1. Unit I-Basics of Human Anatomy and Physiology Chapter 2 Basics of Tissue Injury

2. Objectives Explain the various types of soft tissue injuries Explain tissue repair and healing Explain the various bone injuries Explain bone repair and healing

3. Soft Tissue Injuries Often called “wounds” Commonplace in athletics Injured tissue – May bleed – Become inflamed – Produce extra fluid

4. Soft Tissue Injuries-Incision Open wound Made by a cutting object – i.e. scalpel Edges are smooth Rarely seen in athletics

5. Soft Tissue Injuries-Abrasion Scraping off a layer/s of skin May or may not bleed – Depends on depth Often seen in athletics – Softball & Baseball – Sliding into a base

6. Soft Tissue Injuries-Contusion Closed wound Common name-bruise Bleeds under the skin causing – Swelling – Discoloration Seen in athletics – Athlete runs into something – i.e. athlete’s eye into someone’s elbow

7. Soft Tissue Injuries-Laceration Open wound Edges are jagged & irregular Created by a non- cutting object – steel pole or wall – i.e. player runs into the goalpost

8. Soft Tissue Injuries-Avulsion Partial tearing away of a body part or tissue Part or tissue is left hanging Ring avulsion seen in basketball – One catches a ring on the hoop when dunking

9. Soft Tissue Injuries-Amputation Open wound Part is completely cut away from the body – i.e. cutting of a finger with an ice skate

10. Soft Tissue Injuries-Puncture Pointed object enters the body – i.e. stepping on a nail Bleeding is minimal More likely to become infected

11. Soft Tissue Injuries-Contrecoup Injury occurring on the opposite side of the initial injury Usually occurs in the brain – Head hits against an unyielding object or surface – Impact on one side forces brain against the other side – Results in a contrecoup injury

12. Sprains & Strains Sprain Bleeds internally causing fluid buildup Injury to ligaments – Strong pieces of tissue that hold bones together Strain Bleeds internally causing fluid buildup Injury to a muscle or tendon – A tendon attaches a muscle to a bone – Transmits the force a muscle exerts

13. SprainStrain

14. Sprains & Strains Categorized in order of severity – First degree-no loss of motion in injured body part – Second degree-some loss of motion in injured body part – Third degree-athlete cannot move the injured body part

15. Nerve Injury Nerves – Transmit sensations – Relay messages from brain to muscles to contract/relax Nerve injury – Athlete may experience Lack of sensation and/or movement – Stretched nerve can send a message of extreme pain – Nerve injury takes a long time to heal If damage is severe-it will not heal

16. Stages of Soft Tissue Healing Three Stages of Healing Stage 1: Acute Inflammatory – Body part is injured – Cells within the area die Ripped apart Cut off from food and O2 supply – Increased flow of blood to area Bringing cells and chemicals to begin healing process Phagocytes (specialized cells) – Engulf and eat up dead cells Leukocytes (infection-fighting white blood cells) Platelets (blood clotting materials) – Lasts for about 2 days

17. Stages of Soft Tissue Healing Three Stages of Healing Stage 2: Repair – Injured area is filled with blood, cells & chemicals – Rebuilds area to as near normal as possible – Fibroblasts (fiber-building cells) Build fibers across the area of injury Form the “scar” – Takes from 6 weeks to three months – Depending on the extent of the injury

18. Stages of Soft Tissue Healing Three Stages of Healing Stage 3: Remodeling – Takes up to a year or more to accomplish – Body’s way of building tissue strength In tendons, ligaments and muscles To withstand stresses applied to body during activity

19. Healing Time In general… – Greater the injury – Longer the healing time Depends on – Degree of the injury – Location of & blood supply of the injury Poor blood supply-longer healing process – Age of the athlete Other factors that slow the healing process – Poor nutrition – Illnesses (i.e diabetes) – Medications (corticosteroids) – Infections

20. Complications of Healing Scar tissue – Excessive delays healing time Forms deep within joints May have to be surgically removed – For proper movement to occur Large wounds – Take longer to heal – Stitches or closures will help Resuming activity too soon – Early activity causes more cellular injury – AT must use good judgment to insure proper healing

21. Types of Bone Injuries Common athletic injuries – Fractures – Dislocations Why do bones break & how much force must be applied before a bone will break – Answer varies depending on The athlete Where the force is applied Bone type Body position

22. Dislocation Articulate – When bones come together at a joint Dislocation – Significant force displaces bone – The two bone ends in the same joint no longer line up – Can also cause Avulsion fracture Strain Sprain Disruption of blood flow Disruption of nerve conduction

