Mechanisms and Characteristics of Sports Trauma

(please note that some pictures may be graphic) Basic Injury Terms (please note that some pictures may be graphic) Soft Tissue Trauma The skin = wounds Abrasion Incision Friction blister Laceration Avulsion Puncture Contusion

Abrasion - skin is scraped away against a rough surface. The epidermis and dermis are worn away, exposing numerous capillaries Incision - skin is sharply cut

Laceration - a wound where the flesh has been irregularly torn Avulsion - skin is completely ripped from its source

Skin bruise - a blow compresses or crushes the skin surface producing bleeding under the skin - called a contusion Puncture - penetration of skin by a sharp object

Friction blister - continuous rubbing over the surface of the skin Friction blister - continuous rubbing over the surface of the skin causes a collection of fluid below or within the epidermal layer

Care for blisters Prevention: Treatment: Talcum powder or petroleum jelly can protect skin against abnormal friction Wearing tubular socks or 2 pairs of socks Correct size shoe Shoes must be broken in Treatment: Leave intact first 24 hrs. Popping a blister depends on pain and severity Avoid infection by cleaning with antiseptic soap May use 2nd skin or moleskin Doughnut pad may decrease pain

Soft Tissue Trauma Skeletal Muscle Trauma Contusions: Superficial to deep Hematoma may be formed by localization of the bleeding into a clot

Strains - stretch, tear or rip in the muscle tissue or tendon Possible causes: abnormal muscle contraction due to a strength imbalance, electrolyte imbalance May range from a minute separation of connective tissue and muscle fibers to a complete tendinous avulsion or muscle rupture

Soft Tissue Trauma Strains Grade I = Some muscle fibers stretched or torn, mild tenderness, pain on active motion but full range of motion (ROM) is possible, no discoloration, mild loss of strength Grade II = Some muscle fibers torn, extremely painful, loss of strength and movement, discoloration due to capillary bleeding, possible divot felt Grade III = complete rupture, significant impairment or total loss of movement, pain is intense but quickly diminishes due to complete nerve separation

Soft Tissue Trauma Muscle Soreness 2 Types: Acute-Onset Muscle Soreness - usually accompanies fatigue, during and immediately after exercise Delayed-Onset Muscle Soreness (DOMS) - appears 12-24 hrs after exercise. Most intense 24-48 hrs later. Takes about 72 hrs to go away

Soft Tissue Trauma Tendon - attaches muscle to bone Tendonitis - inflammation of the tendon-muscle attachments, tendon or both due to overuse Gradual onset, diffuse tenderness, swelling, pain Grade I = pain before, no pain during, pain after Grade II = pain before, during and after but sill functional Grade III = pain all the time and debilitating

Joint Trauma Ligaments Connect 2 bones Primary Function = motion control and stability Sprain = stretching or tearing of ligaments, joint capsule, or both

Cartilage Connective tissue that provides firm and flexible support Because of its great strength, cartilage can be deformed without damage and still return to its original shape Occurs throughout body and consists of 3 types: Hyaline - nasal septum, trachea, larynx, articular ends of bones of the synovial joints Fibrous - vertebral discs, meniscus Elastic - external ear, eustachian tube

Hyaline Articular cartilage no direct blood supply Receives nourishment from synovial fluid Acts like a sponge Articular cartilage Motion control Stability Load transmission

Joint Trauma Sprains Grade I = some pain, mild pt. tenderness, mild loss of function, little to no swelling, little to no discoloration, no instability Grade II = pain, moderate loss of function, swelling, and moderate instability Grade III = extremely painful, major loss of function, severe instability, swelling, rupture of the ligament

Joint Trauma Dislocations: complete joint disruption 2nd to fractures in terms of disabling the athlete Highest incidence = fingers, shoulder, elbow 1st time dislocations (all except finger) should always be treated as emergencies and 911 called (finger should be referred but not an emergency)

Skeletal Trauma Acute Bone Fractures: disruption in the bone’s continuity Depressed Greenstick Impacted Longitudinal Spiral Transverse Comminuted Avulsion Open or compound

Skeletal Trauma Stress Fractures Weakened areas of bone Starts as stress reaction and progresses to stress fracture Causes - theories include: Coming back from injury too soon Going from one event to another without proper training Starting too quickly Changing environment (running surfaces, shoes, etc.) Postural and foot mal-alignments

Skeletal Trauma Stress Fractures Common areas: tibia, fibula, metatarsals (3rd and 4th), calcaneus, femur, lumbar vertebrae (extension athletes), ribs, humerus Signs and symptoms: progression of pain from intermittent to constant, more intense at night, focal to one spot, swelling, does not respond to treatment Management: send athlete for xray to rule out fx; possible bone scan may be necessary if pain persists and xray is negative, usu. walking boot is recommended