Download Slide 1 - Athletic Medicine

Injuries
Signs and Symptoms






Pain
Swelling
Heat
Redness
Loss of function
Depends on severity of injury
Treatment








R.I.C.E. and possible NSAIDs
Range of Motion (Stretching!)
Strength and Endurance
Neuromuscular Control & Balance
Functional and Sports Specific Progressions
Maintain Cardio Fitness
All depend on severity.
Begin rehab as soon as possible.
What are the two categories of acute
muscle injuries?


Contusions
Strains
How does one receive a contusion?
Sudden traumatic blow to the body
a.
b.
c.
d.
What is typical in cases of severe
contusions?
the athlete reports being struck by a hard
blow
the blow causes pain and a transitory
paralysis caused by pressure on and shock
to the motor and sensory nerves
palpation often reveals a hard area,
indurated because of internal hemorrhage
ecchymosis, or tissue discoloration, may
take place
What is a strain?
A stretch, tear, or rip in the muscle or
adjacent tissue such as the fascia or
muscle tendon
How are strains most often produced?
Abnormal muscular contraction



What is the cause of abnormal muscular
contraction?
It is fault in the reciprocal coordination of the
agonist and antagonist muscles take place. The
cause of this fault or un-coordination is a
mystery. However, possible explanations are
that it may be related to:
a mineral imbalance caused by profuse sweating
to fatigue metabolites collected in the muscle
itself
to a strength imbalance between agonist and
antagonist muscles.
What is a grade 1 (or 1st degree or
1°) strain?
Slight over-stretching to mild tearing
(20%) of the muscle fibers. It is
accompanied by local pain, which is
increased by tension in the muscle,
and a minor loss of strength. There is
mild swelling, ecchymosis, and local
tenderness.
What is a grade 2 (or 2nd degree or
2°) strain?
Moderate tearing (20% - 70%) of the
muscle fibers. It is similar to a grade
1, but has moderate signs and
symptoms (moderate loss of strength,
moderate swelling, ecchymosis, and
local tenderness).
What is a grade 3 (or 3rd degree or
3°) strain?
Has signs and symptoms that are
severe (severe swelling, ecchymosis,
and local tenderness) with a loss of
muscle function and, commonly, a
palpable defect in the muscle.
What does a tendon attach?
Muscle to bone
What does a ligament attach?
Bone to bone
What is a cramp?
A painful involuntary contraction of a
skeletal muscle or muscle group.
Cramps have been attributed to
what?
A lack of water or other electrolytes in
relation to muscle fatigue.
What is a spasm?
A reflexive reaction caused by trauma
of the musculoskeletal system
List and define the two types of
spasms or cramps:
a.
clonic – alternating involuntary
muscular contraction and relaxation in
quick succession
b.
tonic – rigid muscle contraction that
lasts a period of time.
What are the four specific indicators of
possible overexertion?
a.
b.
c.
d.
acute muscle soreness
delayed muscle soreness
muscle stiffness
muscle cramping
a.
b.
List and define the two types of muscle
soreness:
Acute-onset muscle soreness – which
accompanies fatigue. This muscle pain is
transient and occurs during and immediately
after exercise.
Delayed-onset muscle soreness (DOMS) –
becomes most intense after 24 to 48 hours
and then gradually subsides so that the
muscle becomes symptom-free after 3 or 4
days. (This second type of pain is described
as a syndrome of delayed muscle pain
leading to increased muscle tension, swelling,
stiffness, and resistance to stretch).
What are the possible causes for
delayed-onset muscle soreness?


It may occur from very small tears in
the muscle tissue, which seems to be
more likely with eccentric or isometric
contractions.
It may also occur because of disruption
of the connective tissue that hold
muscle tendon fibers together.
What is muscle stiffness?
Muscle stiffness does not produce pain.
It occurs when a group of muscles have
been worked for a long period of time.
The fluids that collect in the muscles
during and after exercise are absorbed
into the bloodstream at a slow rate. As
a result, the muscle becomes swollen,
shorter, and thicker and therefore
resists stretch.
What can be done to assist in reducing
muscle stiffness?



