Chapter 13 Recognizing Different Sports Injuries PDF

Chapter 13 Recognizing Different Sports Injuries Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Fractures, 1...

Chapter 13 Recognizing Different Sports Injuries Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Fractures, 1 Occur as a result of extreme stresses and strains placed on bones Gross structure of long bones Diaphysis Main shaft of the bone Hollow, cylindrical, and covered by compact bone Epiphysis Located at the ends of long bones Joint surfaces are covered with a layer of articular cartilage Periosteum Dense, white, and fibrous membrane Covers long bones except at joint surfaces Inner layer contains blood vessels and osteoblasts (bone-forming cells) Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Fractures, 2 Can be classified as either open or closed In an open fracture, the overlying skin is lacerated by protruding bone fragments A closed fracture does not penetrate superficial tissue Both can be serious if not managed properly Symptoms include obvious deformity, point tenderness, swelling, and pain on active and passive movement Long bones can be stressed by tension, compression, bending, torsion, and shear More complex the fracture, more energy that is required External energy can be used to deform and fracture bone Some energy can be dispersed to soft tissue adjacent to the bone Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Healing of a Fracture The fracture of a bone usually requires immobilization for some period in a cast Fractures of the long bones of the arm and leg require 6 weeks of casting Fractures of the bones in the hands and feet require 3 to 4 weeks of either casting or splinting Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Stress Fractures Result from overuse rather than acute trauma Commonly occur in the weight-bearing bones of the leg or foot Pain usually begins as a dull ache that becomes progressively worse over time Initially, pain is severe during activity As the fracture develops, pain becomes worse after the activity is stopped Treatment Stress fractures do not show up on X-rays until osteoblasts begin laying down bone If a stress fracture is suspected, the athlete should suspend the activity for 14 days Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Dislocations and Subluxations, 1 Dislocation Occurs when at least one bone in a joint is forced completely out of its normal and proper alignment Must be manually or surgically put back into place or reduced High level of incidence in the shoulder joint, elbow, and fingers Subluxation Partial dislocation Bone is forced out of alignment but goes back into place Commonly occurs in the shoulder joint and in the knee cap (patella) Will likely result in a rupture of the stabilizing ligaments and tendons surrounding the joint Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Dislocations and Subluxations, 2 Additional concerns Avulsion fractures Growth plate separation Once a joint has been either subluxated or completely dislocated, it is extremely vulnerable to subsequent dislocations Treatment A first-time dislocation should always be considered and treated as a possible fracture Once it has been ascertained that the injury is a dislocation, a physician should be consulted Dislocations should not be reduced immediately, regardless of where they occur Athlete should get an X-ray to rule out fractures or other problems 2020 McGraw-Hill Copyright © Return toEducation. play is largely All rights reserved. dependent on the No reproduction or distribution degree without of consent the prior written soft-tissue of McGraw-Hill Education.  Ligament Sprains, 1 Sprain Damage to a ligament or joint capsule that provides support to a joint Ligament: Band of tissue that connects one bone to another Characteristics of synovial joints Composed of two or more bones that articulate with one another Articulating surfaces are lined with articular, or hyaline, cartilage All joints are surrounded by a joint capsule Inner surface is lined by a very thin synovial membrane Synovial membrane produces synovial fluid Mechanoreceptors Located in muscles, tendons, ligaments, and joints Provide information on joint position Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Ligament Sprains, 2 Some joints contain a thick fibrocartilage called a meniscus Ligaments Primary providers of structural support and joint stability Thickened portions of the joint capsule or totally separate bands Anatomical position partly determines the movements that joint can make If a joint is forced to move beyond normal limits or planes of movement, injury to the ligaments is likely to occur Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Grades of Sprains, 1 Severity of the damage is subject to many different classifications Grade 1 sprain Some stretching and separation of the ligamentous fibers, with minimal instability of the joint Mild to moderate pain, localized swelling, and joint stiffness Grade 2 sprain Some tearing and separation of the ligament fibers, with moderate instability of the joint Moderate to severe pain, swelling, and joint stiffness Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Grades of Sprains, 2 Grade 3 sprain Total tearing of the ligament, which leads to instability of the joint Can result in a subluxation or even dislocations Severe pain, followed by little or no pain as a result of total disruption of nerve fibers Swelling may be great, and the joint tends to become very