Download Sports Injuries - Presence Health

Sports Injuries:
“Head, shoulders, knees
and toes. . .”
Presence Regional EMS System
August 2015
Objectives
Discuss the structure and function of the
musculoskeletal system
Compare the orthopedic physiology for
growing children, mature adults, and
geriatric patients.
Name 4 mechanisms of injury related to
sports injuries
Discuss the assessment and management
of patients with sports injuries including
pain management.
Objectives
Outline the basic principles of splinting
Using a variety of scenarios describe the
assessment and management of sports
injuries.
Functions of the
Musculoskeletal System
Provides the body shape
Provides the internal structures with
protection
Provides for movement
Muscles
Three types:
– Skeletal
Gives body
shape and
movement
– Smooth
Lines
internal
organs
– Cardiac
Heart
muscle
Skeleton
– Components
Skull
Spinal column
Thorax
Pelvis
Lower
extremities
Upper
extremities
Joints
Joints:
– Formed
wherever two
bones meet
Tendons:
– connect muscle
to bone.
Ligaments:
– connect bone to
bone.
Anatomy and Physiology
Children and Adolescents
– Not just small adults
– Bones, muscles, tendons, and ligaments
are still growing
Can create a serious growth plate
injury
Children and Adolescents
– Abdominal muscles are less developed
Increases chance of internal organ
injury with blunt trauma
– Liver and spleen more exposed until
puberty
Increases chance of internal organ
injury with blunt trauma
Anatomy and Physiology
Adults
– Muscle and bones fully developed
– Warm up and cool down phase
important
– Female athletes have a higher number
of injuries
May be related to training methods
– Highest number of injuries associated
with recreational sports (racquet sports,
golf, bowling, and hiking)
Anatomy and Physiology
Elderly
– Osteoporosis makes bones more
susceptible to fractures and slows the
healing process
– Vertebrae of the spine narrow, causing
curvature in the spine (seen in 2 out of
3 patients)
– Joints loose mobility
falls
– Loss of muscle mass
falls
Elderly Athletes
– Loss of balance
falls
– Thinning of skin
More prone to injury and slower
healing
– Less perspiration is produced
More prone to heat related injury
Mechanisms of Injury
Force may be applied in several
ways:
– Direct Force
– Indirect force
– Twisting force
– High-energy injury
High School Sports
Injuries
Types of Injuries
Muscle sprains and strains
Knee injuries
Compartment syndrome
Achilles tendon injuries
Fractures
Dislocations
Head and neck injuries
Types of Injuries
Strain
– Twisting, pulling or tearing of a muscle or
tendon (connects muscle to bone)
– Noncontact injury resulting from
overstretching or over contracting
– Range from mild to severe
– Signs and symptoms include:
Pain
Muscle spasm
Loss of strength
swelling
Types of Injuries
Sprain
– Stretching or tearing of a ligament
– Caused by trauma (i.e. fall or direct hit to a
joint)
– Range from first degree (minimal stretching)
to third degree (a complete tear).
– Most common joints effected include ankles,
knees, and wrists.
– Signs and symptoms include:
Pain/tenderness
Bruising
Swelling
Inability to move joint
Joint looseness or instability
Types of Injuries
Knee injuries
– Most commonly injured joint
– Result from a direct blow or twisting, improper
landing after a jump, or running too hard, too
much, or without proper warmup.
– Signs and symptoms:
Pain
Swelling
Bruising
Inability to move joint/extremity
Inability to bear weight
Lateral View of the Knee
Types of Injuries
Compartment Syndrome
– Muscles are enclosed in fascia, a tough
membrane.
– Muscles become injured, swelling can occur
inside the fascia, not allowing for expansion.
– Nerves, blood vessels and muscle can become
compressed, causing damage.
