Chapter 13: Recognizing Different Sports Injuries

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 may increase with active and passive motion of involved muscle; Pain with palpation, with predictable pattern of referred pain which may also limit motion

Inflammatory Response Phase

-begins immediately following injury = critically important; without the inflammatory phase other phases 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

Muscle Strains & Injuries

-causes = stretch, tear or rip to muscle or adjacent tissue -grade 1 = some fibers stretched or torn resulting in tenderness and pain on active ROM, movement painful but full range present -grade 2 = number fo fibers torn and active contraction is painful, usually a depression or divot is palpable some swelling and discoloration result -grade 3 = complete rupture of muscle or musculotendinous junction, significant impairment, with initially a great deal of pain that diminishes due to nerve damage

S & S Dislocations

-deformity = almost always present -loss of function -swelling, point tenderness -additional concerns = avulsion fractures, growth plate separation, "once a dislocation, always a dislocation" -treatment = dislocations should always be considered and treated as a fracture until ruled out -x-ray is the only diagnostic technique -return to play often determined by extent of soft tissue damage

Dislocations & Subluxations

-dislocation = at least 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 seperation of two bones; often occur in shoulder and females (patella)

Compression

-external loads applied toward one another on opposite surfaces in opposite directions

Shearing

-force that moves across the parallel organization of tissue

Tension

-force that pulls and stretches tissue

Healing of a Fracture

-generally require immobilization for some period = approx. 6 weeks for bones of arms and legs; 3 weeks 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

Types of fractures

-greenstick = in children -comminuted = pieces -linear = jumping and landing from a height -transverse, non displaced = direct blow from outside -oblique, nondisplaced and spiral = torsion common in football and skiing

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 warmth -if source of irritation is not removed then inflammatory process becomes chronic

Tenosynovitis

-inflammation of synovial sheath -in acute case = rapid onset, crepitus and diffuse swelling -chronic cases result in thickening 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

Tendinitis

-inflammation of the tendon -crepitus = crackling sound caused by "sticking" of tendon when sliding; sticking occurs due to chemical products of inflammation -management = key for treatment is rest and removal of causal factors; work to maintain cardiovascular fitness using means that don't irritate inflamed tendon

Tendon Ruptures

-large tendon ruptures will require surgery -biceps tendon and Achilles -rehab = lengthy process regardless of severity; generally require 6-8 weeks; return to activity too soon may result in re-injury

Torsion

-loads caused by twisting in opposite direction from opposite ends -shear stress encountered will be perpendicular and parallel to the loads

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

Muscle Guarding

-muscles within an effected area contract to splint the area in an effort to minimize pain through limitation of motion -involuntary muscle contraction in response to pain following injury = not spasm which would indicate increased tone due to upper motor neuron lesion in the brain

Chronic Injury

-occurs from overuse -ex: tendinitis; tenosynovitis; bursitis; osteoarthritis; myofascial trigger points

Acute Injury

-occurs from trauma -ex: fractures; dislocations/subluxations; contusions; ligament sprains; muscle strains; muscle soreness; nerve injury

Muscle Soreness

-overexertion in strenuous exercise resulting in muscular pain -generally occurs following participation in activity that individual is unaccustomed -two type of soreness = acute-onset muscle soreness accompanies fatigue and is transient muscle pain experienced immediately after exercise; delayed-onset muscle soreness (DOMS) = pain that occurs 24-28 hours following activity that gradually subsides (pain free 3-4 days later), potentially caused by light micro trauma to muscle or CT structures -prevent muscle soreness through gradual build-up of intensity -treat with static or PNF stretching and ice application within 48-72 hours of insult

Stress Fractures

-overload due to muscle contraction -altered stress distribution due to muscle fatigue -changes in surfaces -rhythmic repetitive stress vibrations -change in surfaces can cause stress fracture -progressively becomes worse over time = initially pain during activity and then progresses to pain following activity -early detection is difficult, bone scan is useful, x-ray is effective after several weeks -if suspected -stop activity for 14 days -generally does not require casting

Muscle Cramps

-painful involuntary contraction -attributed to dehydration/electrolyte imbalance -may lead to muscle or tendon injuries

Acute Bone Fractures

-partial or complete disruption that can be either closed or open (through skin) -serious musculoskeletal condition -presents with deformity, point tenderness, swelling and pain on active (move on own) and passive motion (moved by another) -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 results in a more complex fracture; while force goes into fracturing the bone, energy and force is also absorbed by adjacent soft tissue; some bones will require more force than others

Fibroblastic Repair Phase

-proliferative 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 pain and tenderness will decrease

Tendionsis

-refers to chronic tendon injury without inflammation -most common overuse problem in sports -likely that pain occurred with initial stages of injury without proper tendon healing

Fractures

-result of extreme stress and strain on bone -diaphysis = shaft -epiphysis -periosteum = contains blood vessels and osteoblasts

Contusions (bruise)

-result of sudden blow -can be both deep and superficial -hematoma results from blood and lymph flow into surrounding tissue = minor bleeding result sin discoloration of skin -may be painful to touch and active movement -must be cautious and aware of more severe injuries associated with repeated blows = calcium deposits may form with fibers of soft tissues -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

Sprains

-result of traumatic joint twist that causes stretching or tearing of CT -graded based on severity of injury -grade 1: some pain, minimal loss of function, no abnormal motion and mild point tenderness, slight swelling and joint stiffness -grade 2: pain, moderate loss of function, swelling, and instability, some tearing of ligament fibers and joint instability -grade 3: extremely painful, inevitable loss of function, severe instability and swelling and may also represent subluxation -restoration of joint stability is difficult with grade 1 and 3 injuries -must rely on other structures around the joint = rely heavily on muscles surrounding joint -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 -once you stretch ligament it does not go back

Ligament Sprains

-sprain = ligament (not tendon) -damage to a ligament = ligaments provide joint support -synovial joint characteristics = 2 or more bones; hyaline cartilage; joint capsule; blood and nerve supply -some joints will have thick fibrocartilage for shock absorption and stability (ex: knee with meniscus) -ligaments = thickened portions of the capsule or totally separate bands; dictates partially the motions the joint

Bursitis

-sudden irritation can cause actor bursitis while overuse and constant external compression can cause chronic bursitis = results in increased fluid production, causing increase in pressure due to limited space around anatomical structures -signs and symptoms include swelling, pain and some loss of function

Bending

-two force pairs act at opposite ends of a structure -three forces cause bending -already bowed structures encounter axial loading

Nerve Injuries

-two main causes of injury = compression and tension; resulting in radiating pain and muscle weakness (stinger or burner) -may be acute or chronic = causes pain and can result in a host of sensory responses; hypoesthesia diminished sense of feeling; hyperesthesia increased sense of feelings such as pain or touch; paresthesia numbness, prickling or tingling -neuritis = chronic nerve problem caused by overuse or a variety of forces; results in minor to sever problems; crushing or severed nerve injury = life long implications; paraplegia/quadriplegia could result -for healing (slow and long term): optimal environment is critical; CNS (never repair/replace) vs. PNS repair (can repair/replace)

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 from an activity such as running or cycling -Symptoms include pain (as the result of friction), stiffness, localized tenderness, creaking, grating, and often is localized to one side of the joint or generalized joint pain