Chapter 13: Recognizing Different Sports Injuries

1. Chapter 13: Recognizing Different Sports Injuries

2. Acute Injuries • Fractures • Dislocations and subluxations • Ligament SPRAINS • Contusions • Muscle STRAINS • Muscle cramps • Muscle soreness • Nerve injuries

3. Fractures • Fractures (broken bones) occur because of extreme stress placed on the bone • Parts of the bone • Diaphysis- shaft (hollow) • Epiphysis- ends (place of growth) • Articular cartilage- covers joint surface (provides protection and shock absorption) • Periosteum- outer covering

4. Fractures

5. Closed Fracture • Little or no movement or displacement of broken bones

6. Open Fracture • Bone breaking through the surrounding tissues, including the skin, secondary to significant displacement of the bones

8. Forces Causing Fractures • Bending • Torsion • Compression

9. Fracture Healing • Requires brief immobilization • Long bones in the limbs (humerus, femur, tibia, fibula, radius, ulna) • 6 weeks of casting • Long bones in the feet and hands (metacarpals, metatarsals, phalanges) • 3 weeks of casting or splinting

10. Fracture Healing • Osteoblasts • Bone cells that build bone • Osteoclasts • Bone cells that reshape and break down bone • Callus • Location of increased osteoblast activity following a fracture that is the initial sign of bone healing

11. Fracture occurs • Osteoblastic activity begins • Callus formation • Osteoclastic activity begins • Bone healing ends

12. Greenstick Fractures • Incomplete breaks in bones that have not completely ossified • Tend to happen on the convex bone surface

13. Transverse Fracture • Occurs in a straight line at right angle to the shaft • Usually caused by a direct blow

14. Spiral Fractures • S-shaped separation of the bone • Common in football and skiing • Occurs when the foot is firmly planted and body is suddenly rotated

15. Oblique Fractures • Occurs when one end of the bone receives sudden torsion and the other end is fixed or stabilized

16. Impacted Fractures • Commonly occurs when falling from heights • Causes the long bone to become compressed along the long axis • Requires immediate splinting and traction to ensure normal length of the injured limb

17. Comminuted Fractures • Consists of three or more fragments at the fracture site • Caused by a hard blow or falling in an awkward position • Difficult for healing because of the displacement of the fragments • Often requires surgical intervention because of involvement of soft tissue

19. Longitudinal fractures • Bone splits along its length • Result of jumping from a height and landing applying a force along the long axis of the bone

20. Avulsion Fractures • Separation of bone fragment from its cortex at an attachment of a ligament or tendon • Result of sudden, powerful twist or stretch of a body part • Common sites of this type of fracture • Base of the 5th metatarsal (peroneus brevis) • Anterior superior iliac spine (sartorius) • Medial malleolus (deltoid ligament)

21. Dislocation • When one bone is forced completely out of its normal alignment and must be manually or surgically reduced • Occur mostly at the shoulder, elbow, and fingers

22. Dislocations • First dislocations should be treated like fractures • Should not be immediately reduced • X-rays should be taken to rule out a fracture prior to reducing the dislocation

23. Subluxation • Similar to a dislocation except the bone partially comes out of the joint and slides back into place on its own with out any external force applied • Occurs mostly at the shoulder and the patella

24. Ligaments • Tough, inelastic bands of tissue connecting bone to bone • Synovial joints allow motion in one or more planes • Hyaline cartilage- cartilagenous covering over ends of bones • Joint capsule- thick ligamentous covering • Synovial membrane- thin lining of joint capsule • Synovial fluid- provides lubrication, shock absorption, and joint nutrition

25. Synovial Joint

26. Ligament Sprain • Grade 1 • Some stretching of ligament fibers with minimal instability • Mild to moderate pain, localized swelling, joint stiffness • Grade 2 • Some tearing of ligament fibers with moderate instability • Moderate to severe swelling and joint stiffness • Grade 3 • Total tearing of the ligament with major joint instability • Significant pain followed by no pain secondary to disruption of nerve fibers • Significant swelling • Often require surgical repair

27. Contusions • “Bruise” • Caused by a direct blow to soft tissue • Capillaries are torn and bleeding into the tissues occurs • Causes discoloration that persists for days • Pain may be experienced with active movement or to the touch

28. Contusions • Repeated blows (Myositis ossificans) • Small calcium deposits develop and accumulate • Found between several fibers in the muscle belly or build up to form a spur projecting into the underlying bone • When deposits cause impairments in movement • Occur usually at the quadriceps and biceps

29. Muscle Strains • Overstretched muscle • Muscle forced to contract against too much resistance • Results in separation or tearing of the muscle fibers

30. Muscle Strains • Grade 1 • Some muscle fibers stretched or torn • Tenderness and pain with active motion • Painful but full range of motion • Grade 2 • Muscle fibers torn • Active contraction of the muscle is painful • Palpable deformity • Some swelling and discoloration • Grade 3 • Complete rupture of the muscle • Significant loss of movement • Pain is intense, but often subsides due to nerve tissue damage

31. Muscle Cramping • Extremely painful involuntary muscle contractions • Occur most commonly in the calf, abdomen, hamstrings • Heat cramps • Secondary to significant loss of water

32. Muscle Soreness • Acute onset muscle soreness • Accompanies fatigue • Transient and occurs immediately following exercise • Delayed onset muscle soreness (DOMS) • Appears approximately 12 hours following exercise • Becomes more intense at 24-48 hours then subsides • Delayed muscle pain leading to increased muscle tension, swelling, and resistance to stretching

33. Nerve Injuries • Compression or tension injuries • Hypoesthesia • Diminished feeling • Hyperesthesia • Increased sensation of pain or touch • Paresthesia • Numbness, tingling, prickling

34. Stingers of Burners

35. Chronic Injuries • Tendonitis • Tenosynovitis • Bursitis • Osteoarthritis

36. Tendonitis • Inflammation of a tendon • Tendon can become irritated or inflamed with repetitive movement • Causes pain on movement, swelling, some warmth, and crepitus (cracking or crunching upon palpation) • Rest is most important aspect to treatment (2 weeks) • Most common types of tendonitis are at the Achilles and patella

37. Tenosynovitis • Tendons are surrounded by synovial sheaths providing a tight space for the tendon to move • Tendon adheres to the sheath causing inflammation • Treatment involves rest and anti-inflammatory medications

38. Bursitis • Bursa is a synovial membrane filled with synovial fluid and located at areas of high friction • Between bone and tendon • Between skin and bone • Between muscles • Direct trauma or overuse can cause irritation and increased synovial fluid • Pressure increases, pain increases, movement is restricted

39. Osteoarthritis • Degeneration of the of the articular or hyaline cartilage • Cartilage wears away to the underlying bone • Most often affects weight-bearing joints • Knees • Hips • Lumbar spine

40. Role of Inflammation • Inflammation must occur for the healing process to begin • Should be acute and end when its role in the healing process is completed • When inflammation persists it is considered chronic and prevents further healing • SYMPTOMS (KNOW THESE) • Pain • Swelling • Warmth • Loss of function • Redness

41. Healing Process(KNOW THIS SLIDE) • Inflammatory response (first 2 to 4 days) • Direct injury to cells • Phagocytic cells clean up dead cells • Injured cells release chemicals • Symptoms of redness, swelling, tenderness, heat, loss of function • Fibroblastic repair (2 days to 4-6 weeks) • Proliferative and regenerative activity leads to scar formation • Symptoms subside including tenderness and pain with movement • Maturation-remodeling (3 week to several years) • Realignment or remodeling of the scar tissue • Stress realigns collagen parallel to lines of tension