1. Lesson 3 Unit 1 General Injuries (cont)
Conducting Subjective/Objective Assessments
General Injuries (cont)

2. Aims of the Session
This session will allow candidates to have an understanding of the general injuries and identification of them.

3. Learning Outcomes
By the end of the lesson the candidate will be able to
Identify 4 general injury pathology, including signs & symptoms
Describe the common probable causative factors
Explain the assessment findings of the conditions
Explain the treatment needs

4. Compartmental Syndrome
Introduction
Compartment syndrome is a painful and potentially serious condition caused by bleeding or swelling within an enclosed bundle of muscles (a muscle 'compartment').
Each group of muscles in the arms and legs, together with the nearby blood vessels and nerves, is contained in an enclosed space surrounded by layers of tissue called fascia.
Compartment syndrome occurs when pressure within a compartment increases and affects the function of the muscle and tissues.

5. Compartmental Syndrome
Introduction

6. Compartmental Syndrome
Pathology
Compartment syndrome results from an increase of pressure in any muscular compartment of the arms or legs.

7. Compartmental Syndrome
Signs & Symptoms
Localised pain and swelling of the area,
The symptoms depend on whether you have acute compartment syndrome – which happens suddenly, after injury like being crushed – or chronic compartment syndrome, which comes on gradually.
Acute compartment syndrome causes intense pain, especially when the affected muscle is stretched. You may also have a tingling or burning feeling in the skin, and the muscle may feel tight. It is a medical emergency because the high pressure inside the compartment can potentially cause permanent muscle and nerve damage.
Acute compartment syndrome usually happens after a fracture or a crush injury but can also be caused by severe bruising of a muscle. In rare cases it can occur without an injury. Chronic compartment syndrome causes cramping pain during exercise, mostly in the leg, that eases when the activity is stopped.
You may also have difficulty moving the foot and visible muscle bulging. It is much less serious than acute compartment syndrome. It comes on gradually, usually after a long period of repetitive-motion exercise, such as running or cycling.

8. Compartmental Syndrome
Possible Causative Factors
Post-impact bleeding following an impact,
Rapid hypertrophy of compartment muscles,
Inflammation of tendons from repetitive movement or impact (football),
Reduced flexibility in an adjacent compartment.

9. Compartmental Syndrome
Assessment Findings
Post-impact bleeding following an impact,
Rapid hypertrophy of compartment muscles,
Inflammation of tendons from repetitive movement or impact (football),
Reduced flexibility in an adjacent compartment.

10. Compartmental Syndrome
Treatment
Rest and modifying activities to avoid stressing the affected area,
Massage of tight muscles,
Minor surgery to release the tight fascia.

11. Stress Fractures Introduction
A stress fracture is a crack in a bone, and can be a common injury in high impact sports such as distance running or basketball. Stress fractures can be quite painful, but usually heal themselves if rested for a few months.
Many different sports increase the risk of stress fractures. Activities that require running and jumping may cause fractures in the legs or feet. More than half of all adult and adolescent stress fractures occur in the lower leg bones. In adults 25% of fractures are in the metatarsal bones of the feet (the bones of the instep).
Other sports that require repetitive movements - such as bowling a ball in cricket or rowing - can result in stress fractures in other parts of the body.

12. Stress Fractures Introduction
Stress fractures are much more likely to develop in people who have just started a new exercise or abruptly stepped up the intensity of their workout. When the muscles aren't conditioned, they tire easily and can't support and cushion the bones as well. Increased pressure is exerted directly on the bones, which can lead to a fracture.
Stress fractures seem to be more common in women, especially in women who do not have regular menstrual cycles. A reduction in oestrogen can cause osteoporosis, or weakening of the bones. Teenagers may also be at greater risk, since their bones aren't fully hardened.
Any anatomical abnormalities - such as fallen arches - can distribute stress unequally through the feet and legs, increasing the risk of stress fractures. Poor-quality equipment such as worn-out running shoes has the same effect.
Unfortunately, stress fractures tend to recur. About 60% of people who have a stress fracture have also had one previously.

13. Stress Fractures Pathology
This is when micro-trauma leads to small fractures which develop in the bone, the most common site being the surface of the Tibia.

14. Stress Fractures Signs & Symptoms
Pain on the anterior or posterior surface of the bone at the affected site, most commonly the site of the Tibia.

15. Stress Fractures Probable Causative Factors Muscle imbalance,
Poor posture – pronation,
Overuse,
Too much too soon – change in training stressors, i.e. footwear, surface, intensity.

16. Stress Fractures Assessment Findings
history consistent with possible causes of the injury,
Onset of pain with any activity level,
Symptoms will ease shortly after activity stops,
Pain on palpation of the specific compartment,
Nodules along the anterior surface of the tibia may be felt in the more chronic stages.

17. Stress Fractures Treatment
The initial treatment for a stress fracture is to elevate the extremity and rest while the bone heals itself.
Ice the affected area for 24 to 48 hours and reduce activity.
For pain, painkillers may be recommended.
Depending on which bone is involved, your doctor may recommend a splint or cast to immobilise the affected area.
When the swelling has decreased to the point you can see skin creases, you can begin partially putting weight on the area. In some cases, crutches or a walking stick is necessary. Usually you can begin full weight bearing two weeks after the symptoms started. Weight bearing stimulates healing. For the next six to eight weeks, or until you're free of pain, avoid the activity that caused the stress fracture. If you exercise again too soon, you could delay the healing process. You could even cause damage that may never heal properly. When you are ready to return to the activity, do it slowly. If you rush back in, you could injure yourself again. Very severe stress fractures that won't heal on their own may require surgery. Full recovery may take months or years.

