Sports Injury and Types Lecture 2

Definition of Sports Injury Occurs as a result of participation in an organized practice or game Requires medical attention by a therapist or physician Results in restriction of the athlete’s participation or performance for one or more days.

Mechanism or Injury MOI What happened , how was the athlete injured, main cause Provide clues as to acute or chronic

Importance of MOI Details how injury occurred Determines when it occurred Guides evaluation Determines levels of severity Leads to s differential diagnosis Guides treatment plans

Questions to Determine MOI What is your primary complaint What happened how did it happen where do you hurt What makes it feel better Wha makes it feel worse When did it happen What can you do , what can’t you do Was the pain sudden or did it gradually appear

Acute injury a single force ( macrotrauma ) definite moment of onset ( usually rapid onset) followed by a relatively predictable pattern of events Usually a single traumatic event

Critical Force tissues are said to have a limit that it is able to withstand a force , this limit is the critical force the critical force value varies for each type of tissue The critical force may depend upon age, temperature, skeletal maturity , sex, and body weight

Chronic Injury repeated loading or stress ( microtrauma) develops and worsens over a period of time, slow or insidious onset pain and inflammation - worsen with time may persist for months – years Often occur in activities with repeated, continuous movements Often called overuse injuries

Catastrophic Injuries Involve damage to the brain and or spinal cord and are potentially life threatening or permanent

Soft tissue Includes muscle , fascia ,tendons, joint capsules, ligaments , blood vessels and nerves . Soft tissue injuries Contusions, sprains, strains,

Injury Classification Sprains stretch or tear of stabilizing connective tissue , ligaments History of acute onset MOI may be due to overstretch or overload Pain is localized over the injury site Discolouration in severe cases ( caused by blood pooling distally to site of trauma)

Sprains lst degree: mildest form of sprain , mild pain, mild dysfunction , point tenderness, little to no swelling 2nd degree: more severe, imply more damage to ligament involved, increased amount pain and dysfunction , swelling more pronounced with abnormal movement

Sprains 3rd degree: most severe and imply a complete rupture, severe pain, major loss function, major instability, severe swelling

Sprain ankle

Strains Injuries to muscles. Tendons or muscle tendon junctions ( MTJ). Most common location for a strain is MTJ There is a tremendous variability in the severity of strains

Strains 1st degree: mildest form of strain with little associated damage to muscle and tendon structures, pain noticeable during use , with mild swelling 2nd degree:more extensive damage to soft tissue, pain , swelling are more pronounced and functional loss is moderate

Strains 3 rd degree: most severe and imply a complete tear or rupture of structure involved Significant swelling and loss of function A defect may be apparent through the skin

Hamstring strain

Contusions a result of compressive force or a direct blow to the body surface. Characterized with pain, stifness and swelling as well as Ecchymosis - tissue discolouration if haemorrhage is superficial Haematoma – pooling of blood

Fractures is a disruption in the continuity of a bone a) simple bone ends remain intact within surrounding soft tissues b) compound one or both ends protrude from the skin Associated with swelling , deformity , pain, tenderness loss of use, grating sensation

Types of fractures transverse - break occurs in straight line across the bone oblique - break occurs diagonally across the bone spiral - jagged bone ends are S- shaped avulsion - bony fragment is pulled off by attached tendon stress - repeated low magnitude forces over time

Types of fractures comminuted - bone fragments into several pieces greenstick - bone breaks incompletely as with a green stick impacted - a bone impacts or is driven into another bone

Fracture dislocation

Dislocations Luxation A temporary separation b/w articulating ends & remains that way for extended period. results in extreme damage to connective tissue. common: fingers, G-H jt. S/S --dysfunction , deformity, athlete will often report a snapping or popping sound

Subluxation incomplete separation b/w articulating ends. less severe damage than luxation. common: patellafemoral jt.

