Musculoskeletal Injuries Lecture Notes PDF

latrobe.edu.au Musculoskeletal Injuries Dr Mick Lo La Trobe University CRICOS Provider Code Num...

latrobe.edu.au Musculoskeletal Injuries Dr Mick Lo La Trobe University CRICOS Provider Code Number 00115M 1 latrobe.edu.au Lecture Outline  Injuries and Musculoskeletal Injuries.  Anatomy of injuries.  Common sport injuries. 2 1  latrobe.edu.au INJURY 3 latrobe.edu.au INJURY  Any physical harm or damage that occurs to someone’s body.  Musculoskeletal injuries are injuries that occur to someone’s soft (muscles, ligaments, tendons) or hard (bones) body tissues.  Musculoskeletal injuries are common in sport, but they can be ”easily” treated and even prevented. 4 2  latrobe.edu.au ANATOMY OF COMMON INJURIES 5 latrobe.edu.au Outline  Bone injuries-Fractures.  Joint injuries-Dislocations and Subluxations.  Ligament injuries-Sprains.  Muscle injuries-Strains 6 3  latrobe.edu.au FRACTURES 7 latrobe.edu.au Bone injuries-Fractures  A fracture is a partial or complete break in the continuity of a bone.  Fractures can happen to any bone.  Fractures can happen at any age including children (greenstick fractures), 8 4  latrobe.edu.au 9 latrobe.edu.au Bone injuries-Fractures  A fracture is a partial or complete break in the continuity of a bone.  Fractures can happen to any bone.  Fractures can happen at any age including children (greenstick fractures), but they are more common with ageing (osteoporosis). 10 5  latrobe.edu.au 11 latrobe.edu.au Bone injuries-Fractures (Classification)  Traumatic 12 6  latrobe.edu.au 13 latrobe.edu.au Bone injuries-Fractures (Classification)  Traumatic or pathologic fractures (osteoporosis). 14 7  latrobe.edu.au 15 latrobe.edu.au Bone injuries-Fractures (Classification)  Traumatic or pathologic fractures (osteoporosis).  Open or closed fractures. 16 8  latrobe.edu.au Bone injuries-Fractures (Classification)  Traumatic or pathologic fractures (osteoporosis).  Open or closed fractures.  Displaced (shortened, angulated, rotated, translated) 17 Shortened Rotated Translated Angulated 18 9  latrobe.edu.au Bone injuries-Fractures (Classification)  Traumatic or pathologic fractures (osteoporosis).  Open or closed fractures.  Displaced (shortened, angulated, rotated, translated) or non-displaced fractures. 19 latrobe.edu.au 20 10  latrobe.edu.au Bone injuries-Fractures (Classification)  Traumatic or pathologic fractures (osteoporosis).  Open or closed fractures.  Displaced (Translated, angulated, rotated, shortened) or non-displaced fractures.  Complete, incomplete and comminuted fractures. 21 latrobe.edu.au Comminute Incomplete Complete 22 11  latrobe.edu.au Bone injuries-Fractures (Classification)  Traumatic or pathologic fractures (osteoporosis).  Open or closed fractures.  Displaced (Translated, angulated, rotated, shortened) vs non-displaced  Complete, incomplete and comminuted fractures.  Fracture’s patterns: Traverse, linear, oblique, spiral, compression (vertebrae) and avulsion fractures. 23 latrobe.edu.au 24 12  latrobe.edu.au Compression Avulsion 25 latrobe.edu.au JOINT INJURIES 26 13  latrobe.edu.au Joint injuries- Dislocations and subluxations  A joint is a functional connection between two or more bones in the skeleton.  Some joints permit a large degree of movement (diarthrosis), 27 latrobe.edu.au 28 14  latrobe.edu.au Joint injuries- Dislocations and subluxations  A joint is a functional connection between two or more bones in the skeleton.  Some joints permit a large degree of movement (diarthrosis), some permit only slight movements (amphiarthrosis, vertebral joint), 29 latrobe.edu.au 30 15  latrobe.edu.au Joint injuries- Dislocations and subluxations  A joint is a functional connection between two or more bones in the skeleton.  Some joints permit a large degree of movement (diarthrosis), some permit only slight movements (amphiarthrosis, vertebral joint), some permit minimal to no movements (synarthrosis, skull sutures). 31 latrobe.edu.au 32 16  latrobe.edu.au Joint injuries- Dislocations and subluxations  A joint dislocation (or luxation) occurs when there is an abnormal separation of the articular surfaces of the bones making a joint. 