– Signs and symptoms:
Severe pain or burning sensation
Decreased strength in the extremity
Paralysis of the extremity
Pain with movement
Extremity feeling hard to palpation
Compartment Syndrome
Early symptoms
– Pain
– Paresthesia
Late symptoms
– Pain
– Pallor
– Pulselessness
– Paresthesia
– Paralysis
Types of Injuries
Achilles tendon injury
– Tendon connecting the calf muscle to the heel
– Tearing or stretching the tendon
– Most common in middle-aged “weekend
warriors” (do not exercise routinely, and do
not warmup)
– Most occur during acceleration
– Signs and symptoms:
Severe sudden pain
Inability to move foot
Inability to bare weight
Types of Injuries
Fractures
– Acute Fractures
Open vs. closed
Signs and symptoms:
– Pain
– Swelling
– Bruising
– Numbness or tingling
Types of Injuries :
Fractures
Closed fracture
– A fracture that
does not break
the skin
Open fracture
– External wound
associated with
fracture
Nondisplaced
fracture
– Simple crack of
the bone
Displaced fracture
– Fracture in which
there is actual
deformity.
Critical Fractures
Fractures usually not fatal.
Management of ABCs, C-spine is
priority.
HOWEVER: Two potentially deadly
fractures:
– Femur
– Pelvis
– Potentially life-threatening blood loss.
– Look for S+S of SHOCK.
Greenstick Fracture
Incomplete fracture: often occurs in children
Comminuted Fracture
Shattering/fragmentation
Pathologic Fracture
Weakened or diseased bone: little force needed
Ex: Osteoporosis, bone cancer
Epiphyseal
Fracture
•Fracture of growth plate
•Can affect
growth/development
← Closed Fracture
Open Fracture
→
Stress Fractures
Most common in the feet and legs
Most common in sports that have
repetitive impact (i.e. gymnastics and
track and field)
Signs and symptoms:
–Pain that increases with weightbearing
–Tenderness
–Swelling
Signs and Symptoms of
a Fracture
Deformity
Tenderness
Guarding
Swelling
Bruising
Signs and Symptoms of
a Fracture
Crepitus
False motion
Exposed
fragments
Pain
Locked joint
Open Bone and Joint
Injury
Types of Injuries
Dislocation
– A disruption in the joint, or separation of a
joint
– Caused by contact sports, high impact sports,
and sports resulting in excessive stretching
– Most common dislocated joints are in the
hand, followed by the shoulder. Knees, hips,
and elbows are less common.
– Signs and symptoms:
Pain
Unable to use extremity involved
Numbness, tingling in effected extremity
Elbow Dislocation
Elbow Dislocation
Types of Injuries
Head injuries
– Concussion most common
– Brain injury is the leading cause of
sports-related death to children
Brain Injuries
Concussion
– No structural injury to brain
– Level of consciousness
Variable period of unconsciousness or
confusion
Followed by return to normal consciousness
– Retrograde short-term amnesia
May repeat questions over and over
– Associated symptoms
Dizziness, headache, nausea and/or ringing in
ears
Brain Injuries
Cerebral contusion
– Bruising of brain tissue
Swelling may be rapid and severe ** potentially
fatal
– Level of consciousness
Prolonged unconsciousness, profound confusion
or amnesia
– Associated symptoms
Focal neurological signs
May have personality changes
Neck injuries
– Most common sport involved is football.
Equipment Removal
Most protective equipment can be
removed without issues
– Baseball gloves
– Baseball helmets
– Baseball catching
equipment
– Skateboarding
pads/helmets
– Bicycle helmets
– Winter sports gear
Special Spinal Motion
Restriction (SMR) Situations
Protective gear
• Motorcycle helmet: removal if
Poorly fitted to patient
Significant neck flexion
Full face and open face
• Note:
Remove to evaluate and manage airway
Spinal Trauma - 45
Special SMR Situations
Protective gear
• Remove athletic helmet when:
Face mask cannot be removed
Airway cannot be controlled
Does not hold head securely
Helmet prevents stabilization
• Note:
Cut chin strap; do not unhook
Spinal Trauma - 46
Equipment Removal Pearls
Football helmet and shoulder pads
– Remove face mask
Cut the clips that secure the face
mask with pruning shears or PVC pipe
cutters or
The coaching staff may have special
tools to remove the face mask
Do not use a screwdriver. This
creates too much movement of the
head/neck.