Light exercise
Massage
Passive mobilization
What is muscle guarding?
Following injury, the muscle that
surrounds the injured area contract, in
effect, splint that area, thus minimizing
pain by limiting movement. (Quite often
this splinting is incorrectly referred to
as a muscle spasm)





The suffix “itis” means inflammation:
Myositis/Fasciitis - inflammation of the
muscle tissue
Tendinitis – inflammation of a tendon
Tenosynovitis - Inflammation of the
synovial sheath surrounding a tendon
Bursitis – inflammation of the bursa
Periostitis – inflammation of the bone
covering
What are the major acute injuries that
happen to synovial joints?



Sprains
Subluxations
Dislocations
What is a sprain?
Stretching or total tearing of the
stabilizing connective tissues
(ligaments)
What is a grade 1 (or 1st degree or 1°)
sprain?
Slight over-stretching to mild tearing
(20%) of the ligament. It is
characterized by some pain, minimum
loss of function, mild point tenderness,
little or no swelling, and no abnormal
motion when tested.
What is a grade 2 (or 2nd degree or 2°)
sprain?
Moderate tearing (20% - 70%) of the
ligament. There is pain, moderate loss
of function, swelling, and in some cases
slight to moderate instability.
What is a grade 3 (or 3rd degree or 3°)
sprain?
It is extremely painful, with major loss
of function, severe instability,
tenderness, and swelling.
What is a subluxation?
Partial dislocations in which an
incomplete separation between two
articulating bones occurs.
What is a dislocation (luxation)?
Total disunion of bone apposition
between articulating surfaces
What are several factors that are
important in recognizing and evaluating
dislocations?




Loss of limb function
Deformity
Swelling
Point tenderness
What is an acute bone fracture?
A partial or complete interruption in a
bone’s continuity
What is a stress fracture?
Rhythmic muscle action performed over
a period of time at a sub-threshold level
causes the stress-bearing capacity of a
bone to be exceeded
What are the typical causes of stress
fractures in sports?




