Sports Injuries
Volkmann's Contracture
- A complication resulting from a lack of circulation and nerve innervation to the forearm and hand resulting in nerve impingement. The condition is irreversible. - The first sign is pain when passively extending the fingers - Needs to be treated immediately to restore blood flow and decompress the nerves (permanent if not treated)
Subungual Hematoma
- A contusion of the finger underneath the nail bed - bleeding and swelling become trapped under the nail causing extreme pain and pressure (fills up with blood and pushes down into soft tissue) - treatment involves releasing the pressure by forming a hole in the nail to allow the blood to drain - this can be done with a heated paperclip or a nail drill designed specifically for this purpose - Or you can do nothing and the nail will eventually fall off
Bennett's Fracture
- A fracture of the base of the first metacarpal bone which extends into the carpometacarpal joint. - It is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or dislocation of the carpometacarpal joint. - Treatment usually involves surgery to insert pins. Failure to heal properly will inhibit one's ability to grasp objects - Signs and Symptoms are very similar to the Gamekeeper's thumb so an X-ray is the best way to rule out this injury.
Elbow Dislocation
- A separation of the ulna from the humerus, the olecranon process slips behind the humerus (the most common type of dislocation) - Caused by hyperextension such as falling on an outstretched arm
Shoulder Separation
- A sprain of the acromioclavicular ligament is referred to as a shoulder separation. - This joint can be injured by impact to the top of the shoulder or by falling on an outstretched arm. - The treatment of first degree sprains includes PRICES and second or third degree treatment involves seeing an orthopedist.
Colles Fracture:
- A very common injury, the most common fracture - Fracture of the distal radius - Caused by falling on an outstretched arm - Classic deformity gives the illusion of a false joint - A compound fracture involves both the radius and ulna and may result in the bones protruding through the skin - Immobilization for 6 weeks followed by PT
Name the two mechanisms that can cause an ulnar dislocation.
- A violent hyperextension injury. - A severe blow to the lateral aspect of the elbow.
The two most commonly injured joints of the shoulder girdle are the:
- Acromioclavicular joint - Glenohumeral joint
What are the 2 functions of the transverse carpal ligament?
- Also known as the flexor retinaculum. - Located on the anterior aspect of the carpal bones and lies over the wrist and flexor tendons and median nerve. - Functions: 1. stabilizes the carpal bones 2. provides a protective covering over the flexor tendons and median nerve that pass beneath it.
Lunate Dislocation
- Although the most commonly dislocated carpal bone, it is relatively rare in sports. - Most occur from a forceful hyperextension of the wrist.
Impingement Syndrome
- An athlete develops impingement syndrome from repetitive overhead movements. - Freestyle swimmers, throwers, and tennis players are prone to this injury. - The treatment includes modifying activity, strengthening the posterior muscles of the shoulder, and improving flexibility of tight pectoral muscles.
Carpal Tunnel Syndrome:
- An inflammation of one or more of the tendons that pass through the tunnel compressing the median nerve - Caused by overuse - Heredity may also play a role (small wrists)
Tennis Elbow/ Lateral Epicondylitis
- An inflammation of the extensor muscles at the origin of the lateral epicondyle in the elbow and forearm - Caused by overuse of the wrist extensors such as gripping and using a tennis racquet (especially when performing a backhand) - as a result of poor mechanics and continual use over a long period of time, the wrist extensor tendons at the lateral epicondyle of the humerus can become chronically inflamed.
Little League Elbow/pitchers elbow/golfer's elbow/ Medial Epicondylitis
- An inflammation of the wrist flexor tendons (and pronator teres) in the elbow and forearm - Can occur in any sport that requires forceful wrist flexion (baseball and golf) - Same S & S as tennis elbow except pain occurs during active resistive wrist flexion and pronation - Treatment for chronic elbow injuries involves extended periods of Rest and RICE followed by physical therapy. Prevention is better than treatment!
