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 BruiseEcceymosis
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
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