Sports and Injuries: Chapter 18,

•Involves the tearing away of a finger flexor tendon. •Mechanism of injury involves catching the finger in an opponent's clothing. •The flexor digitorum profundus is torn from its attachment to the distal phalanx. Complaints •Inability to flex distal phalanx.

Jersey finger

Glenohumeral, acromioclavicular, sternoclavicular

Joints of the Shoulder

-Popping -Clicking -Catching -Grinding -Weakness (Diminished Strength) -Pain with overhead movements

Labral Tear: SLAP

-Signs of Injury •Severe point tenderness at the joint -Collateral ligaments •Lateral or medial joint instability

Ligament Sprain dislocation

•From a forceful hyperextension ("jammed") of either the MCP, IP or DIP joint.

MOI dislocations

•Point tender & painful movement. •Possible deformity of SC joint •Athlete holds arm close to the body.

AC and SC joint injury complaints

•Sling & swathe (ACE) bandage. •Refer to a physician

AC and SC joint injury first aid

-Max external rotation until ball release (humerus adducts, horizontally adducts and internally rotates) -Scapula elevates and abducts and rotates upward

Acceleration Phase

occurs from a direct blow to the tip of the shoulder or from falling on an outstretched arm ("FOOSH"). •1st degree - no significant ligament damage. Stretching of AC ligament. •2nd degree - partial tearing of ligaments. •3rd degree - complete rupture AC and CC ligaments.

Acromioclavicular joint injury mechanism

•AC joint is located on the superior aspect of the shoulder -Injuries involve the Acromioclavicular & Coracoclavicular Ligaments

Acromioclavicular joint location

"Extreme" biceps and triceps injuries (i.e. tears/ruptures) are rare in sports. •Eccentric contraction force •Fall on outstretched hand ("FOOSH") •Either mechanism can result in partial or complete rupture of muscle or tendon.

Bicep and tricep strain

•History of sudden popping •Visible defect within muscle or tendon •Discoloration and swelling

Bicep and tricep strain complaints

•Painful abduction of the shoulder joint. •Painful abduction and external rotation of shoulder. •Pain in shoulder joint when the athlete resists flexion and supination.

Bicep tendon injuries complaints

1.Tendonitis - long head of the tendon may develop tendonitis in the bicep groove. 2.Subluxation - when the tendon enlarges as a result of inflammation, it becomes less stable in the groove and may possible subluxate. 3.Tear - if force is violent enough the muscle may rupture in the belly. 4.Labral Tear - long head of the biceps tendon attaches to the superior shoulder labrum. Repetitive strain at the attachment may cause a lesion on the bicep. Acute/Chronic ❖"SLAP" lesion.

Biceps tendon injuries

An eccentric loading of the bicep muscle during deceleration and follow-through

Biceps tendon injuries mechanisms

Clavicle, scapula, humerus

Bones of the shoulder

•Injury involves tearing of the central band of the extensor digitorum tendon •Allows the PIP to "pop" through the opening, like a button through a buttonhole. •Mechanism is a blow while the finger is flexed during active extension.

Boutonniere Deformity

-Mechanism includes blows with a clenched fist. -Fracture involves 4th and/or 5th metacarpal bone(s) near the distal end(s).

Boxer's Fracture

•Cause of Injury -Compression of median nerve due to inflammation of tendons and sheaths of carpal tunnel → Result of repeated wrist flexion or direct trauma to anterior aspect of wrist •Signs of Injury -Sensory and motor deficits (tingling, numbness and paresthesia); weakness in thumb

Carpal Tunnel Syndrome

-Hands separate (achieve max. external rotation) while lead foot comes in contact w/ ground

Cocking Phase

•Cause of Injury -Occurs in lower end of radius -M.O.I: fall on extended wrist, forcing radius and ulna into hyperextension •Displacement occurs posteriorly

Colles' Fracture

The most notable area is at the olecranon process. Complaints •Swelling around the olecranon process. •Pain and stiffness, especially when elbow is flexed. ❖Olecranon Bursitis!!

Contusions of the elbow

•May be the most common form of tenosynovitis of the wrist. •Condition involves the tendons of the thumb: -The extensor pollicis brevis and the abductor pollicis longus. •Thumb flexion and extension will be painful.