33 latrobe.edu.au 34 17  latrobe.edu.au Joint injuries- Dislocations and subluxations  A joint dislocation (or luxation) occurs when there is an abnormal separation of the articular surfaces of the bones making a joint.  A subluxation is an incomplete or partial separation of the articular surfaces of the bones making a joint. 35 latrobe.edu.au 36 18  latrobe.edu.au Joint injuries- Dislocations and subluxations  A joint dislocation (or luxation) occurs when there is an abnormal separation of the articular surfaces of the bones making a joint.  A subluxation is an incomplete or partial separation of the articular surfaces of the bones making a joint.  They are both common and can happen on any joint. However, they are more common in the ankle and shoulder (more mobility). 37 latrobe.edu.au LIGAMENTS INJURIES 38 19  latrobe.edu.au Ligaments and other joint structures injuries  Joint stability and mobility are increased by muscles and specific articular structures (ligaments, bursae, cartilage, capsules, discs and menisci). 39 latrobe.edu.au Ligaments and other joint structures injuries  Joint stability and mobility are increased by specific articular structures (ligaments, discs and menisci, bursae, cartilage, capsules) and muscles. 40 20  latrobe.edu.au Ligaments and other joint structures injuries  Joint stability and mobility are increased by specific articular structures (ligaments, discs and menisci, bursae, cartilage, capsules) and muscles.  All these structures can also be damaged (dislocations and subluxations).  Sometimes they can be damaged even without a clear dislocation (sprain).  A sprain occurs when a joint moves beyond its functional range of motion, causing a ligament to stretch or even break (acute and chronic injuries). 41 latrobe.edu.au Ligaments and other joint structures injuries  Sprains can happen to every ligament, but they are very common in ankles, knees and neck (whiplash). 42 21  latrobe.edu.au Ligaments and other joint structures injuries  Sprains can be classified as mild (1st grade, partial tear), moderate (2nd grade, incomplete tear with moderate functional impairment), and severe (3rd grade, complete tear with functional impairment). 43 latrobe.edu.au Ligaments and other joint structures injuries  Sprain can be classified as mild (1st grade, partial tear), moderate (2nd grade, incomplete tear with moderate functional impairment), and severe (3rd grade, complete tear with functional impairment).  Discs and menisci can also be damaged following a sprain or for excessive axial load.  Cartilage, capsules and bursae can also get damaged or inflamed following any joint injury or mechanical overload. 44 22  latrobe.edu.au MUSCLE INJURIES 45 latrobe.edu.au Musculo-tendon injuries  Muscles and tendons can be damaged when stretched beyond their physiological limits (strain).  Strains are similar to sprains and, like sprains, are classified in three grades. 46 23  latrobe.edu.au Musculo-tendon injuries  Muscles and tendons can also be damaged when stretched beyond their physiological limits (strain).  Strains are similar to sprains and, like sprains, are classified in three grades.  Strains are very common sport injuries. They usually affect calf, hamstrings, and the back but they can occur to any muscle. 47 latrobe.edu.au Musculo-tendon injuries  Muscles can also cramp during exercise. A cramp is a painful involuntary muscle contraction that can induce a temporary and reversible paralysis-like state.  Cramps are common in sport and caused by muscular fatigue, dehydration and lack of electrolytes or other conditions (menstruation, gastroenteritis). 48 24  latrobe.edu.au 49 latrobe.edu.au Musculo-tendon injuries  Muscles can also cramp during exercise. A cramp is a painful involuntary muscle contraction that can induce a temporary and reversible paralysis-like state.  Cramps are common in sport and caused by muscular fatigue, dehydration and lack of electrolytes or other conditions (menstruation, gastroenteritis).  Contusions (bruises) although uncommon, can also occur to muscles. 50 25  latrobe.edu.au HALF TIME 51 latrobe.edu.au COMMON INJURIES COMMON INJURY IN SPORT IN SPORT 52 26  latrobe.edu.au Ankle sprain  Risk factors: History of previous sprains/strains, footwear/ground condition, being overweight and stupidity.  