Coming back into competition too soon
after an injury or illness
Going from one event to another
without proper training in the second
event
Starting initial training too quickly
Changing habits or the environment
Strains
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Groin Strain (Hip)
Running, Jumping, Twisting (ER)
Typical
Typical, May need crutches,
compression wrap during activity
Quadriceps Strain (Thigh)
Sudden stretch from knee flexion
Typical
Typical, May need crutches,
compression wrap during activity
Hamstring Strain (Thigh)
Sudden stretch from knee extension
Typical
Typical, May need crutches,
compression wrap during activity
Gastrocnemius Strain (Leg)
Quick starts & stops, jumping,
sudden knee extension.
Typical
Typical, heel wedge, compression
wrap during activity
Achilles Tendon Strain (Ankle)
Usually after ankle sprains or sudden
excessive ankle dorsiflexion.
Typical
Typical, heel lift, compression wrap
during activity
Achilles Tendon Rupture (Ankle)
Sudden pushing-off action of the
forefoot with the knee being forced
into complete extension.
Typical, hears a pop, indentation at
site, positive Thompson’s Test
RICE, X-ray to rule out fracture,
possible surgical repair,
immobilization for 4 to 6 weeks,
begin rehab. Heel lifts in both shoes
Longitudinal Arch Strain
Repetitive contact with a hard
playing surface. It may appear
suddenly or slowly over time.
Typical
Typical, Reduce weight bearing
activity, possible arch support taping
Metatarsal Arch Strain
Excessive pronation and weak
intertarsal ligaments will allow the
foot to abnormally spread resulting
in a fallen arch
Typical
Typical, orthotic or pad to elevate
the fallen arch.
Patellar Tendon Rupture
Sudden powerful contraction of the
quadriceps
Typical, Defect can be palpated,
athlete cannot extend the knee,
swelling, initial significant pain
followed by a feeling that the injury
is not serious
Typical, surgery
Strains
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Elbow strain
Excessive resistive motion, repeated
microtears
Typical
Typical
Lumbar strain
Sudden extension on an overloaded,
unprepared, or underdeveloped
spine, usually in combination with
trunk rotation; chronic strain,
commonly associated with faulty
posture that involves excessive
lumbar lordosis.
Typical
Typical
Neck and Upper Back strain
Turn the head suddenly or forced
flexion, extension, or rotation
Typical, muscle guarding and
reluctance to move the neck in any
direction
Typical, possible soft cervical collar
Cervical sprain (Whiplash)
Turn the head suddenly or forced
flexion, extension, or rotation, but
much more violently than the
cervical strain
Typical, muscle guarding and
reluctance to move the neck in any
direction; this pain may persist much
longer than that of the cervical
strain.
Typical, X-rays to rule out fracture.
and possible soft cervical
Sprains
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Hip Sprain
Sudden stretch from knee flexion
Typical
Typical, May need crutches
MCL Sprain (Knee)
Direct blow (valgus force), severe
outward twist
Typical, positive valgus stress test
Typical, May need crutches
LCL Sprain (Knee)
Direct blow (varus force)
Typical, positive varus stress test
Typical, May need crutches
ACL Sprain (Knee)
Direct blow, rotation, hyperextension
Typical, positive anterior drawer test,
positive Lachman’s test
Typical, crutches, immobilization,
physician referral, possible surgery
PCL Sprain (Knee)
Direct blow, knee flexion, landing on
a flexed knee
Typical, positive posterior drawer
test
Typical, crutches, immobilization,
physician referral, possible surgery
Inversion (Lateral) Ankle Sprain
Foot inversion, plantar flexion,
adduction
Typical, positive anterior drawer test,
positive Talar tilt test
Typical, possible crutches, possible
immobilization, possible physician
referral, possible surgery
Eversion (Medial) Ankle Sprain
Foot pronation, hypermobility,
depressed medial longitudinal arch
Typical, positive anterior drawer test,
positive Talar tilt test
Typical, possible crutches, possible
immobilization, possible physician
referral, possible surgery
Syndesmotic (High) Ankle Sprain
External rotation, forced dorsiflexion
Typical
Typical, may take months to heal
Sprained Toes or Turf Toe
Force against an unyielding object
Typical, Valgus & Varus Stress Tests,
Anterior & Posterior Drawer Tests
Typical, tape
Acromioclavicular (AC) Sprain
Direct Impact
Typical
Typical, immobilization, possible
physician referral
Sprains
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Elbow sprain
Hyperextension or valgus forces
Typical
Typical
Wrist sprain
Fall on hyperextended wrist; any
abnormal, forced movement of the
wrist
Typical
Typical
Finger sprain
Fall on hyperextended wrist; any
abnormal, forced movement of the
wrist
Typical
Typical
Finger fractures
Direct trauma or violent twisting
Typical
Typical
Lumbar sprain
Forward bending and twists while
lifting or moving some object
Typical
Typical
Sacroiliac sprain
Twisting with both feet on the
ground, stumble forward, fall
backward, step too far down and
lands heavily on one leg, or bends
forward with the knees locked while
lifting
Typical, associated muscle guarding.
Possible asymmetry with the ASIS
and/or PSIS, difficulty with forward
bending, straight leg raising
increases pain after 45º, as well as
side bending toward the painful side.
Typical, Bracing may be helpful. Joint
should be mobilized to correct
existing asymmetry
Bursitis
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Trochanteric Bursitis
Repetitive
Typical, pain may radiate to the knee
causing a limp
Typical, May need crutches, NSAIDs
and analgesics.
Patellar Bursitis
Continual kneeling, overuse
Typical, ballotable
Typical, eliminate the cause, NSAIDs
Shoulder bursitis
Overuse
Typical, positive impingement test
Typical
Olecranon Bursitis
Direct force, overuse
Typical
Typical
Dislocations and Subluxations
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Shoulder dislocation/subluxation
Forced abduction, external rotation,
direct blow
Typical, possible deformity, unable to
touch opposing shoulder (Apley’s
scratch test
Typical, Immediate immobilization,
RICE, pillow under the arm for
comfort, physician referral, x-rays to
rule out a fracture
Elbow dislocation
Fall on the outstretched hand with
the elbow in a position