stiff some hours after the injury If coupled with marked instability, surgical repair may be required Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Grades of Sprains, 3 Rehabilitation Long-term process for grade 3 sprains if surgery is involved Restoration of joint stability is difficult with grade 1 and 2 sprains Stretched or partially torn ligament results in formation of inelastic scar tissue, preventing the ligament from regaining its original tension Structures around the joint should be strengthened Increased muscle tension provided by strength training can improve joint stability Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Contusions, 1 Produced by impact from some external object that causes soft tissue to be compressed against hard bone underneath If the impact is hard enough, capillaries are torn, which allows bleeding into the tissues Minor bleeding results in discoloration of the skin Contusion may be sore to the touch If damage has occurred to muscle, pain may be present on active movement Pain usually ceases within a few days, and discoloration disappears usually in a few weeks Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Contusions, 2 Myositis ossificans Calcium deposits that result from repeated trauma May be found between several fibers in the muscle belly or build up to form a spur, which projects from the underlying bone May significantly impair movement Prevention Protect the injured area with padding Protection and rest may allow calcium to be reabsorbed, eliminating any need for surgery Quadriceps and biceps Most vulnerable to repeated contusions during physical activity Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Muscle Strains and Injuries, 1 Strain A stretch, tear, or rip in the muscle or its tendon Muscle strain grades Grade 1 Some fibers have been stretched or actually torn Results in tenderness and pain on active motion Movement is painful but full range of motion is usually possible Grade 2 A number of fibers have been torn, and active contraction of the muscle is extremely painful Usually a depression or divot is palpable May result in some swelling and discoloration Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Muscle Strains and Injuries, 2 Grade 3 Complete rupture of a muscle has occurred in the area of the muscle belly at the tendinous attachment to the bone Significant impairment or total loss of movement Intense pain initially that quickly diminishes due to nerve damage Rehabilitation Grade 3 strains involving large tendons that produce great amounts of force must be surgically repaired Regardless of severity, rehabilitation is a lengthy process Returning to activity too soon may result in reinjury Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Muscle Strains and Injuries, 3 Muscle guarding Voluntary muscle contractions that occur in response to pain following musculoskeletal injury Muscles surrounding the injured area contract to splint the area and minimize pain by limiting movement Often confused with a spasm Increased tone or contractions due to some upper motor neuron lesion in the brain Muscle cramps Painful involuntary contractions Occur in muscle groups that are overloaded and fatigued during high demand activities Muscle fatigue alters neuromuscular control by increasing muscle spindle activity while decreasing Golgi tendon organ activity Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Muscle Strains and Injuries, 4 Muscle soreness Overexertion in strenuous exercise resulting in muscular pain Occurs when individuals perform a physical activity to which they are unaccustomed Types of soreness Acute-onset muscle soreness, which accompanies fatigue, is transient and occurs during and immediately after exercise Delayed-onset muscle soreness (D O M S) is a syndrome of delayed muscle pain leading to increased muscle tension, swelling, stiffness, and resistance to stretching Prevented by beginning exercise at a moderate level and gradually progressing the intensity of the exercise over time Treatment involves: Static or P N F stretching activity Applying ice within the first 48 to 72 hours Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Nerve Injuries, 1 Involve either compression or tension Can be acute or chronic Trauma directly affecting the nerves may cause: Hypoesthesia (diminished sense of feeling) Hyperesthesia (increased sense of feelings such as pain or touch) Paresthesia (numbness, prickling, or tingling, which may occur from a direct blow or stretch to an area) Neuropraxia Trauma directly affecting nerves Often called a “burner” or “stinger” Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Nerve Injuries, 2 Neuritis Chronic nerve irritation Caused by a variety of forces that usually have been repeated or continued for a long time Symptoms can range from minor nerve problems to paralysis Serious injuries involve the crushing of a nerve or complete division May result in paraplegia or quadriplegia Specialized tissue, such as nerve cells, cannot regenerate once the nerve cell dies Peripheral nerves fibers can regenerate significantly if the injury does not affect the cell body An optimal environment for healing is necessary for regeneration Damaged nerves in the central nervous system regenerate poorly Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Chronic Overuse Injuries, 1 Inflammation Essential part of the healing process Must occur to initiate healing Signs and symptoms Pain, swelling, loss of function, warmth, and perhaps