Transcript Chapter 13: Recognizing Different Sports Injuries

Chapter 13:
Recognizing Different
Sports Injuries
Acute Injuries
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Fractures
Dislocations and subluxations
Ligament SPRAINS
Contusions
Muscle STRAINS
Muscle cramps
Muscle soreness
Nerve injuries
Fractures
 Fractures (broken bones) occur because
of extreme stress placed on the bone
 Parts of the bone
 Diaphysis- shaft (hollow)
 Epiphysis- ends (place of growth)
 Articular cartilage- covers joint surface
(provides protection and shock absorption)
 Periosteum- outer covering
Fractures
Closed Fracture
 Little or no
movement or
displacement of
broken bones
Open Fracture
 Bone breaking
through the
surrounding
tissues,
including the
skin, secondary
to significant
displacement of
the bones
Forces Causing
Fractures
 Bending
 Torsion
 Compression
Fracture Healing
 Requires brief immobilization
 Long bones in the limbs (humerus, femur,
tibia, fibula, radius, ulna)
 6 weeks of casting
 Long bones in the feet and hands
(metacarpals, metatarsals, phalanges)
 3 weeks of casting or splinting
Fracture Healing
 Osteoblasts
 Bone cells that build bone
 Osteoclasts
 Bone cells that reshape and break down
bone
 Callus
 Location of increased osteoblast activity
following a fracture that is the initial sign of
bone healing
 Fracture
occurs
 Osteoblastic
activity begins
 Callus
formation
 Osteoclastic
activity begins
 Bone healing
ends
Greenstick Fractures
 Incomplete breaks in bones that have not
completely ossified
 Tend to happen on the convex bone
surface
Transverse Fracture
 Occurs in a straight
line at right angle to
the shaft
 Usually caused by
a direct blow
Spiral Fractures
 S-shaped separation
of the bone
 Common in football
and skiing
 Occurs when the foot
is firmly planted and
body is suddenly
rotated
Oblique Fractures
 Occurs when one
end of the bone
receives sudden
torsion and the other
end is fixed or
stabilized
Impacted Fractures
 Commonly occurs
when falling from
heights
 Causes the long
bone to become
compressed along
the long axis
 Requires immediate
splinting and traction
to ensure normal
length of the injured
limb
Comminuted Fractures
 Consists of three or more fragments at
the fracture site
 Caused by a hard blow or falling in an
awkward position
 Difficult for healing because of the
displacement of the fragments
 Often requires surgical intervention
because of involvement of soft tissue
Longitudinal fractures
 Bone splits along its length
 Result of jumping from a height and
landing applying a force along the long
axis of the bone
Avulsion Fractures
 Separation of bone fragment
from its cortex at an attachment
of a ligament or tendon
 Result of sudden, powerful twist
or stretch of a body part
 Common sites of this type of
fracture
 Base of the 5th metatarsal
(peroneus brevis)
 Anterior superior iliac spine
(sartorius)
 Medial malleolus (deltoid ligament)
Dislocation
 When one bone is
forced completely out
of its normal alignment
and must be manually
or surgically reduced
 Occur mostly at the
shoulder, elbow, and
fingers
Dislocations
 First dislocations
should be treated like
fractures
 Should not be
immediately reduced
 X-rays should be taken
to rule out a fracture
prior to reducing the
dislocation
Subluxation
 Similar to a dislocation except the bone
partially comes out of the joint and slides
back into place on its own with out any
external force applied
 Occurs mostly at the shoulder and the
patella
Ligaments
 Tough, inelastic bands of tissue
connecting bone to bone
 Synovial joints allow motion in one or
more planes
 Hyaline cartilage- cartilagenous covering over
ends of bones
 Joint capsule- thick ligamentous covering
 Synovial membrane- thin lining of joint
capsule
 Synovial fluid- provides lubrication, shock
absorption, and joint nutrition
Synovial Joint
Ligament
Sprain
 Grade 1
 Some stretching of ligament fibers with minimal instability
 Mild to moderate pain, localized swelling, joint stiffness
 Grade 2
 Some tearing of ligament fibers with moderate instability
 Moderate to severe swelling and joint stiffness
 Grade 3
