1、Chapter 13: Recognizing Different Sports Injuries,No matter how much time is spent on injury prevention sooner or later an injury occurs Either acute or chronic in nature Acute injuries Result of trauma Chronic Caused by repetitive, overuse activities,Acute Traumatic Injuries,Fractures,Result of ext
2、reme stress and strain on bone Anatomical Characteristics Dense connective tissue matrix Outer compact tissue Inner porous cancellous bone including Haversian canals,Gross StructuresDiaphysis -shaft - hollow and cylindrical - covered by compact boneEpiphysis - composed of cancellous bone and has hya
3、line cartilage covering Periosteum - dense, white fibrous coveringwhich penetrates bone viaSharpeys fibers- contains blood vessels andosteoblasts,Acute bone fractures partial or complete disruption that can be either closed or open (through skin) serious musculoskeletal condition Presents with defor
4、mity, point tenderness, swelling and pain on active and passive motion,Load Characteristics Bones can be stressed or loaded to fail by tension, compression, bending, twisting and shearing Either occur singularly or in combination Amount of load also impacts the nature of the fracture More force resu
5、lts in a more complex fracture While force goes into fracturing the bone, energy and force is also absorbed by adjacent soft tissues Some bones will require more force than others,Healing of a Fracture Generally require immobilization for some period Approx. 6 weeks for bones of arms and legs 3 week
6、s for bones of hands and feet Fracture healing requires osteoblast activity to lay down bone and form callus Following cast removal, normal stresses and strains will aid in healing and remodeling process Osteoclasts will be called on to assist in re-shaping of bone in response to normal stress,Stres
7、s fractures No specific cause but with a number of possible causes Overload due to muscle contraction, altered stress distribution due to muscle fatigue, changes in surface, rhythmic repetitive stress vibrations Begins with a dull ache and progressively becomes worse over time Initially pain during
8、activity and then progresses to pain following activity Early detection is difficult, bone scan is useful, x-ray is effective after several weeks Due to osteoblastic activity If suspected stop activity for 14 days Generally does not require casting,Dislocations and Subluxations Dislocation At least
9、one bone in a joint is forced completely out of normal and proper alignment High level of incidence in fingers, elbow and shoulder Subluxation Partial dislocations causing incomplete separation of two bones Often occur in shoulder and females (patella) S&S of dislocations Deformity almost always pre
10、sent Occasionally obscured by heavy musculature = requires palpation to determine normal contours,Other factors associated with dislocations - 1) loss of limb function, 2) swelling and point tenderness Additional concerns Avulsion fractures Growth plate separation “Once a dislocation, always a dislo
11、cation” Treatment Dislocations (particularly first time) should always be considered and treated as a fracture until ruled out X-ray is the only absolute diagnostic technique Return to play often determined by extent of soft tissue damage,Ligament Sprains,Sprain Damage to a ligament Ligaments provid
12、e support to a joint Synovial joint characteristics 2 or more bones Capsule or ligaments Capsule is lined with synovial membrane Hyaline cartilage Joint cavity with synovial fluid Blood and nerve supply with muscles crossing joint Mechanoreceptors within joint structures provide feedback relative to
13、 position,Some joint will have meniscus (thick fibrocartilage) for shock absorption and stabilityLigaments Thickened portions of the capsule or totally separate bands Dictates partially the motions the joint,Sprains Result of traumatic joint twist that causes stretching or tearing of connective tiss
14、ue Graded based on the severity of injury Grading System Grade I - some pain, minimal loss of function, no abnormal motion, and mild point tenderness, slight swelling and joint stiffness Grade II - pain, moderate loss of function, swelling, and instability, some tearing of ligament fibers and joint
15、instability Grade III - extremely painful, inevitable loss of function, severe instability and swelling, and may also represent subluxation,Restoration of joint stability is difficult with grade I and II injuries Must rely on other structures around the joint Rely heavily on muscles surrounding join
16、t Ligament has been stretched/partially torn causing development of inelastic scar Ligament will not regain original tension Increased muscle tension due to strength training will improve joint stability,Contusions Result of sudden blow to body Can be both deep and superficial Hematoma results from
17、blood and lymph flow into surrounding tissue Minor bleeding results in discoloration of skin May be painful to the touch and with active movement Must be cautious and aware of more severe injuries associated with repeated blows Calcium deposits may form with fibers of soft tissue Myositis ossificans
18、,Prevention relies on protection and padding Particularly when dealing with myositis ossificans Protection and rest may allow for calcium re-absorption Surgery would not be necessary to remove Quadriceps and biceps are very susceptible to developing myositis ossificans,Muscle Strains and Injuries,Ca
19、uses Stretch, tear or rip to muscle or adjacent tissue Muscle Strain Grades Grade I - some fibers have been stretched or actually torn resulting in tenderness and pain on active ROM, movement painful but full range present Grade II - number of fibers have been torn and active contraction is painful,
20、 usually a depression or divot is palpable, some swelling and discoloration result,Grade III- Complete rupture of muscle or musculotendinous junction, significant impairment, with initially a great deal of pain that diminishes due to nerve damage Tendon ruptures Large tendon ruptures will require su