De Quervain's disease

-Ball release until max shoulder internal rotation -Eccentric contraction of ext. rotators to decelerate humerus while rhomboids decelerate scapula

Deceleration Phase

•Elbow dislocations constitute extreme sprains. •Mechanism for this injury includes falling either on an outstretched hand. ✓Elbow deformity-posterior ✓Loss of function and severe pain ✓Possible neurological symptoms

Elbow dislocations

-ulnar collateral ligament -radial collateral ligament -annular ligament-stabilizes the head of the radius

Elbow is stabilized by the

•Ulnar & radial collateral ligaments protect elbow from valgus and varus forces. •Sprains result from either a valgus or varus force

Elbow sprains

-Lateral (tennis elbow) -Tennis, baseball, swimming, golfing -repeated forearm flexion and extension -Medial (pitchers or golfers elbow) -Repetitive wrist flexion, valgus stress on elbow

Epicondylitis MOI

-aching pain during and after activity -decreased ROM -Hand weakness

Epicondylitis S/S

-RICE, NSAIDS -ROM, PRE, Deep friction massage -Elbow sleeve or band just below the bend of the elbow

Epicondylitis TX

•Medial epicondyle is the attachment site of the forearm flexors and ulnar collateral ligament. •Lateral epicondyle is the attachment site of forearm extensors and radial collateral ligaments.

Epicondylitis of the elbow

•Sports that require gripping combined with wrist movements place great stress on the elbow. ✓Little League baseball pitching ("Little league elbow") and golf ("Golfer's elbow") associated with injury to the flexor muscles and medial humeral epicondyle. ✓Backhand motion in tennis ("Tennis elbow") is associated with injury to the extensor muscles and the lateral humeral epicondyle.

Epicondylitis of the elbow injuries

-Sling and swathe, immobilize w/ figure 8 brace for 6-8 weeks

First aid of fractured clavicle

-End of motion when athlete is in a balanced position

Follow Through Phase

•Cause of Injury -Common in youth - due to falls -Fracturing ulna or radius -Radius most common •Signs of Injury -"Pop or crack" followed by moderate to severe pain, swelling, and disability -Edema, ecchymosis w/ possible deformity

Forearm shaft fractures

•Cause of Injury -Fractures occur as a result of a direct blow -"FOOSH" •Signs of Injury -Pain, swelling, point tenderness, decreased ROM -X-ray is positive for fracture

Fracture of the humerus

•This injury usually results from falls or direct blows. •"FOOSH": Fall on outstretched hand •Many adolescent have a "greenstick" fracture to the clavicle. •Look for deformity and swelling

Fractured clavicle

Although rare, such fractures are usually associated with collisions sports •Severe pain in upper arm. •Deformity and loss of function.

Fractures of the upper arm complaints

•Gamekeeper's thumb involves sprain of the ulnar collateral ligament of the thumb. ✓Mechanism of injury is a valgus force to the MP joint of the thumb. ✓Pain and swelling over the area of the ulnar collateral ligament (MP joint).

Gamekeeper's Thumb

•A ganglion results from a herniation of the synovium surrounding a tendon. -Herniated area becomes filled with fluid. -Some ganglions are soft; others are hard and painful. Complaints -Visible swelling. -Painful, hardened nodule, in advanced cases.

Ganglions

•of injury is having the arm abducted and externally rotated. Most common type of serious injury to the shoulder is anterior dislocation.

Glenohumeral joint injury mechanism

•GH joint consists of humeral head and the glenoid fossa of scapula. ✓Extremely mobile but inherently unstable joint.

Glenohumeral joint location

subacromial, subdeltoid, subscapular

Major bursa of the shoulder

•Injury involves distal phalanx and torn extensor tendon. (DIP) •Flexion deformity is the MOST important sign. •Inability to extend fingertip.

Mallet finger

•Most notable - Ulnar Nerve •Cause of Injury -Direct blow (a.k.a. "Funny Bone") -Ulnar nerve dislocation - due to extreme valgus force - such as pitching side arm or with throwing curveball •Signs of Injury •Generally paresthesia in 4th and 5th fingers

Nerve injuries

-Cause of Injury •Crushed, hit by ball, twisted •Multiple mechanisms of injury -Signs of Injury •Pain and swelling •Tenderness at point of fracture

Phalanx fracture

Adduction, abduction, flexion, extension, internal and external rotation, and 360 circumduction -scapular protraction , retraction, elevation, depression

ROM for the shoulder

•Occurs when the subacromial bursa or the supraspinatus tendon is squeezed between the subacromial arch and the humeral head. •Athletes in sports that emphasize overhead arm movements have a high risk of this injury.

