Download Recognizing Different Sports Injuries

Recognizing Different Sports
Injuries
Mechanisms and Characteristics
of Sports Trauma
Sports Trauma: A physical injury or wound sustained in sports caused by an
internal or external force.
Mechanical injury results from a force causing a harmful disturbance in
function and/or structure of a body part.
This is not the same as a repetitive strain or overuse condition.
Load = a singular or group of internal or external forces acting on the body.
Mechanical stress is a resistance to this load - results in tissue deformation
A yield point is reached when tissue is deformed to the maximum of its
elastic properties.
Mechanical failure occurs when the yield point is exceeded = tissue damage.
Mechanisms and Characteristics
of Sports Trauma
Mechanisms of sports injuries
• Tension
force that pulls or stretches tissue
• Stretching
force beyond yield point = sprain, strain, avulsion fracture
• Compression
crushing force - the force can no longer be absorbed
• Shearing
force that moves across the parallel organization of tissue
eg. blisters, abrasions, vertebral disk injuries
• Bending
force on a horizontal beam of bone that places stress
within the structure causing it to bend. This occurs with
other forces to create several types of fractures and
torsion injuries.
Soft tissue Classification
Contractile
• Muscle
• Tendon, or bony insertion
Soft tissue Classification
Non-contractile
• Skin
• Joint capsule
• Ligament
• Fascia
• Cartilage
• Nerve
• Dura
Skin Injuries
Blister - collection of fluid in or below epidermal
layer caused by continuous rubbing.
Abrasion - epidermis and dermis are worn away due to
scrape on rough surface
Skin bruise - blow compresses or crushes skin surface
causing bleeding under the skin
Laceration - flesh is irregularly torn
Skin Avulsion - tissue is ripped from its source
Incision - skin has been sharply cut
Puncture - penetration of skin by sharp object
Acute Traumatic Injuries
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Bone Trauma
• Closed fracture
• Open fracture
• TYPES
• Contrecoup
• Depressed
• Greenstick
• Comminuted
• Longitudinal
• Oblique
• Serrated
• Spiral
• Transverse
• Impacted
Other Acute Injuries
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Stress Fracture/ Avulsion Fracture
Dislocations and Subluxation
Ligament Sprain
Contusion
Muscle Cramps
Contusion
Crushing of soft tissue causing a bruise of the skin,
muscle, deep or superficial tissues, or bone, resulting
from a direct blow.
Treatment of contusions
•PIER
•Restricted movement
•Treat as strain after acute phase
Contusion
First Degree
Second Degree
Third Degree
Mild blow causing tissue
compression
Moderate blow causing
haematoma
Sever blow
Little bleeding and
minimal damage
Significant bleeding
May look like a fracturesevere bleeding
Little loss of f unction
20% - 80% loss ROM
Complete loss of function
May have slight spasm
Spasm may last hours
Extreme spasm present
Little/no swelling
Moderate swelling
Gross swelling
No Discolouration
Moderate Discolouration
Severe Discolouration
No palpable indentation
May have indentation and
palpable tenderness
Extreme palpable
tenderness and indentation
Increased skin temp.
Warm to touch
Significant pain
Extreme pain
Mild discomfort
Strains
Strains pertain to contractile tissue.
Caused by excessive forcible contraction or overstretch or
chronic overuse resulting in local tissue trauma to the muscle,
musculotendinous unit or the muscle tendon.
Strains
Predisposing factors
Prevention
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lack of or poor flexibility
lack of or poor warm up
muscle fatigue
poor muscle strength
poor skill level
antagonistic muscle imbalance
poor playing/workout
conditions or surfaces
existing minor inflammation
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lack of or poor flexibility
Equipment
Environment
increase flexibility
proper warm up and cool down
skill improvement
increase muscle endurance
increase muscle strength and
power
muscle balance
Strain
First Degree
Second Degree Third Degree
Classification
Mild micro tearing
Moderate strain
Severe with palpable rut
Swelling
Slight
Measurable
Visibly apparent –gross
Pain
Localized
Indefinable
sever
Strength
Slight loss
35% - 83% loss
Complete loss
Function
Partial to non
weight bearing
Abnormal gait to
non weight bearing
Non weight bearing
Range
Slight loss
Moderate loss
Complete loss
Discolouration
Little to none
Obvious
Obvious – severe
Healing
1 –2 weeks
3 – 12 weeks
3 months onward
Sprain
Sprains
First Degree
Second Degree
Third Degree
Classification
mild micro
tearing at cellular
level
moderate - partial severe- complete
tearing
rupture
Function
95% functional
with partial
weight bearing
for 1-3 minutes
and then able to
return to activity
loss of function partial weight
bearing to non
weight bearing
Non - weight
bearing due to
pain and swelling
Swelling
none at time of
injury with
minimal visible
swelling after
several hours or
the next day
moderate to
severe intra
capsular
swelling- usually
not immediately
visible
moderate to
severe swelling may be
immediate - will
be visible and
measurable
Sprains
First Degree
Second Degree
Third Degree
Discolouration
usually none
moderate localized
discolouration - not
immediate
initially some mild
discolouration and
then will turn very
dark (almost black)
around the injury site
Range of Motion
near full
20% to 80% loss
unable to move joint
due to pain - on
passive tests there is
no tension in the
joint - bone on bone
contact will usually
stop the range of
motion at the
extreme end of
range
Sprain
Sprains
First Degree
Joint instability none - no laxity
on stress tests
Second Degree
Third Degree
5 to 10 degrees
laxity on stress
test and will feel
unstable using
joint
complete laxity
of joint - gross
instability
Strength
minimal to no
weakness
20% to 80% loss
- may not do
resisted test
pain will cause
unwillingness to
resist or move
limb
Point
Tenderness
size of dime
size of quarter
defuse palpable
tenderness - all
over area
Sprain
Sprains
Pain
First Degree
Second Degree
minimal
discomfort at
time of injury and
minimal pain on
stress test - able
to continue
moderate local
pain at time of
injury and on
stress test unable to continue
Third Degree
may have no pain
due to nerve
involvement usually extreme
pain at time of
injury - pain in
large area near
injured structure
Chronic Overuse Injuries
 Tendinitis
 Muscle
Soreness
 Tenosynovitis
 Osteoarthritis
Tendonitis
Inflammation and degenerative changes in the tendon or
musculotendinous junction caused by; excessive overuse (too
much too soon), excessive friction over the tendon, direct or
repeated trauma to the area.