Tissue Response to Injury tendons, ligaments , muscle , bones with progressive training all structures gradually get stronger and larger injuries occur as a result of the bodies inability to adapt to an increased load of training ( rapid changes ) “Healing is a matter of time but sometimes also a matter of opportunity” Hippocrates

Force Directions Compressive - an axial loading that produces a squeezing or crushing effect on a structure ( bruises) Tensile - axial force that is opposite to compressive force ( longitudinal force) (muscle stretch) a pulling force that tends to stretch the structure Bending –results in tension on one side and compression on the other ( ankle sprains damage to both sides)

Shear - a force that acts perpendicular to the tissues involved (structures slide or displace) (ligament tears , blisters) Rotational- combination of tension and shears ( spiral fractures , acl tears)

Soft Tissues Skin - tendons - ligaments all made up of collagen Collagen - is a protein strong in resisting tension but stretches slightly under tensile loading as fibres straighten thus collagen provides both strength and flexibility to tissues ( but are relatively inelastic) Elastin another protein provides added elasticity to some connective tissue structures.

Skin 3 layers largest organ of the human body loose multidirectional arrangement of collagen fibres - enables the resistance of multidirectional loads, including compression, tension and shear

Epidermis outer sheath of the body acts as a barrier. Contains pigments hair, nail and glands

Dermis 1 st layer under the epidermis blood vessels nerve endings glands ( sweat, sebaceous)

Subcutis subcutaneous fat primary area for fat storage producing internal temperature regulation mobility of skin over internal body core

Skin Injury Classification

Blister Repeated application of a shear in multiple directions excessive friction on skin results in a pocket of fluid accumulation below epidermis. hot spot. open vs closed

do not aspirate if blood filled … otherwise aspirate after 24 hours , with a sterile needle , clean and dress the wound .. leave the top layer of skin on … cover with donut pad and or second skin.

Skin Bruise Ecceymosis a direct compressive force , from a blow or trauma damage to underlying bloods vessels causing accumulation of blood within the skin ice and pad if necessary

Abrasion result of scraping or shear of skin on rough surface. results in loss of epidermis or worse depending on amount of force clean and remove any debris flush with saline solution dress with non stick adherent pad and secure

Punctures direct penetration of skin by sharp object - eg: T&F spike, javelin. CAUTION!! Tetanus Bacillis lockjaw - acute disease - booster shots if not had one in five years

Lacerations sharp object (skate blade) direct blow (squash racquet) stitches vs steri-strips 1/2" length, 1/8" deep, need to be done with in 10 hours

Ligaments and Tendons Injury Classification

Tendons connect muscles to bones dense connective tissue fibers parallel - enable resistance of high unidirectional tensile loads

Ligaments connect bone to bone dense connective tissue fibers parallel and interwoven resistance along long axis and also small resistance to loads of other directions more elastin in ligaments than tendons thus more elastic in nature

Tendon Injuries stronger than muscle, so usually damage to muscle belly or musculotendinous junction. however, tendons can be weakened by collagen re-absorption with: early conditioning. post - immobilization. repeated micro trauma. Note: also weakened with steroid use

Tendonitis S/S History of chronic onset MOI due to overuse, or repeated overstretch or overload Pain exists through out the length of tendon and increases with palpation Swelling may be minor to major and thickening of tendon may be present

Crepitus may be present Pain usually at the extremes of motion Pain increases during stretching and resisted actions Strength decreases with pain

Tenosynovitis inflammation of synovial sheath around tendon. occurs quickly crepitus - snapping sound acute or chronic if chronic a nodule is often formed

Fascitis inflammation of fascia which separates muscle layers eg. - plantarfascia.

Bursitis may be acute or chronic direct trauma or repetitive forces fluid filled sac found in areas where friction might occur

Joints Types

Fibrous lack of synovial cavity. articulation held together by fibrous connective tissue. little to no movement. eg.: distal tib fib joint.

Cartilaginous no synovial cavity. articulation held together by cartilage. little to slight movement. eg.: symphasis pubis, intervertebral discs.

Synovial -freely movable joints. -must process following criteria: space/potential b/w articulating ends. articular cartilage (hyaline cartilage). Articular Capsule: i) Fibrous (outer). ii) Synovial membrane (inner). secretes synovial fluid to lubricate joint and provide nutrition.

Types of Synovial Joints Ball & Socket Hinge Pivot Saddle Gliding

Bone like lig. & tendon connective tissue, except: calcium carbonate , calcium phosphate, collagen and water some degree of flexibility and strength progressive loss of collagen with age - which increases the bones brittleness Periosteum - contains blood supply to bone