Athletic Injuries

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Athletic Injuries

• Connie Rauser
• ATC
• Sabino Sports Medicine Class

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Injuries

• Acute
• Sudden onset
• traumatic
• Chronic
• Overuse
• Repetitive activities

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Types of injuries

• Closed Wounds
• Skin
• Musculoskeletal
• Open Wounds
• Skin
• Musculoskeletal

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What you need to know

• What is the injury?
• What is the mechanism of injury?
• How do you recognize the injury?
• Signs?
• Symptoms?
• How do you care for the injury?

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Types of stress that cause injury

• Tension
• Stretching
• Compression
• Shearing
• Bending

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Tension

• A force that pulls or stretches tissue
• Example sprain, strain

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Stretching

• Going beyond the yield point leading to a
  rupturing of soft tissue or fracturing a bone
• Examplessprain, strain, avulsion fracture

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Compression

• A force with enough energy to crush tissue
• Example arthritic changes, fracture, contusion

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Shearing

• A force that moves across the parallel
  organization of tissue
• Example blister, abrasion, vertebral disk injury

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Bending

• A force on the horizontal bone that places stress
  within the structure causing it to bend
• Example fracture
• There can also be torsion or twisting that causes
  compression and tension in a spiral pattern.

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Closed Wounds

• Contusions
• Strains
• Sprains
• Dislocations
• Fractures

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Contusions

• Also known as bruise or charley horse
• Direct blow to the body part
• Pain, temporary LOM, bruising or discoloration,
  swelling
• RICE, stretch

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Contusion
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Complications

• If not treated properly can develop myositis
  ossificans
• Bony formation within muscle

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Myositis Ossificans
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Myositis Ossificans
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Sprains

• Injury to ligaments, also know as rolling or
  twisting
• Moving the joint beyond the normal range of
  motion
• Pain, swelling, discoloration, LOM
• RICE, crutches, immobilization, medical referral

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Degrees of Sprains

• 1st degree
• overstretching
• 2nd degree
• Partial tearing
• 3rd degree
• Complete rupture

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1st degree sprain

• Stretching of ligament
• Minimal instability of joint
• Mild to moderate pain
• Localized swelling (minimal)
• Joint stiffness
• POT (point tenderness)
• Discoloration

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2nd degree sprain

• Partial tearing of ligament
• Moderate joint instability
• Moderate to severe pain
• Swelling
• Joint stiffness
• POT
• Discoloration
• Inability to bear weight

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3rd degree sprain

• Complete tearing of ligament
• Joint instability
• Severe pain initially followed by less pain due
  to disruption of nerve fibers
• Lots of swelling
• Discoloration
• Joint stiffness
• POT

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Complications

• Once a ligament is stretched/torn, it heals with
  inelastic scar tissue which prevents the ligament
  from regaining its original tension
• Ruptured/torn ligaments may require surgery

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Strains

• Injury to muscle or tendonpulling
• Stretching beyond a normal range or strong muscle
  contraction
• Pain, swelling, discoloration, divot, LOM
• RICE, crutches, medical referral

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Strains
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Degrees of Strains

• 1st degree
• Overstretching of muscle or tendon
• no tearing of tissue
• 2nd degree
• Partial tearing of muscle or tendon
• 3rd degree
• Complete tearing or rupture of tissue

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Strains

• Signs and symptoms are similar to those of the
  sprains---it just occurs within the muscle or
  tendon area

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Strains
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Complications

• Scar tissue is not as elastic, may lose some
  flexibility
• Returning too soon can cause reinjury to area
• Rehab may take longer than for sprains due to
  contractile properties of muscles

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Dislocations

• Bone ends at a joint are out of place
• Joint is stressed beyond its normal boundaries
• Obvious deformity, pain, LOM at that joint, shock
• Immobilize joint, ice, treat for shock, call 911
  or send to ER for reduction

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Dislocations
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Subluxations

• Partial or incomplete dislocation
• Joint stretched beyond normal ROM
• Pain, swelling, LOM
• RICE, immobilize if necessary, medical referral

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Fractures

• Broken bone
• Great force on the bone that moves it or bends it
  beyond the break point
• Pain, possible deformity, crepitus, unable or
  unwilling to move body part, discoloration,
  swelling
• RICE, immobilize, crutches, medical referral

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Kinds of Fractures

• Avulsion
• Blowout
• Comminuted
• Compression

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Blowout fracture
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Kinds of Fractures

• Epiphyseal
• Greenstick
• Longitudinal

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Kinds of fractures contd

• Oblique
• Pathological
• Serrated
• Spiral

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Pathological fractures
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Kinds of Fractures

• Stress
• Transverse

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Kinds of Fractures

• A few more photos

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Open Fractures Dislocations

• A break in the bone or the bone ends come out of
  place
• The bone (end) is exposed, may be bleeding, pain,
  LOM, shock
• Cover the exposed bone
• Immobilize
• Treat for shock
• Transport or send to ER