Signs and Symptoms of
Tendonitis
•
Local thickening of the tendon.
•
Point tenderness.
•
Possible crepitus.
•
Usually becomes self limiting.
Phases of Tendonitis
Phase 1
symptoms following activity, no performance
disability,
Phase 2
symptoms during and after activity, progresses
from no significant performance disability to
some performance disability to episodes of
significant performance disability,
Phase 3
symptoms during and after activity, persistent
performance disability,
Phase 4
symptoms all the time.
Preventing Tendonitis
•
Slow gradual warm - up prior to all activity (increases
blood flow to tendons).
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Slow gradual increase in level of activity.
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Increase the flexibility of the muscles.
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Proper equipment.
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Recognize early S&S of tendonitis.
Bursitis
•
Inflammation of the bursal sac leading to pain and
swelling which, if not allowed to resolve, will
progress to a chronic condition with secondary
thickening in the bursal walls and a tendency to
recur.
•
Caused by direct trauma, chronic irritation (over
use), infection, calcium deposits.
Signs and Symptoms of Bursitis
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onset may be slow or gradual,
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pain in region of bursa,
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pain may increase when bursa is squeezes, (abduction),
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varying disability,
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swelling,
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tenderness,
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crepitus,
•
limited range of motion,
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often increased pain in morning,
•
usually subsides in six weeks but may remain for several
years.
Inflammatory Response Phase
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Inflammatory Response Phase
• most critical stage
• phagocytosis
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Fibroblastic Repair Phase
• scar formation
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Maturation-Remodeling Phase
• new fibers
Acute Inflammatory Phase
The function of the inflammation response is to:
•
Localize the extent of the injured area
•
Remove waste products or foreign material resulting
from the initial trauma and secondary response
•
Set the stage for healing to take place
•
Protect site or joint
The reaction is always the same.
This phase is present for as long as the signs and symptoms are present
Do not get hung up on time factors - Acute inflammation is different
for everyone and every condition.
Acute Inflammatory Phase
Causes of inflammation:
•
Physical trauma
•
Chemical irritation
•
Bacterial invasion
•
Extremes of temperature
Characteristics of Inflammation
Swelling, Heat, Altered function, Redness, Pain
Swelling caused by the accumulation of blood and inflammatory exudate.
Heat caused by increased biochemical activity and the increase of blood
flow to the area.
Altered function caused by the resulting pain and swelling or the actual
destruction of an anatomical structure.
Redness caused by the dilation of vessels and increased blood flow to the
area.
Pain caused by the direct injury to the nerve fibres, pressure from swelling,
chemical irritants, as well as protective muscle spasm around the injury
site.
The Affects of the P.I.E.R.
principle on the Acute
Inflammatory Response.
P
Pressure
I
Ice
E
Elevation
R
Rest
P.I.E.R.
PRESSURE
1. Decrease the amount of space for swelling to occur,
2. Direct pressure on vessels decreases blood flow around
injury site ( thus decreasing blood swelling),
3. Decreases plasma fluid leakage.
4. Decreases lymph leakage.
ICE
1. Decreases metabolic rate, which decreases:
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The affects of the toxins in the area;
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The need for oxygen, therefore decreases secondary cell
death;
•
The conduction of the nerve cells in the area which helps
to decrease the pain and minimize the amount of muscle
spasm,
1. Decreases blood flow to the site
2. Decreases tissue elasticity in surrounding injury area.
3. Decreases hydrostatic pressure.
ELEVATION
1. Assists venous and lymphatic return.
2. Decreases blood flow to area.
RESTRICTED FUNCTION
1. Decreases chance of re-injury.
1. Decreases blood flow to area.