Sport Injury Management Chapter 13

CHAPTER Q: What active motions would produce pain due to an acute 2nd strain involving the

A) the brachialis, biceps brachii, and brachioradialis?

CHAPTER Q: 1. Why is a dislocation of the PIP joint of the finger a potentially serious injury? What is the management for a suspected PIP dislocation? Should a coach attempt to reduce the dislocation?

Its because the PIP joint is a hinge joint. Also the central slip of the extensor tendon ruptures at the middle of the phalanx leaving no active extensor mechanism intact over the PIP joint. The management for it is any injury that limits the PIP extension to 30 degrees or less and produces dorsal tenderness over the base of the middle phalanx should be treated as an acute tendon rupture and immediately referred to a physician. No the coach should no attempt to reduce the dislocation.

1. What is "little league elbow"? Explain the mechanism of injury. Provide signs and symptoms of the injury.

Little league elbow is a medial human growth plate. It is a common chronic condition in activities involving pronation and supination often the individual reveals a pattern of poor technique fatigue or overuse. Common in activities such as tennis pitching volleyball or golf. The signs and symptoms are swelling, I can mouses, and point tenderness directly over the humeroulnar joint or on the medial epicondyle. pain is usually severe and aggravated by resisted wrist flexion and pronation and my Volga stress. If the owner nerve is involved in tingling and numbness me radiate into the forearm and hand particularly the fourth and fifth finger

contusions:

Nature of injury:direct blow to the are and forearm. They result from a compressive force sustained from a direct blow. Injuries vary in severity within where the area and depth where the blood vessels are ruptured. Signs and Symptoms:trauma can lead to internal hemorrhage, rapid swelling, and a hematoma formation that can limit ROM Management: many contusions are minor its important to be alert for an underlying fracture. Treatment involves ice, compression, elevation, and rest. SYMPTOMS usually disappear in 2-3 days

· Medial Epicondylitis (little league elbow)

Nature of the injury, background information, and/or mechanism of injury: A common chronic condition in activities involving pronation and supination often the individual reveals a pattern of poor technique fatigue or overuse. Common in activities such as tennis pitching volleyball or golf. o Relationship to "little league elbow" simultaneously lateral compressive forces can damage the lateral condyle of the humerus and Radiohead. Posterior stressors may lead to a tricep strain, impingement, fractures, or loose bodies o Signs and symptoms: swelling, I can mouses, and point tenderness directly over the humeroulnar joint or on the medial epicondyle. pain is usually severe and aggravated by resisted wrist flexion and pronation and my Volga stress. If the owner nerve is involved in tingling and numbness me radiate into the forearm and hand particularly the fourth and fifth finger o Management: this should be a parent to the coach during the history component that the injury is overuse in nature and the coach should refrain from continuing assessment. The coach should refer the individual toy physician for accurate diagnosis and treatment options. The coach should not permit the individual to continue activity as doing so could potential exacerbate The condition. The coach could suggest the application of cold to the area to decrease pain and potential spasms o Return to play. when cleared by physician

Scaphoid Fracture

Nature of the injury, background information, and/or mechanism of injury: Account for more than 70% of all carpal bone injuries in the general population and are the most common wrist bone fracture in physically active individuals. Peak incidence is between 12 and 15 years of age and in many cases the individual falls on the wrist, has normal radiographs, and discharged with a diagnosis of wrist sprain without further care o Signs and symptoms: assessment reveals a history of falling on an outstretched hand. Pain is present during palpation of the anatomical snuffbox which lies directly over the scaphoid or with word pressure along the axis of the first metacarpal bone. Pain increases during wrist extension and radial deviation o Management: I suspected fracture should be mobilized in the individual should be referred to a physician immediately. Application of caulking help reduce swelling and inflammation o Return to play. when cleared by physician

Wrist Sprain

Nature of the injury, background information, and/or mechanism of injury: Axle load in on the proximal palm during the fall an outstretched hand is the leading cause of us friends. This injuries often neglected leading to chronic wrist pain o Signs and symptoms: Point of tenderness on the dorsum of the radiocarpal joint. Pain increases with active or passive extension. carpal bone is particularly prone to dislocation during axial loading. The dorsum of the hand point is tender and a thickened area on the palm can be palpated just distal to the end of the radius if not obscured by swelling. passive and active motion may not be painful but if the bone moves into the carpal tunnel compression of the median nerve leads to pain numbness and tingling in the first and second fingers o Management: Immediate treatment involves immobilization, application of cold, elevation, and immediate referral to a physician to rule out a fracture or carpal dislocation o Return to play. One cleared to play by a healthcare physician