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Fixing the Fracture

• Casting
• Internal fixation
• External Fixation

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Open wounds

• Abrasions
• Incisions
• Lacerations
• Avulsions
• Amputations
• Puncture

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Abrasions

• Road rash, strawberry, traumatic tattoo
• Top layer(s) of skin are rubbed off
• Pain, some bleeding, oozing, dirt/debris in the
  wound
• Clean the wound with soap and water, apply
  antibacterial ointment, cover, watch for infection

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Incisions Lacerations

• Open cut with either smooth
• or jagged edges
• Cut by blunt trauma
• or sharp object
• Bleeding, open wound,
• pain, shock
• Control bleeding, clean wound,
• pull ends of skin together,
• send for stitches if necessary

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Avulsions Amputations

• Body part or skin partially or completely torn
  away from body
• Trauma
• May be profuse or little bleeding, body part
  missing (or partly), shock
• Get the missing body part in plastic bag, control
  bleeding, treat for shock, call 911, ER

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Puncture

• Object is imbedded or impaled in the person
• Force to push the object into the body
• Little bleeding, object impaled, shock
• Leave the object in if in more than ¼ in.,
  control bleeding, Call 911 or send to ER

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Punctures

• Very small or large object
• Leave in place to prevent further trauma and
  control bleeding

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Tendinitis

• Inflammation of a tendon
• Due to overuse
• Common sites
• Achilles tendon
• Biceps tendon
• Peroneal tendon

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Tendinitis

• Signs/symptoms
• Pain with movement
• Swelling
• Warmth
• crepitus

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Tendinitis

• Treatment
• Rest
• Ice
• Heat
• Anti-inflammatory drugs

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Tenosynovitis

• Inflammation of tendon surrounded by a synovial
  sheath
• Signs/symptoms are similar to tendinitis
• Treatment is similar

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Bursitis

• Bursae
• Fluid filled (synovial) sac found at joints
• Decrease friction during movement
• Inflammation of bursa
• Subacromial bursa, olecranon bursa, prepatellar
  bursa

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Bursitis

• Acute or chronic
• Produce large amounts of synovial fluid
• More irritation, more fluid
• More fluid, more pain
• Restricts movement

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Nerve injuries

• Acute or chronic
• Stretched, compressed, torn/severed
• Produce variety of sensations
• Hypoesthesia, hyperesthesia, paresthesia
• Nerves damaged in periphery can regenerate, but
  spinal nerves cannot (rate of 3-4 mm per day)

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Tissue healing

• Injury must occur
• Inflammation must occur for healing to begin

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Soft tissue healing

• 3 stages
• Inflammatory response stage
• Fibroblastic Repair stage
• Maturation-Remodeling stage

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Inflammatory Response stage

• Begins immediately after injury
• Last 2-4 days
• Cells die due to injury, lack of O2, nutrients
• Phagocytes come in to eat the dead cells
• Leukocytes (WBC) come in to help fight infection

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Inflammatory Response Phase

• Platelets are blood clotting cells
• Come in to help control bleeding
• Area will have redness, swelling, tenderness,
  discoloration, loss of function

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Fibroblastic Repair phase

• Fibroplasia-period of scar formation
• Begins within first few hours
• Lasts 4-6 weeks
• Fibroblasts are fiber building cells that lay
  fibers across injured area
• Form the scar tissue for healing

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Maturation-Remodeling Phase

• Long term process
• Can take a year or longer
• Realigns the scar tissue when subjected to
  stresses applied
• Realigns in a parallel form to become normal in
  appearance and function
• Must use strengthening exercises to provide
  stress needed to remodel

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Bone Fracture healing

• 3 stages
• Acute fracture stage
• Repair stage
• Remodeling stage

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Acute fracture stage

• Get bleeding in area due to fracture of bone
• Osteoclasts come in to eat the debris and help
  resorb it into the body
• Osteoblasts add new layers of bone to the
  outside of bone

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Repair stage

• Osteoclasts and osteoblasts continue to
  regenerate bone
• Bony splint (callus) forms both internally
  externally to hold ends of bone together
• Transformation of callus to bone starts at
  about 3rd week continues to 3rd month

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Remodeling

• Can take years
• Usually return to activity within 6-16 weeks
• Callus is resorbed and replaced with fibrous
  bone around fracture site.
• Stress must be applied to help remodel/reorganize
  the site

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Summary

• Any injury can cause shock
• Treat the signs and symptoms you find
• If in doubt as to the severity of the injury, be
  conservative
• Call 911 and let EMS take over

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Terms/prefixes/suffixes

• Hyper-to increase
• Hypo- to decrease
• Itis- inflammation
• Cardio- heart
• Heme- blood
• Edema- swelling
• Arthro- joint

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Terms

• Myo- muscle
• Oss/osteo- bone
• Rhino- nose
• Oto- ear
• Laryngo- larynx throat
• Neuro- nerve
• Gastro- stomach

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Terms

• Algia- pain
• Sub- below
• Ab- away
• Add- towards
• Dys- bad
• Eu- good
• Inter- between

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Terms

• Intra- within or inside
• Supra- above
• Infra- below
• Cyan/o- blue
• Erythr/o-red
• Leuk/o-white
• Melan/o- black
• Poli/o-gray