Athlete Care, Spinal, and Visceral Injuries

Question 1

Quais são as regras e considerações na avaliação?

Answer 1

Be calm, do not panic; Eye to eye contact with athlete; Airway, Breathing, Circulation – Level of Consciousness ; Mechanism of injury; Position of athlete; Be thorough: Do no harm; Expect the worst; Calm the conscious athlete; Pain location, type, severity; Previous injury; Stabilization; Removal from the field.

Question 2

Qual a informação que devemos procurar na avaliação objetiva?

Answer 2

Visual inspection: deformity, edema, discoloration;
Palpation: DOTS (Deformity, Open wound, Temperature, Swelling);
Neurological check;
Circulatory check;
Stability;
Removal from the field (decision).

Question 3

Quais são os sintomas de lesão do plexo braquial?

Answer 3

Burning or stinging sensation between neck and shoulder radiating into the arm and hand; Arm feels “dead” - numb and weak; Tingling from neck to hand or anywhere in between; Transient paralysis or weakness; Last few seconds to a few minutes; Repeated trauma takes longer to heal; In rare cases the damage can be permanent.

Question 4

Quais as causas e mecanismos de lesão do plexo braquial?

Answer 4

Result of compressive or traction forces on the brachial
plexus;
Force applied in a downward direction to the shoulder at the same time a force is applied to the head in the opposite direction - result is a stretch to the brachial plexus;
Downward force directly to clavicle.

Question 5

O que avaliar em caso de suspeita de lesão no plexo braquial?

Answer 5

History and physical exam;
On the field: dead arm, numb and weak - comes off the field shaking hand as though asleep or arm hanging as if dead;
Nerve function and reflexes evaluated;
Rule out cervical spine injury;
X-rays, MRI, EMG in severe cases.

Question 6

Como lidar com uma lesão no plexo braquial?

Answer 6

Remove from game until full strength and ROM regained in neck, shoulder, and upper extremity (UE).
If down on the field, consider treating as Spinal Cord Injury (SCI).
Subacute PT: modalities, manual therapy, strengthening exercise, posture correction.
Surgery: not a treatment option for true burners

Question 7

Após lesão do plexo braquial, quando poderá haver regresso à atividade desportiva?

Answer 7

The lesion is self limiting: resolve over time.
Return To Play when symptoms resolve; Full ROM and strength; Full practice without limitation before returning to play; Repeated stingers should be evaluated by physician; Extra padding (Cowboy Collar) may be advised; Definitely avoid spearing (lançar).

Question 8

Quais as suspeições quando ocorre fractura do crânio?

Answer 8

Suspect traumatic brain injury, subdural hematoma, epidural hematoma, intracerebral hematoma. It’s Life Threatening!

Question 9

Quais os tipos de fratura do crânio?

Answer 9

Comminuted: piece of the skull may be driven into
the brain (Risk of bacterial infection, meningitis).
Linear: Nasal fracture (Facial fracture can damage nerves as optic and olfactory).

Question 10

Sinais e sintomas de fratura do crânio?

Answer 10

Mecanism of injury; Hit with ball or bat; Fall on to hard surface; Visible deformity; Deep laceration or severe bruise to scalp; Unequal pupils; Discoloration both eyes or behind ears; Bleeding or clear fluid from nose or ears; Loss of smell; Loss of sight or major visual disturbance; Lost Of Conscienceness (LOC) for more than 2 minutes after direct blow to head.

Question 11

Como lidar com a suspeita de fratura do crânio?

Answer 11

Contact EMS - Provide necessary care, CPR/ AED - Clear area of all athletes - Contact parents - Send someone to meet EMS - Medical supplies and equipment - Assist EMS when they arrive, head and neck stabilization - Manage open wounds, light pressure - Treat for shock.

Question 12

Qual o “slogan” da emergência?

Answer 12

“Expect the worst and hope for the best”

Question 13

Como lidar com uma contusão nas costelas?

Answer 13

Mechanism of Injury: blow to the rib cage.
Signs and Symptoms: sharp pain with respiration, point tenderness, pain with compression.
Management: X-ray, RICE.

Question 14

Quais as considerações em fratura de costela?

