Assessing sports injuries Flashcards
Concussion
A traumatic brain injury resulting force sustained to the head/neck.
Symptoms can take an hour to develop
Long term impact of concussion
- Dementia
- Sub concussions
- Retirement
11R’S
- Recognise
- Reduce
- Remove
- Refer
- Re-evaluate
- Rest
- Rehabilitate
- Recover
- Return to sport
- Reconsider
- Residual effects
Concussion red flags
- Double vision
- Loss of consciousness
- Weakness or tingling
- Deteriorating conscious state
- Vomiting
- Severe or increasing headache
Pitchside assessment questions (concussion)
- What venue are we at today?
- Which half is it now?
- Who scored last in this match/What is the score?
- Who did you play last week?
- Did your team win the last game?
SCAT
Sport concussion assessment tool
(first 72 hours post injury)
SCOAT
Sport concussion office assessment tool
(72 hours + post injury)
Stages of soft tissue repair
- Acute stage
- Sub-acute stage
- Chronic stage
Acute stage
Inflammatory phase
0-10 days post injury
Sub-acute stage
The repair stage
10 days to 6 weeks post injury
Chronic stage
The remodelling phase
6 weeks to 2 years post injury
Cardinal signs of injury
- Pain
- Swelling
- Heat
- Reduced ROM
- Redness
Aim of the inflammatory stage (acute stage)
The body’s immediate response to injury
The aim is to control fluid loss and cleanse the damaged tissue by delivering white blood cells
Aim of Fibroblastic repair phase
(sub-acute)
Aims to restore damaged tissues to their original condition through proliferation and regeneration leading to scar formation and repair
Aim of Remodelling phase (chronic)
Realignment of collagen fibres
Factors that impede healing
- Extent of injury
- Oedema
- Haemorrhage
- Poor vascular supply
- Tissue seperation
- Muscle spasm
- Atrophy
- Infection
Grade 1 injury
No tissue tearing or loss of function or strength just a low grade inflammatory response
Grade 2 injury
Tissue damage and strength of the muscle is reduced
Grade 3 injury
Complete tear of musculotendinous unit and complete loss of function
Grade 4 injury
Complete tear of the muscle and fascia of the muscle- tendon unit
4 pulses in the body
Radial - wrist
Tibial - ankle
Carotid - neck
Femoral - inner thigh
Primary injury
Result of direct force or trauma
Neurotmesis
This is severe nerve injury that disrupts the entire
nerve.
Usually results in a
permanent neurological
impairment
Sports promoting kyphosis
- Cycling
- Rowing
- Boxing
phagocytosis
A process of removing injured tissue and injury bi-products
Types of shock that may develop with acute spinal cord injury
Hypovolaemic
Neurogenic
AVPU
ALERT
VERBAL
PAIN
UNCONSCIOUS
Secondary injury
after primary injury function may or may not become limited
Examples of primary injury
- ACL Tear
- ATFL Tear
- Hamstring Tear
- Achilles tendon tear
Examples of secondary injury
- Anterior Knee Pain following Ankle Joint
Fracture - Low Back Pain developed since Hip Trauma
- Bicep Tendinopathy following Glenoid
Labrum Tear
Mechanism of injury (MOI)
- What happened, exactly
- When
- Where
- Pain
- Noise
Graze
damage to the skin caused by rubbing against
something rough and hard
Cut
an injury made when something sharp pierces the skin
Burn
an injury caused by fire, heat, radiation, chemical
action, electricity, or friction
Neuropraxia
This is a bruising or compression of a nerve
MECHANISMS OF SPINAL INJURY
- Axial loading/compression
- Hyperflexion or extension
- Excessive lateral flexion
- Hyper rotation
- Distraction
Hypovolemia
loss of effective circulating blood volume
Neurogenic shock
loss of tone in blood vessels
potentially causing blood pooling
SIGNS OF SPINAL INJURY
- Central neck/back pain
- Deformity of column
- Paralysis
- Numbness/ pins and needles
- Heavy limbs
VITAL SIGNS
- Heart Rate / Pulse rate
- Pulse Oximetry/Sp02
- Capillary refill
- Respiratory rate
- Blood Pressure
- Temperature
- Pupils
Other vital considerations
- Diabetes/Blood Sugar levels
- Asthma & Inhalers
- Anaphylaxis
- Epilepsy
PULSE OXIMETRY
- Measurement of oxygen levels in arterial
blood - Mainly measured via finger probe
THE ROLE OF LIGAMENTS
Joint Stability
Enable Proprioception
Ligament Injury Management
- Protect & Immobilise
- Rest – think about weight bearing status.
