux and increased collagen production. This is called
tendinitis.
Muscle cramps and spasmsPainful involuntary
contractionAttributed to dehydration/electrolyte imbalanceReflex
reaction caused by traumaTwo typesClonic- alternating involuntary
muscular contractions and relaxation in quick successionTonic-
rigid contraction that lasts a period of time
Overexertion muscle problemsReflective in muscle soreness,
decrease joint flexibility, general fatigue (24 hours post
activity)Muscle sorenessOverexertion in strenuous exercise
resulting in painGenerally occurs following participation in
activity that individual is unaccustomed Two types of
sorenessAcute- onset muscle soreness- accompanies fatigue, and is
transient muscle pain experience immediately after
exercisedelayed-onset muscle soreness (DOMS)- pain that occurs
24-48 hours following activity that gradually subsides (3-4
days)Prevent soreness through gradual build up of intensityTreat
with static or PNF stretching and ice application within 48-72
hours Muscle StiffnessDoes not produce pain Result of extended
period of workFluid accumulation in muscles, with slow reabsorbtion
back into bloodstream, resulting in swollen, shorter, thicker
muscles- resistant to stretchingLight activity, motion, massage and
passive mobilization assists in reducing stiffnessMuscle
GuardingFollowing injury, muscles within an effected area contract
to splint the area in a effort to minimize pain through limitation
of motionInvoluntary muscle contraction in response to pain
following injuryChronic Muscle InjuriesProgress slowly over long
period of timeRepetitive acute injuries can lead to chronic
conditionConstant irritation due to poor mechanics and stress will
cause injury to become chronicExamples of chronic muscle
injuriesMyositis/fascitis- inflammation of muscle tissue.
Fibrositis or inflammation of connective tissue. Ex. Plantar
fasciitisTendinitis- gradual onset, with diffuse tenderness due to
repeated micro trauma and degenerative changesTenosynovitis-
inflammation of synovial sheathEctopic Calcification (myositis
ossificans)- striated muscle becomes chronically inflamed resulting
in compression traumaAfter injuryAtrophy- wasting away of muscle
due to immobilization inactivity or loss of nerve
functioningContracture is and abnormal shortening of muscle where
there is a great deal of resistance to passive stretch Synovial
jointsAnatomical characteristicsConsist of cartilage and fibrous
connective tissueCapsule or ligaments, synovial membrane,
cartilage, synovial fluid and blood and nerve supply with muscles
crossing joint.
Joint capsuleBones are held together by fibrous cuffConsists of
bundles of collagen and function to maintain relative joint
positionExtremely strong and can withstand cross sectional
forcesWill be slack or taut depending on joint
movementligamentsConnects Bone to BoneSheets or bundles of collagen
that form connection between two bonesStrong in the middle, weak at
the endsPoor viscoelastic properties are primary factor in
ligamentous injuries
Synovial MembraneSingle layer of flattened cells Secretes and
absorbs fluid- serves as lubricant
Articular cartilageProvides firm flexible supportNo direct blood
or nerve supplyFibrocartilage- vertebral disks, sumphysis pubis and
menisciElastic: external ear Hyaline, nasal septum, larynx,
trachea, bronchi and articular ends of bones.Nerve SupplyCapsule,
ligaments outer aspects of synovial membrane and fat pads are well
suppliedTypes of Synovial jointsBall and Socket- allows movement in
all planesHinge- allows for flexion and extensionPivot- rotation
about and axisEllipsoidal- elliptical convex and concave
articulationSaddle- reciprocally convex-concaveGliding- all sliding
back and forth
Types of Synovial jointsBall and Socket- allows movement in all
planes (Hip)Hinge- allows for flexion and extension (elbow)Pivot-
rotation about and axis (Cervical spine)Ellipsoidal- elliptical
convex and concave articulation (Wrist)Saddle- reciprocally
convex-concave (1st MP Joint)Gliding- all sliding back and forth
(carpal Joint)
Synovial Joint Injury ClassificationsAcute InjurySprains- Result
of traumatic joint twist that causes stretching or tearingSprains
is an injury to a ligamentGraded on severityGrade I- some pain,
minimal loss of function, no abnormal motion, mild point
tenderness. < 10% Grade II- Pain, moderate loss of function,
swelling and instability 10-90%Grade III- Extremely painful,
inevitable loss of function, severe in stability and swelling and
instability 100%S/Sx- Joint effusion and swelling, local temperatur
increase, pain and poinst tenerness, ecchymosis (skin color change)
Joint injuries classification continuedSubluxations- partial
dislocations causing incomplete separation of two bonesLuxation-
presents with total disunion of bone apposition between articular
surfacesS/Sx- loss of limb function, gross deformity, swelling and
point tendernessOnce a dislocation, always a dislocation.Chronic
Joint InjuriesStem from microtrauma and overuseInclude,
osteochondrosis, osteoarthritis and epiphyseal injuriesTo prevent
avoid over training and protective gear should be
used.OsteochondrosisDegenerative changes to epiphyses of bone
during rapid child growthOsteoarthritisWearing away of hyaline
cartilage as a result of normal useS/Sx- pain, stiffness, prominent
uprsising in the morning, localized tenderness, creaking, grating,
often is localized to one.BursitisFluid filled sac that develops in
area of frictionS/sx- swelling pain and some loss of function
Skeletal TraumaBone FunctionsBody SupportOrgan protectionMovement
Calcium storageFormation of blood cells
Bones cont.Types of bonesFlat bones- Irregular bonesShort
bonesLong bonesBone InjuriesPeriostitis- inflammation of the
periosteum, result primarily of contusion and produces rigid skin
overlying musclesAcute bone fractures- partial or complete
disruption that can be either closed or open serious conditionType
of Fx include- depressed, greenstick, impacted longitudinal,
oblique, serrated, spiral, transverse, comminuted, blowout,
avulsionStress Fx- no specific cause but with a number of possible
poor mechanics, training surfaceS/Sx- pain with activity, pain
becomes constant particularly at night, positive percussion tap
test.TREATMENT OF ALL INJURIESRICER- RESTI- ICE 20 mins. every
hourC- COMPRESSION- Ace wrapE- ELEVATION- Above the heart.