Phalangeal fracture

Nature of the injury, background information, and/or mechanism of injury: Fractures of the flanges are very common in sport participation. It is fractures can be difficult to manage because they may be caused by having the fingers stepped on or impinged between too hard objects such as a football helmet in the ground or by hyper extension that may lead to a fracture dislocation o Signs and symptoms: Increased pain is present with circulated compression around the involved feelings. Gentle percussion and compression along the long access of the bone increased pain at the fractured site. Particular attention should be given to the possible fracture. The fractures tend to have Mark deformity because the strong pull of the flexor in extensor tendon's. The forefingers move as a unit and failure to maintain the longitudinal and rotational alignment of the fingers can lead to a long-term disability in grasping or manipulating small objects in the palm of the hand. This deformity often results in a finger overlapping another when a fist is made made o Management: The management is same for a metacarpal fracture o Return to play

Lateral Epicondylitis

Nature of the injury, background information, and/or mechanism of injury: The most common overuse injury in the adult elbow. This condition is typically caused by eccentric loading of the extensor muscles predominantly the extensor carpiradialis Brevis during The deceleration phase of the throne motion or tennis stroke o Signs and symptoms: Pain is anterior or just distal to the lateral epicondyle and may your radiate into the forearm extensors during and after activity. Pain increases with resisted wrist extension or in an action similar to picking up a full cup of coffee o Management: The same for medial epicondylitis o Return to play

Bennett's fracture

Nature of the injury, background information, and/or mechanism of injury: and articular fracture of the proximal end of the first metacarpal and it's usually associated with a dislocation. It's typically caused by axial compression as occurs when a punch thrown with a closed fist or an individual falls on a close fist o Signs and symptoms: pain and swelling are localized over the proximal end of the first metacarpal but the foreman he may or may not be present. Inward pressure exerted along the long access of the first metacarpal elicits increased pain at the fractured site o Management: Management is the same as for a metacarpal fracture o Return to play

· Boutonniere deformity

Nature of the injury, background information, and/or mechanism of injury: caused by a blunt trauma to the dorsal aspect of the PIP joint or by rapid forceful flexion of the joint against resistance. an injury to the volar plate also can lead to a flexion deformity of the PIP joint that resembles a boutonniere deformity o Signs and symptoms: usually is not present immediately but develops over 2 to 3 weeks as the lateral slips move in a Palmer direction and causes hyperextension at the MCP joint, I am flexion at the PIP joint, and hyperextension at the DIP joint.This condition is sometimes referred to as buttonhole rupture because the PIP joint is swollen and lax full extension o Management: An injury that limits PIP extension 230° or less and produces dorsal tenderness over the base of the middle feelings should be treated as an acute tendon rupture and immediately referred to a physician o Return to play. when cleared by physician

Olecranon bursitis (acute or chronic) (students elbow)

Nature of the injury, background information, and/or mechanism of injury: fall on a flexed elbow can lead to an acute inflamed bursa. Leaning on ones elbow, repetitive pressure, and friction can lead to a chronic inflamed bursa o Signs and symptoms: presents with immediate tender, swollen area of redness in the posterior elbow. Swelling is relatively painless. If bursa ruptures a decrete, sharply demarcated goose egg is visible directly over the olecranon process. Motion is limited in extreme flexion as tensions increase over the bursa o Management: ACUTE ice, rest, and a compressive wrap applied for the first 24 hours. If there is significant distention the individual should be referred to a physicians as the condition may need aspiration to relieve the swelling. CHRONIC is managed with application of cold to the area, nonsteroidal anti inflammation medications, and ise of elbow cushions to protect the area from further insult o Return to play: when cleared by a physician o Signs and symptoms of a septic bursitis: The area is hot to the touch and inflamed. The individual shows traditional signs of infection including feeling lousy fever pain restricted motion tenderness and swelling at the elbow o Management of a septic bursitis: an individual with an infected birth so should be referred to a visitation. The physician usually aspirates the bursa and takes a culture of the fluid to determine the presence of septic bursitis

