Sports Injury Classification

Classification of Sports Injuries

• Classification of sports injuries is essential before evaluation, inspection, and recognition
• Involves understanding major anatomy, causation, and forces involved in the injury

Primary Injuries

• Result directly from the stress imposed by a particular sport
• Can be acute (caused by trauma) or chronic (result from overuse)
• Can be externally or intrinsically caused
• Examples: macrotrauma (fractures, dislocations, contusions, strains) and microtrauma (tendonitis)

Secondary Injuries

• May arise if the injury has not been properly treated initially
• May arise if the athlete has been allowed to return to competition too soon
• Examples: early secondary problems (chronic swelling, joint laxity, weakness) and later secondary problems (arthritis, repeated re-injury, instability)

Mechanical Forces of Injury

• Types of mechanical forces: compressive, tensile, shear, stress, strain, elastic limit, plastic deformation, bending, and torsion
• Altered movement patterns, altered recruitment patterns, and altered proprioception can lead to abnormal loading and increased tissue stress/strain

Anatomical Classification

• External injuries: skin, wound is highly visible
• Internal and unexposed injuries: muscles, ligament, bone, cartilage, nerves, joint capsules

Exposed Skin Injuries

• Examples: abrasion, laceration, incision, puncture wound, impaled object, and burns

Unexposed Injuries

• Unexposed or closed wounds in sports include those injuries which do not penetrate the epidermal skin layer

Injury Classification

• Majority of athletic injuries involve the neuromusculoskeletal system
• Involves osseous, soft tissue, or nerve injuries
• Affects body tissues: bone, cartilage, muscle, tendon, ligament, skin, bursa, nerve

Fractures

• Defined as a disruption in the continuity of a bone
• Types: simple (closed), compound (open), greenstick (incomplete fracture), stress (incomplete fracture), and epiphysial (fracture involving the epiphyseal plate of a long bone)

Dislocation

• Defined as when at least one bone in an articulation is forced out of its normal and proper alignment
• Bone ends are no longer in contact
• Types: luxation (complete separation) and sub-luxation (partial congruency remains)

Contusion

• Defined as a compression injury caused by a sudden traumatic blow to the body
• Soft tissue is compressed against the bone resulting in capillary damage
• Also known as a bruise

Hematoma

• Defined as a localized collection of blood that has leaked from blood vessels
• Formed by the localization of blood leaking into a clot that becomes encapsulated by a connective tissue membrane

Myositis Ossificans

• Defined as the accumulation of calcium deposits in muscle tissue (ectopic calcification)
• Result of repeated blows to the same area
• May have accumulation in the muscle belly or spur projecting from the underlying bone

Strain

• Defined as a stretch, tear, or separation in the muscle or adjacent tissue such as the fascia or tendon
• Classified as grade 1, 2, or 3
• Result of overstretching or a forced contraction against too much resistance

Tendon and Muscle Injuries

• Grade 1: minimal loss of structural integrity, little or no swelling, localized tenderness, minimal bruising, minimal function loss
• Grade 2: moderate loss of structural integrity, significant structural weakening, some abnormal motion, solid end feel to stress, bruising and swelling, often associated with hemarthrosis and effusion
• Grade 3: complete loss of structural integrity, marked abnormal motion, significant bruising, hemarthrosis, needs prolonged protection, may require surgery

Muscle Cramp

• Defined as a painful involuntary muscle contraction
• May be the result of dehydration, fatigue

Muscle Guarding

• Defined as involuntary muscle contractions that occur in response to pain following musculoskeletal injury
• May be a spasm or spasticity due to upper motor neuron lesion in the brain

Muscle Atrophy

• Defined as a gradual wasting away of muscle due to disease
• May be due to neurological injury or pain inhibition

Muscle Contracture

• Defined as abnormal shortening of muscle and other soft tissue where there is a great deal of resistance to passive stretch

Sprain

• Defined as a stretch or separation of ligamentous fibers resulting from a force causing a joint to move beyond its normal limits of motion
• Classified as per strains

Tendonitis

• Defined as inflammation and tenderness of a tendon with a gradual onset caused by repeated microtrauma and degenerative change
• May be degenerative changes in a tendon without inflammation

Bursitis

• Defined as inflammation of a bursa caused by overuse of muscle or tendon at a bony prominence, or by constant external compression or trauma
• Result from friction leading to inflammation and irritation which causes the bursa to produce large amounts of synovial fluid

Nerve Injuries

• Result from tensile or compressive forces
• Can have sensory or motor changes
• Classified as grade 1, 2, or 3

Pain

• Defined as referred pain (pain that is perceived at a location remote from the injured site) or radiating pain (pain that is felt both at its source and along a nerve)