hyperextension; or a severe twist
while it is in a flexed position.
Typical, Rupturing or tearing most of
the stabilizing ligaments, profuse
hemorrhage and swelling. Severe
pain and disability, possible radial
head fracture.
Typical, sling, physician referral
Lunate Dislocation
Forced hyperextension
Typical, difficulty in executing wrist
and finger flexion. There may be
numbness or even paralysis of the
flexor muscles because of lunate
pressure on the median nerve
Typical, possible physician referral
Finger dislocations/subluxations
Direct trauma or violent twisting
Typical
Typical
Lumbar Vertebrae Dislocation
Compression fracture may occur as a
result of hyperflexion of the trunk;
falling from a height and landing on
the feet or buttocks; direct impact
from a sudden blow
Typical
Typical, X-ray, physician referral, put
athlete on a spine board
Cervical dislocation
Violent flexion and rotation of the
head
Point tenderness, restricted
movement, cervical spasm, cervical
pain and pain in the chest and
extremities, numbness in the trunk
and/or limbs, weakness or paralysis
in the trunk and/or limbs, loss of
bladder and/or bowel control
C-spine, Physician referral
Contusions
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Hip Contusion (Hip Pointer)
Direct blow
Typical, spasms, transistory
paralysis, unable to rotate the trunk
or to flex the thigh without pain
Typical, physician referral to r/o
fracture, 1 to 2 days bed rest, ice
massage, ultrasound, NSAIDs
Quadriceps Contusion
Direct blow
Typical, transitory loss of function
Typical, RICE with the knee in
flexion, NSAIDs
Joint Contusion
Direct blow
Typical
Typical, possible physician referral,
return to activity with protective
padding when initial pain and
irritation subsides.
Shin contusion
Blow to the anterior aspect of the
lower leg.
Typical, rapid hematoma formation,
can be associated with compartment
syndrome or fracture.
Typical, NSAIDs and analgesics,
maintaining compression is critical
(may have to aspirate hematome),
ROM exercises and PRE within pain
limits, doughnut padding and
orthoplast shell for protection.
Calcaneal Contusion
Occurs by impact from running or
jumping
Typical
Typical, moderate activity with the
protection of a heel cup or doughnut
may resume if pain when walking
has subsided by the 3rd day, shock
absorbent footwear shoe be worn.
Finger contusions
Direct trauma
Typical
Typical
Rib contusion
Direct blow
Typical, Sharp pain during breathing,
point tenderness, pain when the rib
cage is compressed
Typical, possible bed rest and
cessation of sports activities
Fractures
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Femoral Stress Fractures
Repetitive
Typical, Groin pain along with an
aching sensation in the thigh that
increases with activity and decreases
with rest. Standing on one leg may
be impossible
Typical, Rest, for 2 to 5 months, xrays and possible bone scan,
swimming
Acute Femoral Fracture
Direct Trauma
Typical, pain over the fracture site,
deformity
Ice, Treat for shock, verify
neurovascular status, splint,
physician referral
Patellar Fracture
Direct or indirect trauma
Typical, Hemorrhage and joint
effusion
Typical, physician referral
Acute Leg Fracture
Direct traumatic blow
Typical, Soft tissue insult and
hemorrhaging, intense pain and
disability, leg appears hard and
swollen.
Splint and ice, refer to a physician
Tibia or Fibular Stress Fracture
Repetitive or Overuse
Typical, positive percussion or
compression test, positive x-ray or
bone scan
Typical, NSAIDs, no activity for at
least 14 days, possible cast and/or
crutches, weight bearing when pain
subsides, correct biomechanics,
running may resume when the
athlete is completely pain free.
Ankle Fracture (misnomer)
Forced abduction or planting in
combination with forced internal
rotation, trauma.
Typical, possible deformity
Typical, x-ray examination, a walking
cast or brace may be applied once
swelling is reduced, for 6 to 8 weeks,
PNF exercises, isometrics (during
immobilization), PRE, and balance
activites up to 4 weeks.
Fractures (cont.)
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Talus Fracture
Occurs either laterally from a severe
inversion and dorsiflexion force or
medially from an inversion and
plantar flexion force with external
rotation of the tibia on the talus.
Typical, History of repeated trauma
to the ankle, feels pain on weight
bearing, complaint of snapping or
catching, intermittent swelling,
anteromedial or anterolateral joint
line of the talar dome is tender when
palpated.
Typical, X-ray is essential for an
accurate diagnosis, non-surgical
management for a non-displaced
sub-chondral compression fracture,
protective immobilization, non-weight
bearing progression to full weight
bearing depending on symptoms, if
conservative treatment fails surgery
may be required, expect to resume
activity 6 to 8 months after surgery.
Calcaneal Fracture
Occurs most often after a jump or
fall from a height. An avulsion
fracture can also occur with this
injury
Typical, inability to bear weight
Typical, X-ray is essential for an
accurate diagnosis, non-surgical
management for a non-displaced
fracture, protective immobilization,
non-weight bearing progression to
full weight bearing depending on
symptoms,
Calcaneal Stress Fracture
Occurs from repetitive impact during
heel strike and characterized by a
sudden onset of constant pain in the
plantar-calcaneal area.
Typical, Feels pain on weight
bearing, pain tends to continue after
exercise stops, bone scan may be
required.
Typical, Conservative management
for the first 2 to 3 weeks, rest, active
ROM exercises of the foot and ankle,
non-weight bearing cardiovascular
exercises, may resume activities
within pain limits when pain
subsides, must wear a cushioned
shoe.
Jone’s Fracture
Inversion and plantar flexion of the
foot, direct forces, or repetitive
stress.
Typical, Immediate swelling and pain
over the 5th metatarsal, high nonunion rate, coarse of healing is
unpredictable.
Typical, Crutches with no
immobilization, gradually progress to
full weight bearing as pain subsides,
return to activity is possible in 6
weeks, non-union may cause refracture to occur.
Fractures (cont.)
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Metatarsal Stress Fracture (March
Fracture)
Most commonly involves the shaft of