Causes: Turning and rolling of the foot (particularly in side-to-side). Inversion: Rolling over the small toe, damaging lateral ligaments (anterior talofibular, calcaneofibular, posterior talofibular ligament); 53 latrobe.edu.au Ankle Sprain 54 27  latrobe.edu.au Ankle sprain  Risk factors: History of previous sprains/strains, footwear/ground condition, being overweight and stupidity.  Causes: Turning and rolling of the foot (particularly in side-to-side). Inversion: Rolling over the small toe, damaging lateral ligaments (anterior talofibular, calcaneofibular, posterior talofibular ligament); Eversion (less common): Rolling over the big toe, damaging medial ligament. 55 latrobe.edu.au Ankle sprain 56 28  latrobe.edu.au Ankle sprain  Risk factors: History of previous sprains/strains, footwear/ground condition, being overweight and stupidity.  Causes: Turning and rolling of the foot (particularly in side-to-side). Inversion: Rolling over the small toe, damaging lateral ligaments (anterior talofibular, calcaneofibular, posterior talofibular ligament); Eversion (less common): Rolling over the big toe, damaging medial ligament. Syndesmotic sprain: Usually after landing on someone else foot damaging the tibiofibular mortise and tenon joint, the anterior and posterior inferior tibio-fibular ligaments, and other ligaments constituting the mortise and tenon joint. 57 latrobe.edu.au Ankle sprain 58 29  latrobe.edu.au Ankle sprain  Risk factors: History of previous sprains/strains, footwear/ground condition, being overweight and stupidity.  Causes: Turning and rolling of the foot (particularly in side-to-side). Inversion: Rolling over the small toe, damaging lateral ligaments (anterior talofibular, calcaneofibular, posterior talofibular ligament); Eversion (less common): Rolling over the big toe, damaging medial ligament. Syndesmotic sprain: Usually after landing on someone else foot damaging the tibiofibular mortise and tenon joint, the anterior and posterior inferior tibio-fibular ligaments, and other ligaments constituting the mortise and tenon joint.  Signs and symptoms: Localised pain, swelling, bruising and limited functionality. 59 latrobe.edu.au Ankle sprain  Immediate management: Stop activity, PRICE and taping. 60 30  latrobe.edu.au ICE, RICE, PRICE, PEACE & LOVE  Ice, Compression, Elevation.  Rest, Ice, Compression, Elevation.  Protection, Rest, Ice, Compression, Elevation.  Protection, Elevation, Avoid anti-inflammatories, Compression, Education, Load, Optimism, Vascularisation, Exercise. 61 latrobe.edu.au Ankle sprain  Immediate management: Stop activity, PRICE and taping.  Rehab and return to play: Rarely surgery, proprioception and taping.  Prevention : Proprioception training. 62 31  latrobe.edu.au Ankle sprain 63 latrobe.edu.au Pulled hamstrings  Risk factors: History of previous injury, age, agonist/antagonist imbalance and fatigue/overload.  Causes: Overstretching of the hamstrings, when running (at the end of the aerial phase when the knee is extended, and the foot approaches the ground). 64 32  latrobe.edu.au Pulled hamstrings 65 latrobe.edu.au Pulled hamstrings  Risk factors: History of previous injury, age, agonist/antagonist imbalance and fatigue/overload.  Causes: Overstretching of the hamstrings, when running (at the end of the aerial phase when the knee is extended, and the foot approaches the ground) and/or jumping (at the beginning of the aerial phase, when the knee is extended). 66 33  latrobe.edu.au Pulled hamstrings 67 latrobe.edu.au Pulled hamstrings  Risk factors: History of previous injury, age, agonist/antagonist imbalance and fatigue/overload.  Causes: Overstretching of the hamstrings, when running (at the end of the aerial phase when the knee is extended, and the foot approaches the ground) and/or jumping (at the beginning of the aerial phase, when the knee is extended).  Signs and symptoms: Localised pain, snapping/popping feeling, bruising and limited functionality. 68 34  latrobe.edu.au Pulled hamstrings  Immediate management: Stop activity, PRICE, taping and kinesio-taping.  Rehab and return to play: Rarely surgery, stretching, strengthening, proprioception and taping/kinesio-taping. An athlete is fully recovered when can stand eccentric workout.  Prevention: Training to reduce agonist/antagonist imbalance (correct strengthening). 