 Total tearing of the ligament with major joint instability
 Significant pain followed by no pain secondary to disruption of
nerve fibers
 Significant swelling
 Often require surgical repair
Contusions
 “Bruise”
 Caused by a direct blow to
soft tissue
 Capillaries are torn and
bleeding into the tissues
occurs
 Causes discoloration that
persists for days
 Pain may be experienced
with active movement or to
the touch
Contusions
 Repeated blows (Myositis ossificans)
 Small calcium deposits develop and
accumulate
 Found between several fibers in the muscle
belly or build up to form a spur projecting
into the underlying bone
 When deposits cause impairments in
movement
 Occur usually at the quadriceps and biceps
Muscle Strains
 Overstretched muscle
 Muscle forced to contract against too
much resistance
 Results in separation or tearing of the
muscle fibers
Muscle Strains
 Grade 1
 Some muscle fibers stretched or torn
 Tenderness and pain with active motion
 Painful but full range of motion
 Grade 2
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Muscle fibers torn
Active contraction of the muscle is painful
Palpable deformity
Some swelling and discoloration
 Grade 3
 Complete rupture of the muscle
 Significant loss of movement
 Pain is intense, but often subsides due to nerve tissue damage
Muscle Cramping
 Extremely painful involuntary
muscle contractions
 Occur most commonly in the
calf, abdomen, hamstrings
 Heat cramps
 Secondary to significant loss of
water
Muscle Soreness
 Acute onset muscle soreness
 Accompanies fatigue
 Transient and occurs immediately following exercise
 Delayed onset muscle soreness (DOMS)
 Appears approximately 12 hours following exercise
 Becomes more intense at 24-48 hours then
subsides
 Delayed muscle pain leading to increased muscle
tension, swelling, and resistance to stretching
Nerve Injuries
 Compression or tension injuries
 Hypoesthesia
 Diminished feeling
 Hyperesthesia
 Increased sensation of pain or touch
 Paresthesia
 Numbness, tingling, prickling
Stingers of Burners
Chronic Injuries
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Tendonitis
Tenosynovitis
Bursitis
Osteoarthritis
Tendonitis
 Inflammation of a tendon
 Tendon can become irritated or
inflamed with repetitive movement
 Causes pain on movement, swelling,
some warmth, and crepitus (cracking
or crunching upon palpation)
 Rest is most important aspect to
treatment (2 weeks)
 Most common types of tendonitis are
at the Achilles and patella
Tenosynovitis
 Tendons are surrounded by synovial
sheaths providing a tight space for the
tendon to move
 Tendon adheres to the sheath causing
inflammation
 Treatment involves rest and antiinflammatory medications
Bursitis
 Bursa is a synovial membrane
filled with synovial fluid and
located at areas of high friction
 Between bone and tendon
 Between skin and bone
 Between muscles
 Direct trauma or overuse can
cause irritation and increased
synovial fluid
 Pressure increases, pain
increases, movement is restricted
Osteoarthritis
 Degeneration of the of the articular or
hyaline cartilage
 Cartilage wears away to the underlying
bone
 Most often affects weight-bearing joints
 Knees
 Hips
 Lumbar spine
Role of Inflammation
 Inflammation must occur for the healing
process to begin
 Should be acute and end when its role in the
healing process is completed
 When inflammation persists it is considered chronic
and prevents further healing
 SYMPTOMS (KNOW THESE)
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Pain
Swelling
Warmth
Loss of function
Redness
Healing Process
(KNOW THIS SLIDE)
 Inflammatory response (first 2 to 4 days)
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Direct injury to cells
Phagocytic cells clean up dead cells
Injured cells release chemicals
Symptoms of redness, swelling, tenderness, heat, loss of
function
 Fibroblastic repair (2 days to 4-6 weeks)
 Proliferative and regenerative activity leads to scar formation
 Symptoms subside including tenderness and pain with
movement
 Maturation-remodeling (3 week to several years)
 Realignment or remodeling of the scar tissue
 Stress realigns collagen parallel to lines of tension