21、rgery Rehabilitation Lengthy process regardless of severity Will generally require 6-8 weeks Return to activity too soon may result in re-injury,Muscle Guarding Following injury, muscles within an effected area contract to splint the area in an effort to minimize pain through limitation of motion In
22、voluntary muscle contraction in response to pain following injury Not spasm which would indicate increased tone due to upper motor neuron lesion in the brain Muscle Cramps Painful involuntary contraction Attributed to dehydration/electrolyte imbalance May lead to muscle or tendon injuries,Muscle Sor
23、eness Overexertion in strenuous exercise resulting in muscular pain Generally occurs following participation in activity that individual is unaccustomed Two types of soreness Acute-onset muscle soreness - accompanies fatigue, and is transient muscle pain experienced immediately after exercise Delaye
24、d-onset muscle soreness (DOMS) - pain that occurs 24-48 hours following activity that gradually subsides (pain free 3-4 days later) Potentially caused by slight microtrauma to muscle or connective tissue structures,Prevent muscle soreness through gradual build-up of intensity Treat with static or PN
25、F stretching and ice application within 48-72 hours of insult,Nerve Injuries,Two main causes of injury Compression and tension Resulting in radiating pain & muscle weakness Stinger or burnerMay be acute or chronic Causes pain and can result in a host of sensory responses (pinch, burn, tingle, muscle
26、 weakness, radiating pain),Injuries can range from minor to severe and life altering Neuritis Chronic nerve problem caused by overuse or a variety of forces Results in minor to severe problems Crushing or severed nerve injury Life long implications Paraplegia/quadriplegia could resultHealing process
27、 is very slow and long term Optimal environment is critical CNS vs. PNS repair,Chronic Overuse Injuries,Importance of Inflammation in Healing Essential part of healing process Must occur following tissue damage to initiate healing Signs and Symptoms Pain, redness, swelling, loss of function and warm
28、th If source of irritation is not removed then inflammatory process becomes chronic,Tendinitis Most common overuse problem in sports Gradual onset, with diffuse tenderness due to repeated microtrauma and degenerative changes Obvious signs of swelling and pain May also experience crepitus (due to che
29、mical products of inflammation) Key for treatment is rest and removal of causal factors Work to maintain fitness but avoid activities that aggravate condition,Tenosynovitis Inflammation of synovial sheath In acute case - rapid onset, crepitus, and diffuse swelling Chronic cases result in thickening
30、of tendon with pain and crepitus Often develops in long flexor tendons of fingers Treatment is similar to that of tendinitis NSAIDs may also be of some assistance,Insert 13-9,Bursitis Bursa Fluid filled sac that develops in area of friction Sudden irritation can cause acute bursitis, while overuse a
31、nd constant external compression can cause chronic bursitis Results in increased fluid production, causing increases in pressure due to limited space around anatomical structures Signs and symptoms include swelling, pain, and some loss of function Three most commonly irritated Subacromial, olecranon
32、, and prepatellar bursa,Osteoarthritis Wearing away of hyaline cartilage as a result of normal use Changes in joint mechanics lead joint degeneration (the result of repeated trauma to tissue involved) May be the result of direct blow, pressure of carrying and lifting heavy loads, or repeated trauma
33、from an activity such as running or cycling Commonly affects weight bearing joints but can also impact shoulders and cervical spine,Symptoms include pain (as the result of friction), stiffness, prominent uprising in the morning, localized tenderness, creaking, grating, and often is localized to one
34、side of the joint or generalized joint pain,Insert 13-10,Myofascial Trigger Points Develop due to mechanical stress Either acute strain or static postural positions producing constant tension in muscle Typically occur in neck, upper and lower back Signs and Symptoms Pain with palpation, with predict
35、able pattern of referred pain which may also limit motion Pain may increase with active and passive motion of involved muscle,Importance of the Healing Process Following Injury,Essential to possess understanding of both sequence and time frame for various phases of healing process Interference with
36、healing process will delay return to full activity Work to create optimal healing environment Little can be done to speed the process, while much can be done to impede it,Inflammatory Response Phase Begins immediately following injury critically important Without the inflammatory phase the other pha
37、ses will not occur Phagocytosis occurs to clean the injured area Chemical mediators are released to facilitate healing Symptomatically presents with the following Redness, swelling, warmth, tenderness and loss of function Stage lasts 2-4 days following injury,Fibroblastic Repair Phase Proliferative
38、and regenerative activity occurs resulting in scar formation (fibroplasia) Occurs within initial hours of injury and continues up to 4-6 weeks S&S of inflammatory phase subside Athlete will still experience some tenderness and pain with motion With increasing development of the scar complaints of pa
39、in and tenderness will decrease,Maturation-Remodeling Phase Long-term process Re-alignment of scar tissue according to tensile forces acting on tissue Re-align to position of maximum efficiency (parallel to lines of tension) Tissue gradually resumes normal appearance and function After 3 weeks Firm, strong, contracted, nonvascular scar exists Maturation may take several years to be totally complete,Insert 13-12,