Tendonitis:
- Any wrist tendon can become inflamed due to overuse. - DeQuervain's Tendonitis is an inflammation of the thenar eminence muscles (thumb) - Finklestein test is used to evaluate DeQuervain's - A brace can help with the pain
What are the signs and symptoms/treatment of claw deformity?
- Atrophy leads to flexion - Treatment involves surgery
Elbow fractures
- Can occur to any of the three bones that comprise the elbow joint - Young athletes are at a greater risk due to the growth plate issues - There may or may not be deformity - Because of the three major nerves and arteries that cross the elbow joint, severe swelling may cause a complication resulting in Volkmann's Contracture
What are the signs and symptoms/treatment of tennis elbow?
- Chronic pain both during and after activity - Positive Tennis Elbow test (Active resistive wrist extension) - Tennis elbow band: holds tendons down which can alleviate the pain
What does the abbreviations DIP,PIP and MCP stand for?
- DIP: distal interphalangeal joint. - PIP: proximal interphalangeal joint. - MCP: metacarpophalangeal joint.
Tommy John Injury
- Defined as a 2nd or 3rd degree sprain of the ulnar collateral ligament (very common in baseball players) - Named for a famous pitcher who was the first player to successfully return to pitching after surgery
What are the signs and symptoms of an elbow dislocation?
- Extreme pain due to the stretching of the ulnar and radial nerves - Classic deformity is a disruption of the "isosceles triangle" and an inability to move the elbow - Possible nerve and artery involvement - First time dislocations often involve fractures to the olecranon process
Dislocations/Sprains of the finger
- Finger sprains are common in athletics and are usually caused by a compression force to the tip of the finger producing a jamming effect - For a dislocation to occur, the force is usually upward from the palmar side, displacing either the PIP or DIP joint dorsally - the result is the tearing of the joint capsule as well as the ligament and possibly tendons surrounding the joint - always suspect a chip or avulsion fracture with a finger dislocation - Do not try and pop it on on your own
Boxer's Fracture
- Fractures of the 4th and/or 5th metacarpals are associated with the sport of boxing or martial arts, therefore given the name of a boxer or brawler's fracture. - it is most often caused by a direct compression force to the metacarpal heads such as punching an object or person - mechanism is a punch of some sort
The three bones that comprise the elbow joint are...
- Humerus - Radius - Ulna
What two mechanisms can cause an acromio-clavicular sprain?
- Impact to the top of the shoulder. - Falling on an outstretched arm
List the three problems that can result from a fall on an outstretched arm or hyperextension.
- Ligament sprain - Muscle strain - Bony compression of the olecranon
List the 7 carpal bones.
- Lunate - Capitate - Scaphoid - Trapezium - Triquetrum - Pisiform - Hamate - Trapezoid
What are the signs and symptoms/treatment of forearm splints and strains?
- Main symptoms are a dull ache and muscle weakness in the extensor wad of the forearm - Traditional RICE treatment in advised
Forearm contusions
- Most common injury site is the ulna, due to the position of the forearm when blocking or making contact with an opponent - Acute injuries vary in degree of pain, swelling and hematoma - Repeated blows to the forearm can result in myositis ossificans - Padding for protection is vital in contact sports
What three muscular problems predispose an athlete to shoulder injuries?
- Muscle weakness, most often the muscles on the posterior side. - Postural problems (rounded shoulders, tight pectoral muscles, or weak posterior shoulder muscles). - The nature of the sport (you need to learn proper techniques).
Forearm Splints and Strains
- Occurs most often in gymnastics and tumblers due to the static muscle contractions on uneven parallel bars and rings or from repeated pounding when vaulting and tumbling - Usually occurs early in the season from lack of conditioning or late in the season due to overuse and fatigue
Smith Fracture:
- Often referred to as a opposite Colles fracture, it is also a fracture of the distal radius - Caused by falling on a flexed wrist - Signs and symptoms are the same as a Colles but the deformity looks different
What three ligaments provide stability to the elbow joint?