Equipment Removal
Pearls
– Do not remove helmet completely
unless
Airway compromise
Full cardiac arrest
**If helmet needs removed, must
remove shoulder pads as well**
Immobilization with Football
Equipment
Maintain inline stabilization by holding the
sides of the helmet
Remove the face mask
Leave helmet, chin strap, and shoulder
pads in place if possible.
A six person lift is recommended to move
the patient to a spine board
Secure to board with straps
Pad sides of helmet with towel or blanket
rolls
Tape helmet to board
Special SMR Situations
Protective gear
• Shoulder pad: removal if
Helmet removed
Unable to maintain neutral alignment
Unable to secure to board
Access to chest needed
• Note:
Cut axillary straps and laces on front,
open from core outward, slide out from under
Spinal Trauma - 50
Assessing Sports Injuries
Follow BSI precautions
Scene Size-up:
– Assess mechanism of injury
Initial assessment:
–
–
–
–
–
General impression
C-Spine control if needed
AVPU
ABC’s
Priority
– Any problems – High Priority!
– Give O2 to keep oxygen saturation > 94%
Assessment
Physical exam
– Unstable patient (High Priority) -- Rapid
trauma assessment (DCAPP-BTLS)
– Stable patient -- exam focused on area of
complaint
Isolated Sports Injury
If focused exam for extremity injury
assess for:
– Pain
– Deformity
– Tenderness on palpation
– Crepitus
– Loss of function
– Open wounds
– Discoloration
– Exposed bone
– Abnormal rotation of extremity
Assessing Sports Injuries
If patient critically injured,
transport immediately
Be alert for compartment
syndrome
Splint injury
Transport
Check neurovascular status during
transport
Evaluating
Neurovascular Function
Examination of the injured limb
should include assessment of the
following:
– Pulse
– Capillary refill
– Sensation
– Motor function
Emergency Medical
Care
Completely cover open wounds.
Apply the appropriate splint.
If swelling is present, apply ice or cold
packs.
Prepare the patient for transport.
Always inform hospital personnel about
wounds that have been dressed and
splinted.
Pain Control for Athletic
Injuries
Advanced Providers only
Adults:
– MORPHINE SULFATE 5 mg slow IVP or
10 mg IM. May repeat IVP dose x 1
after 15 minutes if needed.
– FENTANYL
IV – 1 mcg/kg slow IVP; may repeat x 1
after 5 minutes if needed.
IM – 2 mcg/kg (maximum dose 100 mcg).
IN – 1 mcg/kg (1 ml per nostril via
atomizer*); maximum first dose 50 mcg;
May repeat x 1 after 5 minutes at 0.5
mcg/kg (maximum second dose 25 mcg) if
needed.
Pediatrics -- Consider MORPHINE
SULFATE or FENTANYL as needed for
pain control:
– MORPHINE SULFATE
0.1 mg/kg slow IVP (max. single dose 5 mg)
May repeat IVP dose x 1 after 15 minutes if
needed
0.2 mg/kg IM (max. dose 10 mg).
– FENTANYL
– IV – 1 mcg/kg slow IVP; may repeat x 1 after
5 minutes if needed.
– IM – 2 mcg/kg (maximum dose 100 mcg).
– IN – 1 mcg/kg (1 ml per nostril via atomizer*);
maximum first dose 50 mcg; May repeat x 1
after 5 minutes at 0.5 mcg/kg (maximum
second dose 25 mcg) if needed.
Splinting
Flexible or rigid device used to
protect extremity
Injuries should be splinted prior to
moving patient, unless the patient
is critical.