the 2nd metatarsal (March fracture).
Occurs in the runner suddenly
changing training patterns, such as
increasing mileage, running hills, or
running on a harder surface. An
atypical condition such as a
structural forefoot varus, hallux
valgus, or a short 1st metatarsal will
predispose to a 2nd metatarsal
stress fracture. A stress fracture of
the 5th metatarsal at the insertion of
the peroneous brevis tendon can
occur, but should not be confused
with a Jones fracture.
Typical
Typical, Bone scan is the best way to
detect this injury, 3 or 4 days of
partial weight bearing after two
weeks of rest, return to running
should be gradual, orthotics can help
to reduce stress
Phalanges
Occurs by either kicking an object,
stubbing a toe, or being stepped on.
Dislocations are less common than
fractures.
Typical, deformity. Stiffness and
residual pain may last for several
days
Typical, buddy tape, possible
physician referral
Clavicular Fracture
Fall on the outstretched, a fall on the
tip of the shoulder, or direct impact.
Typical, Clavicle appears slightly
lower than the opposite side.
possible deformity
Typical, Sling and swathe, treat for
shock, X-ray, immobilization for 6 to
8 weeks. After immobilization, begin
gentle isometrics and mobilization
exercises. May require surgery.
Scapular Fracture
Direct impact or force transmitted
through the humerus to the scapula.
Typical, Pain during shoulder
movement
Typical, Sling, x-ray, begin overhead
strengthen in 1 week.
Fracture of the Humerus
Direct blow or fall on the
outstretched arm
Typical, inability to move arm
Typical, Sling and swathe, treat for
shock, physician referral,
immobilization for 6 to 8 weeks
Fractures (cont.)
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Forearm fracture
Direct trauma or fall on the
outstretched arm
Typical, Audible pop or crack
Typical, sling, physician referral
Colle’s Fracture
Fall on an outstretched armforcing
the radius and ulna into
hyperextension, or falling on the
backward hand
Typical, Possible silver fork
deformity, and possible median
nerve damage
Typical, sling, physician referral
Scaphoid (Navicular) Fracture
Force on the outstretched arm
Typical
Typical, splint, physician referral
Hamate fracture
Fall or from contact from a sports
implement
Typical
Typical, splint, physician referral
Lumbar Vertebrae Fracture
Compression fracture may occur as a
result of hyperflexion of the trunk;
falling from a height and landing on
the feet or buttocks; direct impact
from a sudden blow
Typical
Typical, X-ray, physician referral, put
athlete on a spine board
Cervical fracture
Axial loading; sudden forced
hyperextension
Point tenderness, restricted
movement, cervical spasm, cervical
pain and pain in the chest and
extremities, numbness in the trunk
and/or limbs, weakness or paralysis
in the trunk and/or limbs, loss of
bladder and/or bowel control
C-spine, Physician referral
Rib Fracture
Direct or indirect trauma, violent
muscular contractions
Typical, Sharp pain during
inspiration, possible crepitus during
palpation
Typical, physician referral, rest and
immobilization
Tendinitis
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Osgood-Schlatter
repetitive stress at the tibial
tuberosity
Typical, hemorrhage, gradual
degeneration, severe pain when
kneeling, running, or jumping, point
tenderness
Typical, reduce irritating activities,
cast may be required, isometric
strengthening for quads and
hamstrings
Larsen Johansson
repetitive stress at the inferior
patellar pole
Typical, hemorrhage, gradual
degeneration, severe pain when
kneeling, running, or jumping, point
tenderness
Typical, reduce irritating activities,
cast may be required, isometric
strengthening for quads and
hamstrings
Patellar Tendinitis
(Jumper’s or Kicker’s Knee)
Repetitive running, jumping, and
kicking
Typical, Pain and tenderness at the
posterior, inferior patellar pole
Typical, thermal agents, ultrasound,
brace (counter-force) massage
Runner’s (Cyclist’s) Knee
Repetitive, overuse
Typical, Malalignment and structural
asymmetries of the foot and lower
leg. Contributes to iliotibial band
friction syndrome and pes anserinus
tendonitis or bursitis
Typical, Correction of foot and leg
alignment problems, RICE, proper
warm-up and stretching, avoidance
of aggravating activities, NSAIDs.
Achilles Tendinitis
Excessive tensile stresses placed on
it during repetitive movements and
presents with a gradual onset.
Typical, uphill running and hill
workouts aggravate the condition,
weak gastrocnemius-soleus complex,
morning stiffness, discomfort walking
after prolonged sitting, tendon is
warm and painful upon palpation,
palpable crepitus with active plantar
and dorsiflexion, pain on passive
stretching, chronic inflammation.
Typical, may be resistant to quick
resolution, address structural faults
(i.e. footwear, orthotics, etc.)
ultrasound to increase blood flow,
friction massage may be helpful,
strengthening of the gastrocnemiussoleus unit. May be resistant to quick
resolution, address structural faults
(i.e. footwear, orthotics, etc.) RICE,
ultrasound to increase blood flow,
friction massage may be helpful,
strengthening of the gastrocnemiussoleus unit.
Tendinitis (cont.)
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Anterior Tibialis Tendinitis
Common when running downhill for
extended periods of time.
Typical
Typical, avoid hills
Posterior Tibialis Tendinitis
Overuse injury among runners with
hypermobility or pronated feet
Typical, Swelling of the medial
malleolus area, edema and point
tenderness behind the medial
malleolus area, pain can become
more intense during resistive
inversion and plantar flexion
Typical, non-weight bearing short-leg
cast with the foot in inversion may
be used, Low Dye taping or orthotic
can be used to correct pronation.
Peroneal Tendinitis
Problem in athletes with pes cavus
where the foot tends to excessive
supinate.
Typical, Pain of the lateral malleolus
area when rising on the ball of the
foot, tenderness behind the lateral
aspect of the calcaneous distally
beneath the cuboid.
Typical, tape with elastic tape,
appropriate warm-up and flexibility
exercises, Low Dye taping or orthotic
can be used to prevent excessive
supination.
Wrist tendinitis
Repetitive pulling movements
Typical
Typical
Chondramalacia
(Patellofemoral Arthralgia)