Boxers Fracture

Nature of the injury, background information, and/or mechanism of injury: fractures involving the distal metaphysis or neck of the fourth and fifth metacarpal's are commonly seen in young males involved in punching activities such as the name boxers fracture. The fracture typically has an Apex dorsal angulation and is inherently unstable secondary to the deforming muscle forces in frequent volar comminutiom o Signs and symptoms: sudden pain, inability to grip objects, rapid swelling, and possible deformity are present. Palpation reveals tenderness and pain over the fractured site impossible crepitis and bonie deviation. Delayed at the most this is common in pain increases with axial compression of the involved metacarpal and percussion o Management: The same for a metacarpal fracture o Return to play

Distal radius or ulnar fracture

Nature of the injury, background information, and/or mechanism of injury: fractures to the distal radius and owner present a special problem. In adolescents epiphyseal and metaphyseal fractures are common and these fractures usually heal without residual disability. In order individuals one or both bones may be fractured or one bone maybe fractured with the other bone dislocated at the elbow or wrist joint o Signs and symptoms: Fractures of the girls plate may be present with the distal fragment being dorsally displaced. Other signs and symptoms associated with traumatic fractures include intense pain swelling deformity and a false joint. Swelling and hemorrhage may lead to circulatory impairment or the median nerve maybe damage as it passes through the forearm o Management: fractures should be suspected in all forearm injuries particularly in adolescence. A suspected fracture should be immobilized and the individual should be referred to a physician immediately o Return to play. when cleared by physician

mallet finger

Nature of the injury, background information, and/or mechanism of injury: occurs when an object hits the end of the finger while the extensor tendon is taught such as when catching a ball. Resulting in forceful flexion of the distal phalanx avulses the lateral bands Of the extensor mechanism from it's distal attachment o Signs and symptoms: if the common extensor mechanism is avulsed A characteristic mallet deformity is present and the individual is unable to fully extend the DIP joint with the fore arm pronated o Management: treatment is the same as with jersey finger o Return to play

Metacarpal fracture

Nature of the injury, background information, and/or mechanism of injury: uncomplicated fractures of the metacarpals result in severe pain swelling and deformity. Unique fractures at the base of the first metacarpal may involve a simple intra-articular fracture. A unique fracture involving the neck of the fourth and fifth metacarpal is called a boxers fracture. If it often goes undetected because Adema of scares extent of the injury is fractures of the shaft of the metacarpals are more easily recognized o Signs and symptoms: Increased pain in the palpable deformity are present in the palm of the hand directly over the involved metacarpal. Gentle percussion and compression a long long access of the bone increased pain at the fractured site o Management: Fracture should be immobilized in the position of function with the palm facing down and finger slightly flexed. Cultured be applied to reduce hemorrhage and swelling an elastic compression bandage should not be applied to us one hand because it may lead to increased swelling in the singers. The individual should be referred immediately to physician for further assessment oReturn to play when cleared by physician

· Elbow dislocation (both radial head and ulnar dislocations) (pulled elbow syn.)

Nature of the injury, background information, and/or mechanism of injury; this condition results from longitudinal traction of an extended and pronated upper extremity such as when a young child is swung by the arm. Small tear in the annular ligament allows the Radiohead to migrate out from under the annular ligament o Signs and symptoms: A snapping or cracking sensation is experienced on impact. It is followed by severe pain rapid swelling total loss of function in an obvious deformity. The arms frequently held in flexion within the forearm appearing shortened. The olecranon and Radiohead are palpable posteriorly and a slight indentation in the triceps is visible o Management: The injury should be considered a medical emergency. Activation of the emergency action plan is warranted including summoning of EMS. The risk of neurovascular injury the code should not make any attempt to change the position of the arm. If tolerable application of cold to the area will help to manage swelling and inflammation while the MS is in route o Return to play. when cleared by a healthcare professional

1. Following a dive, a member of the high school swimming and diving team complains of significant pain to her right wrist. Her entry into the water resulted in axial loading and extension at the wrist. She is point tender on the dorsal aspect of the radiocarpal joint. What condition should be suspected? How should this condition be managed?

The condition that should be suspected is a wrist sprain. This condition should be managed by Immediate treatment involves immobilization, application of cold, elevation, and immediate referral to a physician to rule out a fracture or carpal dislocation

1. What conditions should be suspected with the following signs and symptoms:A. Inability to fully extend the DIP joint of the index finger with the forearm pronated? B. A deformity that presents with hyperextension at the MCP joint, flexion at the PIP joint, and hyperextension at the DIP joint? C. Inability to flex the DIP joint of the 4th finger against resistance? D. Pain with stressing the MCP joint of thumb in flexion?

The conditions should be wrist and finger strains. Either mallet finger, jersey finger, boutonniere deformity.