Splinting helps prevent further
injury.
Improvise splinting materials when
needed.
General Principles of
Splinting
Expose the injury: Remove
clothing from the area.
Note and record the patient’s
neurovascular status. (PMS)
Cover all wounds with a dry,
sterile dressing.
Do not move the patient
before splinting.
General Principles of
Splinting
Immobilize the joints above and below
the injured joint.
Pad all rigid splints.
Maintain manual immobilization.
Use constant, gentle, manual traction if
needed.
If you find resistance to limb alignment,
splint the limb in position found.
General Principles of
Splinting
Immobilize all suspected spinal
injuries in a neutral in-line
position.
If the patient has signs of shock,
align limb in normal anatomic
position and transport.
When in doubt, splint.
MANAGEMENT
LOAD & GO PATIENTS
Spinal immobilization
–Long backboard
–C-collar
–Head immobilizer
Limit splinting until en route
Backboard acts as “whole body”
splint
Hazards of Improper
Splinting
Compression of nerves, tissues, and
blood vessels
Delay in transport of a patient with
a life-threatening condition
Reduction of distal circulation
Aggravation of the injury
Injury to tissue, nerves, blood
vessels, or muscle
Assessment Pearl
Check distal pulse, movement and
sensation (PMS) prior to
moving/splinting the patient, AND
after. This includes spinal
immobilization.
Specific Musculoskeletal
Injuries
Clavicle Fracture
Clavicle and Scapula
Injuries
Clavicle is one of
the most fractured
bones in the body.
Scapula is wellprotected.
Joint between
clavicle and scapula
is the
acromioclavicular
(A/C) joint.
Splint with a sling
and swathe.
Shoulder Dislocation
Dislocation/Fx of the
Shoulder
Most
commonly
dislocated
large joint
Usually
dislocates
anteriorly
Is difficult to
immobilize
What Is Wrong With This
Splint??
What Is Wrong With This
Splint?
The patient’s
Hand and wrist are
Not supported.
Swath is too
narrow.
Fractures of the
Humerus
Occurs either proximally, in the
midshaft, or distally at the elbow.
Consider applying traction to realign a
severely angulated humerus,
according to local protocols.
Splint with sling and swathe,
supplemented with a padded board
splint.
ELBOW INJURY
Fracture or
dislocation may
cause
neurovascular
injury
Splint in position
found
Transport promptly
If long transport
time, contact
Medical Control
Extremity Trauma
Elbow: one attempt to reposition if no
pulse
Extremity Trauma - 78
Fractures of the Forearm
Usually involves
both radius and
ulna
Use a padded
board, air,
vacuum, or
pillow splint.
Hand in position
of function–
slightly curled
around bandage
Forearm Fracture
Injuries to the Wrist and
Hand
Follow BSI
precautions.
Cover all wounds.
Apply padded board
splint.
Secure entire length
of splint.
Apply a sling and
swathe.
Place hand in position
of function
Position of Function
Hand Injuries
Fractures of the Pelvis
May involve life-threatening
internal bleeding
Assess pelvis for tenderness.
Stable patients can be secured to
a long backboard or scoop
stretcher to immobilize isolated
fractures of the pelvis.
Consider ways to stabilize
fractured pelvis.
Splinting a Pelvis Fracture
Courtesy of Sam Splints
Extremity Trauma - 85
HIP FRACTURE
Common in the elderly
May be able to support weight
– Ability to walk does not rule out
fracture
Leg often externally rotated
May refer pain to the knee
Use other leg for splint
Use vacuum backboard if available
Hip Fracture
Splinting Hip Fracture
Extremity Trauma - 88
HIP DISLOCATION
Orthopedic
emergency
Posterior
dislocation most
common
Hip flexed, leg
shortened and
rotated internally
Severe pain on
attempts to
straighten
COURTESY ROY ALSON, M.D.