- Radial/lateral collateral ligament (helps stabilize the outside or lateral aspect of the elbow). - Ulnar/medial collateral ligament (stabilize the inside or medial aspect of the elbow). - Annular ligaments (helps hold the radius and ulna together).
What are the signs and symptoms of tommy john injury?
- S & S include hearing a pop (3rd degree), instability and chronic pain when throwing - Surgery is the only option for those who want to continue throwing in their sport - Ulnar collateral ligament reconstruction
What are the signs and symptoms of a lunate dislocation?
- Severe pain, swelling and difficulty executing wrist and finger flexion - possible deformity on the anterior aspect of the wrist - Numbness and paralysis of the flexor muscles because of pressure from the lunate bone on the median nerve.
What four muscles make up the rotator cuff?
- Subscapularis - Infraspinatus - Teres minor - Supraspinatus
Trigger Finger/thumb
- Tendons are secured to the phalanges by a series of retinaculums that hold the tendon against the bones to create movement. - An inflammation of a tendon sheath that become trapped behind a retinaculum upon flexion creates a locked finger - Common in baseball players and secretaries
List three sports prone to overuse injuries to the elbow.
- Tennis - Baseball - Racquetball
Scaphoid Fracture
- The most frequently fractured of the carpal bones, the injury is usually caused by falling on an outstretched hand which compresses the scaphoid bone between the radius and the triquetrum bones.
Claw deformity
- The ulnar nerve is responsible for muscles and movement of the ulnar side of the hand and the 4th and 5th phalanges - If the ulnar nerve is damaged, it cannot innervate the muscles properly. - This lack of nerve impulses can result in atrophy of the lumbrical muscles which aid in metacarpal-phalangeal flexion resulting in a hyperextended MP joint and a contracture of the 4th and 5th finger flexors. - Happens to the fingers on the ulnar side (pinky, ring finger)
What are the signs and symptoms/treatment of carpral tunnel syndrome?
- Tingling and numbness in the thumb, 1st and 2nd fingers - Muscular weakness especially when gripping - Special Tests are the Tinel Sign (tapping where ligament is) and Phalen's Test - If traditional RICE does not work, surgery is recommended (called a Carpal Tunnel Release) - If left untreated, atrophy may result in permanent muscle damage and weakness
What is a Ulnar collateral ligament reconstruction?
- Using a tendon from either the forearm (palmaris longus) or hamstring to thread through the bones to take the place of the ligament - Rehabilitation takes over one year - 83 percent success rate today
Elbow contusions
- Usually caused by a compression force to the exposed olecranon process - Called "golf ball" elbow due to the profuse swelling caused by the olecranon bursa underneath the triceps tendon - Impact to the posterior medial elbow results in a compression of the ulnar nerve causing tingling and numbness into the 4th and 5th fingers - Repeated compression can result in permanent nerve damage
Ganglion cyst
- a pocket of fluid that forms a small lump, usually to the back of the wrist caused by a herniation of the wrist joint capsule of a tendon, or can be an actual cyst - Nicknamed a "Bible Cyst" because of the prescribed treatment in the old days - Lump can be soft, squishy, or hard - Pain may be present or pay not - Treatment involves draining the cyst or surgically removing it if bothersome
Mallet Finger
- an avulsion of the extensor tendon from the distal phalange - A tear of the extensor digitorum tendon at the distal attachment or an avulsion fracture at the distal phalange/ attachment site of the extensor digitorum tendon - CAN NOT EXTEND, STAYS FLOPPING DOWN - Also known as baseball or basketball finger because catching the ball is often the mechanism - mechanism is a compression force on the tip of the finger forcing the DIP joint into flexion
Jersey Finger
- an avulsion of the flexor tendon of the distal phalange - flexor tendon of the hand (opposite of Mallet Finger) - can not flex your fingertip - mechanism is forced DIP joint extension while flexor digitorum profundus is actively contracting - most often occurs in the ring finger - can be accompanied by an avulsion fracture
Gamekeeper's Thumb
- an injury to the medial collateral ligament of the pollux - A sprain of the ulnar collateral ligament of the MP joint. - common among athletes (pulling thumb outwards/ back) - it is given its name due to the chronic form of the injury suffered by wild game keepers who would use their thumbs to snap the necks of the birds - also called Skiers thumb because of the tendency for skiers to become injured handling their poles - the mechanism is falling on an outstretched hand with the thumb forcibly abducted and hyperextended.