69 latrobe.edu.au Pulled hamstrings 70 35  latrobe.edu.au ACL  Risk factors: History of previous injury, footwear/ground condition, genetics (sex) and type of sport.  Causes: Knee’s hyperextensions/twists (Pivoting, changes of direction, one- leg landing) 71 latrobe.edu.au ACL 72 36  latrobe.edu.au ACL  Risk factors: History of previous injury, footwear/ground condition, genetics (sex) and type of sport.  Causes: Knee’s hyperextensions/twists (Pivoting, changes of direction, one- leg landing), direct impact and repeated stress. 73 latrobe.edu.au ACL 74 37  latrobe.edu.au ACL  Risk factors: History of previous injury, footwear/ground condition, genetics (sex) and type of sport.  Causes: Knee’s hyperextensions/twists (Pivoting, changes of direction, one- leg landing), direct impact and repeated stress.  Signs and symptoms: Localised pain, swelling and instability. 75 latrobe.edu.au ACL  Immediate management: Stop activity and PRICE.  Rehab and return to play: Surgery, strengthening, proprioception and NO TAPING.  Prevention: Strengthening and proprioception. 76 38  latrobe.edu.au Menisci and other ligaments  A knee is a complex joint. Other structures that can be damaged are the menisci and lateral ligaments.  Injuries can happen to isolated structures (ACL only, one meniscus only, one lateral ligament only). However, injuries are often impacting 2 or more structures at the same time. The most common combinations are: 1. ACL+Medial Meniscus+Medial Ligament. 2. ACL+Lateral Meniscus+Lateral Ligament. 77 latrobe.edu.au Menisci and other ligaments  But other combinations are possible.  Injury of the PCL (isolated or combined) are very rare. 78 39  latrobe.edu.au Shoulder injury  Risk factors: History of previous injuries, repetitive overhead movements and genetics.  Causes: Trauma (falls or direct hits) and extreme movements. Injuries can affect the entire joint complex. We are only focusing on glenohumeral joint dislocations: these dislocations can be anterior (most common), posterior (rare) inferior (very rare). 79 latrobe.edu.au Shoulder injury 80 40  latrobe.edu.au Shoulder injury  Risk factors: History of previous injuries, repetitive overhead movements and genetics.  Causes: Trauma (falls or direct hits) and extreme movements. Injuries can affect the entire joint complex. We are only focusing on glenohumeral joint dislocations: these dislocations can be anterior (most common), posterior (rare) inferior (very rare).  Signs and symptoms: Localised pain, muscles spasms, popping or rolling out feelings, numbness/weakness, bruising/swelling and limited functionality. 81 latrobe.edu.au Shoulder injury  Immediate management: Stop activity, PRICE and taping/arm support.  Rehab and return to play: Surgery, strengthening, proprioception and taping/kinesio-taping.  Prevention: Strengthening and proprioception. 82 41  latrobe.edu.au Shoulder injury 83 latrobe.edu.au Fractures  Risk factors: History of previous fractures, genetic (sex), age, drinking and smoking.  Causes: Trauma (falls or direct hits). Other causes (osteoporosis related) are not common in sport.  Signs and symptoms: Localised pain, swelling, deformity and limited functionality. Bones protruding from the skin are a clear sign of an open fracture. 84 42  latrobe.edu.au Fractures 85 latrobe.edu.au Fractures  Immediate management: Stop activity and immobilisation.  Rehab and return to play: Possible surgery in sport and immobilisation with incremental load.  Prevention: Exercise and adequate intake of calcium and vitamin D during bone development (also to limit osteoporosis). 86 43  latrobe.edu.au Fractures 87 latrobe.edu.au Concussions  Risk factors: High-contact sports and vehicle sports.  Causes: Trauma and acceleration/deceleration (neck and head).  Signs and symptoms: Headache, nausea/vomiting, dizziness/balance problem, double/blurry vision, light/noise intolerance and cognitive issues (concentration, memory).  Immediate management: Stop activity and HIA protocols.  Rehab and return to play: Monitor for concussion symptoms and start training when all symptoms disappeared.  Prevention: Changes in the laws of the game, helmets and technique improvement. 88 44  Thank you latrobe.edu.au La Trobe University CRICOS Provider Code Number 00115M © Copyright La Trobe University 2017 89 45