MANAGEMENT
HIP DISLOCATION
Splint in most comfortable position
Document distal PMS
Prompt transport
Be alert for associated knee
injuries
Femur Fractures
Muscle spasms can cause
deformity of the limb
Significant amount of blood loss
will occur.
Immobilize with traction splint.
Femur Fracture
Traction Splints
• Three kinds:
• Sager
• Hare
• Kendrick
• Use for the following:
• Femur Fracture
only
• Midshaft
• Closed injury
Do not use a traction
splint under the
following conditions:
– Upper extremity
injuries
– Injuries close to or
involving the knee
– Pelvis and hip injuries
– Partial amputation or
avulsions with bone
separation
– Lower leg or ankle
injuries
Traction Splints
Hare Traction
Splint
Sager Traction Splint
KNEE FRACTURE OR
DISLOCATION
Orthopedic
emergency
Frequently
causes vascular
injury
Dislocation
associated with
high incidence of
leg amputation
MANAGEMENT KNEE
DISLOCATION
Obvious dislocation without distal
pulse
– Apply gentle in-line traction – only once
If gentle traction does not restore
the pulse
– Splint in place
Prompt transport
Dislocation of the Patella
Usually dislocates to lateral side.
Produces significant deformity.
Splint in position found.
Support with pillows.
Extremity Trauma
Knee : may reposition once to get
pulse
Extremity Trauma - 98
Injuries to the Tibia and
Fibula
Usually, both bones fracture at
the same time.
Open fracture of tibia common.
Immobilize with a padded rigid
long leg splint or an air splint
that extends from the foot to
upper thigh.
Splinting the Lower Leg
Extremity Trauma - 10
0
Ankle Injuries
Most commonly injured joint
Dress all open wounds.
Assess distal neurovascular function.
Correct any gross deformity by
applying gentle longitudinal traction
to the heel.
Before releasing traction, apply a
splint.
Foot Injuries
Usually occur after a patient falls or
jumps.
Immobilize ankle joint and foot.
Leave toes exposed to assess
neurovascular function.
Elevate foot 6”.
Also consider possibility of spinal injury
from a fall.
Skills Practice
Put slips of paper with the following
injuries in a hat.
Have individuals pull out an injury
and practice placing appropriate
splints on each other for those
injuries.
Skills Practice Injuries
Clavicle
Upper arm
Lower arm
Pelvis
Femur
Lower leg
Foot
Shoulder
Elbow
Hand
Hip
Knee
Ankle
Review
Answer the following questions as a
group.
If doing this CE individually, please e-mail
your answers to:
[email protected]
Use “August 2015 CE” in subject box.
You will receive an e-mail confirmation.
Print this confirmation for your records,
and document the CE in your PREMSS CE
record book.
IDPH site code: 06-7100-E-1215
1. Give three assessments that are performed
during splinting.
2. A 17-year-old young man was pole vaulting.
He lost his balance and fell 17+ feet onto the
ground. His left leg is swollen and deformed at
the mid-shaft femur area. What is your initial
management of this injury?
3.
4.
5.
In addition to the injury in question 2, what
other concerning complication do you expect
with this patient?
A 15 year-old girl has sustained a painful,
swollen and deformed right shoulder while
playing basketball. She has a good right
radial pulse. How should this injury be
managed?
Should the arm/shoulder be realigned? Why
or why not?
6. Name four common sports related injuries.
7. Name the two times a football helmet is
removed.
Answers
1. Assess distal pulses, movement and sensation
2. Following assessment of Airway, Breathing,
Circulation then apply a traction splint.
3. This patient is at risk of hemorrhagic shock.
4. Splint in place using padding and a sling/swath.
5. Do not attempt to realign the deformed
shoulder because the girl has a radial pulse.
Splint in place.
6. Muscle sprains and strains
Knee injuries
Compartment syndrome
Achilles Tendon injuries
Fractures, dislocations
Head and neck injuries
7. Remove the helmet in the case of airway
compromise or cardiac arrest.