What are the signs and symptoms/treatment of gamekeepers thumb?
- athlete is unable to pinch - passive stress testing of the ulnar collateral ligament shows instability in severe cases - splinting is required for 3 weeks as long as there is no tear in the ligament - a chronic injury occurs to skiers and quarterbacks who receive repetitive trauma at the MP joint
The shoulder is a ______________- joint, but more ____________ than the hip.
- ball-and-socket - shallower
What are the signs and symptoms/treatment of jersey finger?
- characterized by the inability to flex the DIP joint - must be surgically repaired to resume somewhat normal function - there is risk of re injury even after 12 weeks of rehabilitation
Because several nerves and blood vessels pass through the elbow, what should you do during injury evaluation?
- check for a pulse - ascertain that the athlete is able to feel her hand
What are the signs and symptoms/treatment of a boutonniere deformity?
- classic deformity - an inability to extend the finger at the PIP joint - if not treated, the condition will be permanent - treatment involves splinting the PIP joint in full extension for 5 to 8 weeks. while splinted, athlete is encouraged to flex the distal phalangee
What are the signs and symptoms/treatment of mallet finger?
- classic deformity as shown - inability to extend the DIP joint - immediate treatment involves splinting the finger in full extension for 6 to 8 weeks - surgery is needed to reattach the tendon in extreme cases
The triceps muscle performs elbow _________ while the biceps performs elbow ________.
- extension - flexion
What are the signs and symptoms of trigger finger?
- finger or thumb is locked in a flexed position - athlete feels a tightness, but upon massage is often feeling a click during extension - conservative treatment such as RICE is recommended
The three bones that comprise the shoulder are the:
- humerus - scapula - clavicle
Elbow sprains
- hyperextension is the most common elbow sprain - Results in a stretch or tear of the ulnar collateral ligament due the natural "carrying angle" of the elbow being stressed - Along with the usual S & S, there is a reluctance for the athlete to extend the elbow
Olecranon bursitis
- if the olecranon process is contused, the olecranon bursa may become irritated. - This causes fluid to build up at the tip of the elbow, becoming the size of a golf ball.
Boutonniere Deformity
- irregularity that occurs at the proximal interphalangeal joint of the phalanges - boutonniere means buttonhole - the deformity is caused by a rupture of the extensor tendon over the middle phalangee - the disruption of the tendon causes the PIP joint to remain in flexion and the DIP joint to extend, resembling the path a button would take when slipping it in the buttonhole - It is also the path a straight pin would take when attaching a boutonniere to a man's lapel - mechanism is a compression force on the tip of the finger
What are the signs and symptoms/treatment of a hamate fracture?
- pain and weakness in the wrist - point tenderness in the hypothenar eminence - tingling and numbness in the 4th and 5th fingers because of the ulnar nerve being in close proximity to the hamate. - casting of the wrist is usually the treatment of choice - a donut type padding is used over the hamate for protection
What are the signs and symptoms of boxers fracture?
- rapid swelling - palpable defect in the metacarpal shaft - noticeable absence of the knuckle, the finger may appear shorter than usual due to the displaced metacarpal head - inability to make tight fist
The SITS muscles are responsible for __________________.
- rotating the arm internally and externally - abducting the shoulder.