23. Dislocation Deformity Pain Not easily moved Cared for by team physician Not put back in place by the Athletic Trainer

24. Fractures Amount of energy required to cause a fracture – Called the failure point Varies with athlete Age Bone structure i.e. athlete with osteoporosis has a lower failure point than an athlete with healthy bones Named (or classified) according to – Type of impact – How failure of the bone occurs Broken, cracked, chipped, hairline fracture All classifications imply bone has been compromised & weakened

25. Fractures With any fracture – Athlete in splint or cast for 6-8 weeks Time required for proper healing Some fractures – Can be splinted – Athlete can resume participation immediately

26. Types of Fractures-Avulsion Ligament or tendon pulls so hard at its bony attachment – Portion of the bone is torn away Common with – Sprains – Strains – Dislocations

27. Types of Fractures-Stress Known as a fatigue fracture Occurs in a bone subjected to repetitive stress Athlete complains of a persistent sore spot over the bone Microscopic – Cannot be viewed on an X ray (do not show up on initial X ray) – Show up on follow up x-ray (after several months)

28. Types of Fractures-Spiral Torsional force along the length of a bone – i.e. in line skating-foot moves to the right while rest of the body goes to the left On X ray looks like the stripe on a candy cane

29. Types of Fractures-Longitudinal Runs the length of a bone Usually caused by an impact – i.e. pole vaulter misses the mat yet lands on feet

30. Types of Fractures-Compression Occurs when opposing forces are applied – To a bone from both ends at the same time Often occur in the spine – i.e. athlete lands on feet or buttocks from a height (forces-ground & weight of falling body) – Opposing forces cause compression fracture in the vertebrae

31. Types of Fractures-Oblique Diagonal line across a bone – From one side to another If occurs in a weight bearing bone (leg) – Takes longer to heal – Diagonal ends make it easy for bone to move out of alignment Even when in a cast

32. Types of Fractures-Comminuted Bone is crushed into smaller pieces Example-baseball catcher’s bare hand is hit by a bat

33. Types of Fractures-Greenstick Occurs in adolescent and children’s bones – Because they are soft – Still having some of the properties of cartilage Bend and fracture only partway through

34. Types of Fractures-Transverse Fracture travels across a bone – Perpendicular to that bone Occur from perpendicular impacts to that bone – i.e. lacrosse player comes down with his stick across another player’s forearm

35. Types of Fractures-Depressed Occurs from a direct impact to the skull Since skull is naturally rounded – It indents – Indentation is called a depression

36. Types of Fractures-Blowout Occurs when an eye is pushed hard backwards and down into the eye socket Small bones under the eye are crushed and embedded into the muscles of the eye Occurs when a hard object strikes the eye – i.e. a baseball

37. Types of Fractures-Pathological Disease process weakens the bone – Bone tumor – A little stress will cause a fracture Pathological fractures most commonly occur among teenage athletes due to – Improper nutrition – Eating disorders Minerals taken from bones to support vital functions Bones weaken

38. Types of Fractures-Epiphyseal Epiphysis – Area of bone where growth occurs – Susceptible to fracture – Bony tissue is stronger than epiphysis Common in children and adolescents – Especially in long bones Adults don’t get these – Growth areas (plates) are closed (not active) Do not show up on X ray – Epiphysis is clear on film

39. Bone Fracture Healing Three Stages of Healing Stage 1: Acute – Injury causes bone to break Bleeding occurs in the area Osteoclasts – “eat” debris or reabsorb it into the body Osteoblasts – Add new layers to the outside of the bone – Continues for about four days Osteoclast

40. Bone Fracture Healing Three Stages of Healing Stage 2: Repair – Osteoclasts & osteoblasts continue to regenerate the bone – A fibrous callus forms (a bony splint) Extends both internally & externally Holds the bone ends together Transformed into a sleeve of hard callus bone – Begins at about week 3 & continues for 3 months – After 6 weeks in a cast Fracture is strong enough for participation/protection Athlete is able to return to competition – Healing process is far from complete

41. Bone Fracture Healing Three Stages of Healing Stage 3: Remodeling – Takes several years to complete – Callus is reabsorbed and replaced – Fibrous cord of bone forms around the fracture site Can be stimulated through surgically implanted electrodes In cases when the bone is not healing – Bones contain minerals that have an electrical charge – Electrical stimulation increases the layering of the bone – Nonunion fracture Bone that never heals Common in scaphoid bone in wrist – Painful – May lead to arthritis & inability to move the wrist