Etiology:
Abnormal patellar tracking
Signs & Symptoms:
Pain in the anterior aspect while running, walking,
ascending stairs, and squatting. Recurrent swelling,
grating sensation during flexion and extension,
patellar grind test produces crepitus.
Treatment:
Avoid irritating activities, pain-free isometric exercise
to strengthen the quads, anti-inflammatories,
orthotics to correct pronation and reduce tibial
torsion, possible surgery.
Patellofemoral Stress Syndrome (PFSS)
(Patellofemoral Arthralgia)






Etiology:
Hamstrings, gastrocnemius, IT band, or lateral
retinaculum tightness; increased Q angle, foot
pronation, patella alta, VMO insufficiencies
Signs & Symptoms:
Tenderness over the patellar lateral facet, swelling,
dull ache in the center of the knee, patellar
compression will elicit pain and crepitis, positive
apprehension test
Treatment:
Strengthen VMO; stretching for hamstrings,
gastrocnemius, and IT band; orthotics and/or taping to
correct alignment
Cramps and Spasms






Etiology:
Excessive loss of fluids through
sweating, inadequate muscle
coordination.
Signs & Symptoms:
Pain, tonic contraction.
Treatment:
Athlete should relax, gradual stretching,
ice or gentle ice massage.
Medial Tibial Stress Syndrome