- Ice – for how long/often through which stages
- Compress and/or elevate
- Potentially heat – again for how long/often/which stages
Mechanical Instability
Refers to laxity of a joint due to loss of
mechanical restraint, such as ligamentous tissues
Functional Ankle Instability
Describes the perception that the joint, is
weaker, more painful, or less functional following injury.
Rescuer Safety protocol
*S – Shout for help
*A – Assess the Scene
*F – is it Free from Danger?
*E – if so, Evaluate the Player
SCENE SAFETY / HAZARDS
- Other people
- Animals
- Projectiles (balls, debris)
- Bodily fluids
- Traffic
- Weather & Climatic conditions
Steps of Concussion recognition tool
Recognise and remove
Observable signs
Symptoms
Memory assessment
GB Athletics Grading System
A new muscle injury classification
* Classification based on (grades 0–4) and site (a,
b or c) of injury.
* Site of injury is determined as myofascial (a),
muscular/musculotendinous (b) or intratendinous (c).
* Extent of injury is determined by MRI features of the
muscle injury
Muscle injury modifiable risk factors
– Fatigue
– rest & recovery
– Muscle ‘’imbalance’’
– Training environment
– Length/Strength
– Conditioning
Muscle injury unmodifiable risk factors
– Previous Injury
– Sporting ‘Chaos’
– Age
MUSCLE INJURIES physical signs
- Pain – onset, nature & location
- Reduced range of motion
- Bruising/Swelling
- Force production decrease
- Guarding/Limping
MUSCLE INJURY
TESTING
- Position patient to effectively isolate muscle
in question - Passively assess range of motion
- Resist force production in inner, mid & outer
range - Palpate muscle tissue from
origin to insertion
what do dying cells release
Histamine
How many stages are there in a standardised return to play programme or graduated activity return to sport pathway
6
Lordosis
The excessive inward curvature of the spine. It can affect either at the neck or lower back causing pain and discomfort.
Kyphosis
An abnormality of the spine causing excessive curvature of the upper back. This causes pain and stiffness.
SECONDARY PATHOLOGY
FROM SPINAL INJURY
- Obstructed airway
- Reduced pulmonary ventilation
- Hypovolemia
- Impaired vascular supply to the cord
IMMEDIATE ASSESSMENT of spinal injury
– MILS
– Anterior Hold
– Oxygenate & Ventilate
– Call for help!
MILS
(manual inline stabilisation)
Guidelines state that C-spine X-ray is not required if meet all 5 criteria
- No posterior midline C-spine tenderness
- No evidence of intoxication
- A normal level of alertness
- No focal neurologic deficit – leg/arm weakness or numbness
- No painful, distracting injuries – long bone fractures
How to deal with SOFT TISSUE INJURIES OF THE FACE
– Clean wound with saline
– Haemostasis
– Close wound
EPISTAXIS (NOSE BLEED)
– Cotton roll
– Head forward
– Pressure to bridge of nose
– If bleeding is uncontrolled – refer to A&E
WHAT TO DO WHEN HARD TISSUE INJURY OF THE FACE
– LOOK:
– EYES:
– NOSE:
– EARS:
MOUTH AND JAW injury
Check with gloves
– Tongue,
oral cavity
mandible and temporomandibular joint
Proptosis
eyeball pushed forward
Opthalmoplegia
paralysis of eye muscles
MANDIBULAR FRACTURE
- Step deformity
- Loss of arch form
- Malocclusion of the jaw
Periorbital ecchymosis (bruising)
BASAL SKULL FRACTURE
Muscle imbalance
When one arm is stronger than the other
scoliosis
When the spine twists and curves to the side
ASSESS MUSCLE LENGTH AND
STRENGTH
- Range of movement – is it limited compared to the unaffected side?
- Quality of movement
- Pain
- Discomfort
- Strength compared to unaffected side
Purpose of MILS
- Discourage the spinally injured player from moving the head.
- Protect the head and neck from accidental contact during a busy rescue.
- “Red flag” to others that there is a problem with the neck.
Contusion
A bruise
Laceration
A cut from sharp object
Abrasion
Graze
Return to play pathway 6
- Rest period
- Light exercise
- Sport specific exercise
- Non contact training
- Contact training
- Return to play after 19 days