CHAPTER QUESTIONS: 1. What injury is commonly referred to as "nursemaid's elbow" or "pulled elbow syndrome"? What is the mechanism of injury? What population is more likely to be affected by this injury? What active ranges of motion are limited with this injury?

The injury that is commonly referred to as "nursemaid's elbow" or "pulled elbow syndrome" is and elbow dislocation. this condition results from longitudinal traction of an extended and pronated upper extremity such as when a young child is swung by the arm. Small tear in the annular ligament allows the Radiohead to migrate out from under the annular ligament. The people most affected by this are people who are younger than 20 years old.

CHAPTER Q: 1. What is the mechanism of injury for an ulnar dislocation? In addition to severe pain, rapid swelling, total loss of function, and an obvious deformity, what are the signs and symptoms of an ulnar dislocation? What is the management for the condition?

The mechanism is usually hyperextension or a sudden violent unidirectional valgus force that drives the ulna posterior or posterolateral. The signs and symptoms are A snapping or cracking sensation is experienced on impact. It is followed by severe pain rapid swelling total loss of function in an obvious deformity. The arms frequently held in flexion within the forearm appearing shortened. The olecranon and Radiohead are palpable posteriorly and a slight indentation in the triceps is visible. Management: The injury should be considered a medical emergency. Activation of the emergency action plan is warranted including summoning of EMS. The risk of neurovascular injury the code should not make any attempt to change the position of the arm. If tolerable application of cold to the area will help to manage swelling and inflammation while the MS is in route

Jersey Finger

o Nature of the injury, background information, and/or mechanism of injury: Typically occurs when an individual grips and opponents jersey while the opponent simultaneously twists and turns to get away. The jerking action may force the fingers to rapidly extend rupture in the flexor digitorum profundus tendon from its attachment on the distal phalanx. The ring finger is more commonly involved o Signs and symptoms: if avulsed The tendon can be palpated at the proximal aspect of the involved finger. The individual is unable to flex to the DIP joint against resistance o Management: Involves standard acute care with Cole the compression and elevation. Immediate physician referral is necessary for accurate diagnosis and management o Return to play. when cleared by a healthcare professional

· Finger sprain and dislocations

o Nature of the injury, background information, and/or mechanism of injury: excessive Veruis/Vargus Stress and hyperextension can damage The collateral ligament of the fingers. many individuals will consider the injury to be a simple jammed finger but this injury often involves an avulsion fracture from a tendon rupture which requires immediate surgery to repair the damage. Hyper extension of the proximal phalanx can stretch or rupture the volar plate on the Palmer side of the joint o Signs and symptoms: A swollen and painful finger is caused by a ball striking extended finger which is the most frequent initial report. Obvious deformity may not be present unless there's a fracture. The most common dislocation of the body occurs at the PIP joint. Pain is present at the joint line and increases when the mechanism of the injury is reproduced. Because digital nerves in vessels running along the sides of the fingers and thumbs dislocations here can potentially be serious o Management: Now what temp should be made to reduce a finger dislocation by an untrained individual. Immediate treatment for all this location involves immobilization in a finger splint application of cold and referral to a physician o Return to play. When cleared by a healthcare professional

Game keepers thumb

o Nature of the injury, background information, and/or mechanism of injury: occurs when the MCP joint is near full extension and the thumbs forcefully abducted away from the hand tearing the ulnar collateral ligament at the MCP joint o Signs and symptoms: The Palmer aspect of the joint is painful, swollen, and may have visible bruising. Instability is detected by replicating the mechanism of injury or by stressing the thumb in flexion o Management: Initial treatments include application of cold, compression, elevation, and referral to a physician for further care o Return to play. when cleared by a healthcare professional

Elbow Sprain

o Nature of the injury, background information, and/or mechanism of injury: repetitive tensile forces irritate and tear the ligaments particularly the ulnar collateral ligament when this occurs pain can be palpated directly over the involved ligament but one forces are excessive the resulting injury may be an elbow dislocation o Signs and symptoms: if the owner collateral ligament is injured a history of pain localized on the medial aspect of the elbow during the late cocking and acceleration phases of throwing is common.Point tenderness can be palpated directly over the ligament and increases if a Valgus force or stress is applied. if the radio collateral ligament is injured pain is localized on the lateral aspect of the elbow and increases with varus stress o Management: treatment involves standard acute care with ice compression and use of a sling. This injury requires physician referral for accurate diagnosis and treatment options o Return to play. cleared to play when physician allows