Etiology:
Repetitive microtrauma, weak leg muscles, inadequate footwear,
inappropriate training, malalignment problems.
Signs & Symptoms:
Grade 1: pain after activity
Grade 2: pain before and after activity, but does not affect
performance
Grade 3: pain before, during, and after activity, affects
performance
Grade 4: constant pain that makes performance impossible
Pain is along the lower medial anterior tibialis.
Treatment:
Physicians referral to rule out other problems, RICE, NSAIDs and
analgesics, ice massage, modify activity, correct biomechanics,
orthotics and/or arch taping.
Lateral Epicondylitis
(Tennis Elbow)






Etiology:
Repetitive microtrauma, hyperextension activities
Signs & Symptoms:
Aching pain over the region during and after
exercise, pain worsens with continued activity,
weakness in the hand and wrist
Treatment:
RICE, NSAIDs and analgesics, immobilization,
strengthening and stretching exercises, correct
biomechanics, counterforce brace
Medial Epicondylitis
(Pitcher’s Elbow, Racquetball Elbow,
Golfer’s Elbow, Javelin-Thrower’s Elbow)
Etiology:
 Repeated forceful extension of the wrist and valgus torques
of the elbow.
 Signs & Symptoms:
 Pain, possible radiating pain, point tenderness, mild
swelling, AROM produces pain.
 Treatment:
 RICE, NSAIDs and analgesics, immobilization (sling),
strengthening and stretching exercises, correct
biomechanics, counterforce brace. For severe cases, splint
and complete rest for seven to 10 days.

Carpal Tunnel Syndrome






Etiology:
Repetitive wrist flexion, direct trauma
Signs & Symptoms:
Sensory or motor deficits; tingling, numbness, and
paresthesia over the thumb, index and middle
fingers, and palm of the hand; muscular weakness
Treatment:
RICE, immobilization, and NSAIDs. Surgical
decompression may be necessary
de Quervain’s Disease
(Hoffman’s Disease)






Etiology:
Constant wrist movement
Signs & Symptoms:
Aching pain which may radiate into the hand
or forearm, positive Finklestein’s test; point
tenderness and weakness during thumb
extension and abduction; there may be a
painful snapping and catching of the tendons
Treatment:
Immobilization, rest cryotherapy, NSAIDs,
ultrasound, ice massage
Wrist Ganglion






Etiology:
Appears slowly after a wrist sprain
Signs & Symptoms:
Occasional pain with a lump at the site. Pain
increases with use
Treatment:
RICE, pressure with a felt pad, ultrasound, possible
surgical removal
Sciatica






Etiology:
Torsion or direct blow to the back causing inflammation
or compression of the sciatic nerve
Signs & Symptoms:
Pain may be abrupt or gradual, produces a sharp
shooting pain that follows the nerve pathway along the
posterior and medial thigh; there may be tingling and
numbness along its path; nerve may be extremely
sensitive to palpation; straight leg raises intensifies pain.
Treatment:
Rest is essential. Stretching of a tight piriformis muscle
may decrease symptoms; NSAIDs and RICE, surgery may
be necessary.
Brachial Plexus Neurapraxia
(Burner or Stinger)






Etiology:
Stretching or compression of the brachial plexus
Signs & Symptoms:
Burning sensation, numbness, tingling, and pain
extending from the shoulder down to the hand with some
loss of function of the arm and hand that lasts for several
minutes.
Treatment:
RICE; strengthening exercises; Athlete may return to full
activity once symptoms have completed resolve and there
are no associated neurological symptoms.