18. Lateral Epicondylitis
Introduction
Lateral epicondylitis, commonly known as tennis elbow, is a painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow. Tendons anchor the muscle to bone. The muscle involved in this condition, the extensor carpi radialis brevis, helps to extend and stabilize the wrist (see Figure 1). With lateral epicondylitis, there is degeneration of the tendon’s attachment, weakening the anchor site and placing greater stress on the area. This can then lead to pain associated with activities in which this muscle is active, such as lifting, gripping, and/or grasping. Sports such as tennis are commonly associated with this, but the problem can occur with many different types of activities, athletic and otherwise

19. Lateral Epicondylitis
Pathology
Also commonly known as ‘tennis elbow’, it is a lesion to the common origin of the extensor muscles of the
forearm (extensor carpi radialis brevis) around the lateral epicondyle of the humerus,
Repeated activity, especially eccentric lengthening of the extensors causes micro trauma to the tendon and scar tissue is formed leading to inflammation in the area.

20. Lateral Epicondylitis
Signs & Symptoms
Pain on the lateral epicondyle when touch touched,
Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting,
With activity, the pain usually starts at the elbow and may travel down the forearm to the hand,
Occasionally, any motion of the elbow can be painful. 

21. Lateral Epicondylitis
Probable Causative Factors
Weak extensor muscles,
Overuse – work-related or sport,
Trauma/extrinsic damage,
Too much too soon.

22. Lateral Epicondylitis
Assessment Findings
Pain on the lateral epicondyle when palpated,
Weak grip strength,
Pain on resisted extension or stretching of extensors,
Tight extensors.

23. Lateral Epicondylitis
Treatment
Physical Therapy - may be helpful, providing stretching and/or strengthening exercises,
Modalities such as ultrasound or heat treatments may be helpful,
Activity modification – Initially, the activity causing the condition should be limited,
Medication – anti-inflammatory medications may help alleviate the pain,
Brace – a tennis elbow brace, a band worn over the muscle of the forearm, just below the elbow, can reduce the tension on the tendon and allow it to heal.
Steroid injections – A steroid is a strong anti-inflammatory medication that can be injected into the area. No more than (3) injections should be given.
Shockwave treatment – A new type of treatment, available in the office setting, has shown some success in 50–60% of patients. This is a shock wave delivered to the affected area around the elbow, which can be used as a last resort prior to the consideration of surgery. Surgery is only considered when the pain is incapacitating and has not responded to conservative care, and symptoms have lasted more than six months.

24. Medial Epicondylitis Introduction
Medial epicondylitis (ME) is an overuse injury affecting the flexor-pronator muscle origin at the anterior medial epicondyle of the humerus. ME is often discussed in conjunction with lateral epicondylitis (LE), which occurs much more frequently. ME is the most common cause of medial elbow pain, although the doctor is likely to see at least 5 cases of LE for every case of ME.

25. Medial Epicondylitis Introduction
ME involves primarily the flexor-pronator muscles (ie, pronator teres, flexor carpi radialis, palmaris longus) at their origin on the anterior medial epicondyle. Less often, ME also affects the flexor carpi ulnaris and flexor digitorum superficialis. Repetitive stress at the musculotendinous junction and its origin at the epicondyle leads to tendinitis in its most acute form and to tendinosis in its more chronic form.[1] In addition, an ulnar neuropraxia caused by compression of the ulnar nerve in or around the medial epicondylar groove has been estimated to occur in up to 50% of ME cases.
The tendinosis that occurs is primarily the result of failure of the damaged tendon to heal.

26. Medial Epicondylitis Pathology
Also commonly known as ‘golfers elbow, medial epicondylitis is a lesion to the common origin of the
flexor muscles of the forearm around the medial epicondyle of the humerus.
Repeated activity, especially eccentric lengthening (hitting a golf ball/ throwing a ball) of the flexors causes microtrauma to the tendon and scar tissue is formed, leading to inflammation in the area.

27. Medial Epicondylitis Signs & Symptoms
Tenderness and pain at the medial epicondyle of the elbow.
Pain usually starts at the medial epicondyle and may spread down the forearm.
Bending your wrist, twisting your forearm down, or grasping objects can make the pain worse.
You may feel less strength when grasping items or squeezing your hand into a fist.

28. Medial Epicondylitis Probable Causative Factors Weak extensor muscles,
Overuse – work-related or sport,
Trauma/extrinsic damage,
Too much too soon.

29. Medial Epicondylitis Assessment Findings
Pain on the medial epicondyle,
Weak grip strength,
Pain on resisted flexion or stretching of flexors,
Tight flexors.

30. Medial Epicondylitis Treatment As with Lateral Epicondylitis,
Physical Therapy - may be helpful, providing stretching and/or strengthening exercises,
Modalities such as ultrasound or heat treatments may be helpful,
Activity modification – Initially, the activity causing the condition should be limited,
Medication – anti-inflammatory medications may help alleviate the pain,

31. Learning Outcomes
By the end of the lesson the candidate will be able to
Identify 4 general injury pathology, including signs & symptoms
Describe the common probable causative factors
Explain the assessment findings of the conditions
Explain the treatment needs