redness If the source of irritation is not removed, then the inflammatory process becomes chronic Tendinitis Inflammation of the tendon Tendon: Tough band of connective tissue that attaches muscle to bone Repeating a particular movement may cause the tendon to become irritated and inflamed Symptoms include pain on movement, swelling, and possibly Copyright © some warmth 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Chronic Overuse Injuries, 2 Usually results in crepitus, which is a crackling feeling or sound Chemical products of inflammation that accumulate on the irritated tendon cause it to stick to the surrounding structures Key to treatment is rest Substitute some form of activity to maintain fitness levels while avoiding continued irritation of the inflamed tendon Repeated overuse and failure to heal results in tendon degeneration Tendinosis Symptoms are similar to tendinitis but there is no inflammation Affected tendons are usually painful when moved or touched Treatment involves engaging in exercises to strengthen the tendon and consistently stretching the tendon Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Chronic Overuse Injuries, 3 Tenosynovitis Inflammation of a tendon and its synovial sheath Inflammatory process produces “sticky” by-products and cause the sliding tendon to adhere to the synovial sheath surrounding it Commonly occurs in the long flexor tendons of the fingers as they cross over the wrist joint and in the biceps tendon around the shoulder joint Treatment for tenosynovitis is the same as for tendinitis Anti-inflammatory drugs may be helpful in chronic cases Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Bursitis Bursitis Occurs when bursae produce large amounts of synovial fluid due to irritation or inflammation Bursae: Pieces of the synovial membrane that contain a small amount of fluid Increased fluid production causes an increase in pressure due to limited space available Can be an extremely painful condition that may severely restrict movement, especially around a joint Three most commonly irritated bursae Subacromial bursa, olecranon bursa, and prepatellar bursa Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Chronic Overuse Injuries, 4 Osteoarthritis Wearing down of hyaline cartilage Cartilage may be worn away to the point of exposing, eroding, and polishing the underlying bone Any process that changes the mechanics of the joint leads to joint degeneration May be caused by a direct blow or fall, by the pressure of carrying or lifting heavy loads, or by repeated trauma to the joint as in running or cycling Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Chronic Overuse Injuries, 5 Myofascial trigger points Painful or active trigger points most often develop because of some mechanical stress to the muscle Trigger point: Area of tenderness in a tight band of muscle Stress could involve either an acute muscle strain or static postural positions that produce constant tension in the muscle Typically occurs in the neck, upper back, and lower back Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Chronic Overuse Injuries, 6 Signs and symptoms Palpation of the trigger point causes pain in a distribution of referred pain Pressure on the trigger point produces a twitch or a jump response from the pain Pain may increase with active and passive motion of involved muscle Stretching can be incorporated into the treatment process Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Importance of the Healing Process Following Injury Essential to have some understanding of both the sequence and time frame for various phases of healing Interference with the healing process will delay return to full activity Work to create an environment that is conducive to healing The healing process consists of three phases: Inflammatory response Maturation-remodeling Fibroblastic repair phase phase phase Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Inflammatory Response Phase Begins immediately following injury Most critical phase of the healing process Without the inflammatory phase, the other phases will not occur Phagocytic cells clean up the mess created by the injury Injured cells release chemicals that facilitate the healing process Characterized symptomatically by redness, swelling, tenderness, increased temperature, and loss of function Lasts for approximately 2 to 4 days following injury Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Fibroblastic Repair Phase Proliferative and regenerative activity leading to scar formation and repair of the injured tissue occurs Period of scar formation is called fibroplasia Begins within the first few hours following injury and may last for as long as 4 to 6 weeks Many of the signs and symptoms associated with the inflammatory response subside Athlete will still experience some tenderness and pain on certain movements As scar formation progresses, complaints of pain and tenderness will disappear Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Maturation-Remodeling Phase Long-term process Involves the realignment of scar tissue according to tensile forces acting on the tissue Collagen fibers that make up the scar realign to the position of maximum efficiency (parallel to lines of tension) Tissue gradually resumes normal appearance and function After about three weeks, a firm, strong, contracted, nonvascular scar exists Maturation may take several years to be totally complete Copyright © 2020 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.