Rotator cuff impingement occurence

contribute to glenohumeral joint stability

Rotator cuff muscles

•Point tenderness around region of the humeral head that seems to be deep. •Pain within the shoulder, especially during follow through phase of throwing motion. •Difficulty bringing arm up and back during cocking phase of throw.

Rotator cuff strain complaints

-Chronic inflammatory condition due to trauma or overuse -May develop from direct impact or fall on tip of shoulder

Shoulder bursitis etiology

a direct blow or external blow or from falling on an outstretched arm ("FOOSH").

Sternoclavicular joint injury mechanism

•The sternoclavicular joint is formed by the union of the proximal end of the clavicle and the manubrium of the sternum. ✓Injuries are rare compared to AC or GH joints.

Sternoclavicular joint location

-Pain w/ motion and tenderness during palpation in subacromial space

shoulder bursitis signs of injury

Shoulder -this mobility provides the upper extremity with tremendous range of motion. -the wide range of motion also makes the shoulder joint unstable

what is the most mobile joint in the body

Windup Cocking Acceleration Deceleration Follow through

Throwing mechanics five stages:

deoxygenated blood back to the heart

Veins

•Most common carpal fracture involves the scaphoid bone. •"FOOSH" injury •Pain in the anatomical "snuffbox" •Often fails to heal due to poor blood supply

Wrist fractures

•Injury to radiocarpal (wrist) joints, intercarpal joints and ligaments. •Lunate bone is the most commonly dislocated bone of wrist. •Mechanism for this injury is forceful hyperextension.

Wrist sprains and dislocations

pecs, biceps, deltoids

anterior muscles of the shoulder

oxygenated blood to tissues

artery

-humerus -radius -ulna

bones of the arm

•In sports, external blows are common to this region. •Contusions to this region can result in a "shoulder pointer." ✓Intense pain over the bony process

contusions of the shoulder region

•Recent history of blow to shoulder. •Decreased ROM. •Muscle spasm. •Discoloration and swelling, especially over bony areas such as the AC & SC joints.

contusions of the shoulder region complaints

•Immediate application of ice and compression. •Sling & swathe bandage.

contusions of the shoulder region first aid

•Shoulder joint deformity and down-sloping shoulder contour. •Humeral head palpable within axilla. •Athlete supports arm on affected side & resists efforts to move GH joint.

glenohumeral joint injury complaint

•Apply sling & swathe bandage. •Refer to a physician.

glenohumeral joint injury first aid

compensated for by rotator cuff muscles, tendons, ligaments, and glenoid labrum

instability of shoulder

stem from the subclavian artery -Axillary -brachial -radial -ulnar

major arteries of the arm

acromioclavicular, coracoclavicular, coracoacromial, glenohumeral

major ligaments of the shoulder

Major nerves of the should stem from the brachial plexus -Ulnar -Median -Musculocutaneous -Radial

nerves of the brachial plexus

rotator cuff, triceps

posterior muscles of the shoulder

•Pain with abduction & external rotation. •Pain when arm is abducted beyond 80° to 90°. •Strength loss. •Pain felt deep within the shoulder.

rotator cuff impingement complaints

•Rest, anti-inflammatory drugs. •Strengthen Rotator Cuff muscles

rotator cuff impingement first aid

•An eccentric loading of the rotator cuff muscles during deceleration and follow-through. •"FOOSH" injury

rotator cuff strain mechanisms

-First movement until ball leaves gloved hand -Lead leg strides forward while both shoulders abduct, externally rotate and horizontally abduct

Windup Phase

fractured clavicle

What is the most common fracture in the shoulder region

rotator cuff ✓Errors in the execution of a throw or swing can contribute to overuse injury.

What is the most common strain

-humeroulnar -humeroradial -proximal radioulnar

The elbow is composed of three joints:

-Supraspinatus: elevates the shoulder joint out to the side -Infraspinatus: externally rotates the shoulder joint -Teres minor: externally rotates the shoulder joint -Subscapularis: allows humerus to move freely during elevation of the arm

The four rotator cuff muscles

-Cocking -Acceleration -Deceleration

What are the phases injuries are most likely to occur