What are the signs and symptoms/treatment of a scaphoid fracture?
- severe point tenderness in the anatomical snuffbox - treatment includes immobilization for a minimum of 6 weeks - surgery is sometimes needed inserting a pin to hold the bone together - a scaphoid fracture is often mis-evaluated as a wrist sprain. - if missed, necrosis may occur requiring extensive bone graft surgery and a long immobilization process
The distal end of the humerus becomes _________ and forms the __________
- wider - medial and lateral epicondyles.
Where are collateral ligaments located?
Collateral ligaments are located on the sides of each interphalangeal joint.
Why should you not pull on a jammed finger when it is injured?
Sprains are injured ligaments, and pulling on an injured ligament can only cause more injury.
What is buddy taping?
Taping an injured finger to an adjacent uninjured finger
Collar Bone
The clavicle (runs horizontally between the top of your breastbone and shoulder blade).
Where are the flexor and extensor muscles found?
The flexor muscles are found on the anterior surface of the forearm, the extensors on the posterior aspect.
Glenoid fossa
The head of the humerus, which is the bone of the upper arm, is round and smooth and fits into the glenoid fossa of the scapula.
How are the metacarpals numbered?
The metacarpals are numbered 1 through 5 beginning at the thumb side of the hand.
What bone has difficulty healing when fractured?
The scaphoid bone has blood supply on only one end, therefore has difficulty healing when fractured.
Shoulder Blade
The scapula (large, triangle shaped bone that lies in the upper back).
Acromion Process
The scapula has two forward projections that are located on the anterior aspect of the shoulder: the acromion process and the coracoid process.
How many carpals, phalangees, and metcarpals are on each hand?
There are 7 carpals, 5 metacarpals, and 14 phalanges in each hand.
What are the risks of relocating a finger dislocation?
There can be permanent damage to the finger if it is done incorrectly.
Bicipital Groove
Where the biceps tendon moves up and down during flexion and extension of the elbow.
An acute ulnar collateral ligament sprain is caused by _____________
a valgus stress.
The gleno-humeral joint is vulnerable to injury when it is _______________.
abducted and externally rotated.
deQuervain's Tendinitis
an inflammation of the abductor pollicis longus and extensor pollicis brevis
Hamate Fracture
can be caused by falling on an outstretched hand but more often occurs from contact when holding a sports implement such as a racquet, stick or club
The clavicle is most often fractured at the ______________, it's weakest point.
distal third
The elbow is a ________ joint.
hinge
What does the annular ligament do?
holds the radius and ulna together.
What is the most commonly dislocated wrist bone?
lunate.
The most frequent type of chronic inflammatory injury in the elbow is at the _________________.
medial and lateral epicondyles of the humerus called medial epicondylitis and lateral epicondylitis (lateral epicondylitis is more frequent).
Many athletic-related injuries to the shoulder are the result of _______________________.
overhead movements such as throwing a softball and serving a tennis ball.
Many injuries to the elbow are the result of ________.
overuse
Most shoulder muscle or tendon injuries are the result of __________.
overuse
The radius rests against the humerus allowing the forearm to ________________
pronate and supinate.
Dorsal
refers to the back of the hand
Volar
refers to the palm of the hand
The most common type of dislocation causes the head of the humerus to _______________
shift out of its socket (displaced forwards towards the front of the body).
The entire boney formation of the shoulder is referred to as the ________________.
shoulder girdle.
What is another name for gamekeepers thumb?
skier's thumb.
The most often strained rotator cuff muscle is the ______________.
supraspinatus muscle.
The acromioclavicular joint is made up of ___________________.
the acromion process of the scapula and the distal end of the clavicle
The glenohumeral joint is _________________.
the articulation of the head of the humerus and the glenoid fossa.
Avascular Necrosis
the death of body tissue due to lack of blood
A rupture of the biceps is evident by _________________.
the deformity caused when the muscle balls up toward the shoulder.