Answer 14

Mechanism of Injury: block or kick to ribcage, compression of ribcage.
Signs and Symptoms: sharp pain with respiration, crepitus with palpation, point tenderness, abnormality, positive tuning fork test.
Management: X-ray, RICE, brace.

Question 15

E se ocorrer uma separação costo-condral?

Answer 15

Mechanism of Injury: direct blow to anteriorlateral thorax, sudden twist or fall.
Signs and Symptoms: pain localized in the junction of cartilage and ribs, sharp pain with sudden movements, difficulty breathing, rib deformity, crepitus.
Management: X-ray, RICE, immobilization.

Question 16

Como lidar com fratura do esterno?

Answer 16

Mechanism of Injury: high impact blow to the chest.
Signs and Symptoms: point tenderness over the sternum at the site of the fracture, exacerbated by deep inspiration and forceful expiration.
Management: X-ray, monitor closely for signs of trauma to the heart.

Question 17

E se ocorrerem lesões musculares no tórax?

Answer 17

Mechanism of Injury: direct blows or sudden torsions.
Signs and Symptoms: pain with active motion, pain with inspiration/expiration, laughing, coughing, or sneezing.
Management: application of cold for 1 hour, immobilization.

Question 18

Quais as lesões pulmonares mais comuns no desporto?

Answer 18

Pneumothorax; Tension Pneumothorax; Hemothorax.

Question 19

Quais são os sinais e sintomas do pneumotorax? E a fisiopatologia? O que fazer de imediato

Answer 19

Pain, Difficulty breathing, Anoxia.

Pleural cavity becomes filled with air that has entered
through an opening in the chest. As the cavity fills with air, the lung on that side collapses.

Stop the air from going to the cavity! Por exemplo, com umas luvas. Quando a pessoa inspira, a luva penetra impedindo que mais ar entre. A luva pode ser segurada com tape, mas devemos deixar uma porção se fechar para que, quando o atleta expirar, saia algum ar da cavidade.

Question 20

Quais são os sinais e sintomas do tension pneumothorax? E a fisiopatologia?

Answer 20

Shortness of breath and chest pain on the side of the injury; Absence of breath sounds, cyanosis and distention of neck veins; Trachea may deviate away from the side of the injury.

Pleural sac on one side fills with air and displaces the heart and lung toward the opposite side, compressing the opposite lung. Total collapse of the opposite lung is possible.

Question 21

Quais são os sinais e sintomas do hemothorax? E a fisiopatologia?

Answer 21

Pain, Difficulty breathing, Cyanosis, Coughing up frothy blood (lung hemorrhage).

Presence of blood within the pleural cavity; results from tearing or puncturing of the lung or pleural tissue (involving blood vessels in the area). Violent blow or compression to the chest may cause a lung hemorrhage.

Question 22

Quais as considerações acerca de heart contusion?

Answer 22

Mechanism of Injury: Heart is compressed between the sternum and the spine by a strong outside force (hit by a pitched ball; bounces a barbell off the chest in a bench press).
Signs and Symptoms: Severe shock and chest pain; Arrhythmias that cause a decrease in cardiac output.
Management: Transported to the hospital immediately; Be prepared to administer CPR.

Question 23

Quais as lesões que podem ocorrer na zona abdominal?

Answer 23

Abdominal: Muscle strains; Solar Plexus contusion; Stitch in the side; Hernia.

Intra-abdominal: Kidney contusions; Bladder contusions; Liver contusions; Appendicitis; Splenic ruptures.

Question 24

Que considerações em caso de Solar Plexus Contusion?

Answer 24

Mechanism of Injury: Blow to the sympathetic celiac plexus (solar plexus) produces a transitory paralysis of the diaphragm (“wind knocked out”).

Signs and Symptoms: Paralysis of the diaphragm stops respiration and leads to anoxia (usually unable to inhale).

Management: Have the athlete bend their knees; Take short inspirations and long expirations.

Question 25

Quais as considerações clínicas de uma hernia?

Answer 25

Mechanism of Injury: A natural weakness of the of the muscles is aggravated by a strain or direct blow - Inguinal hernias (occur more in men), Femoral hernias (occur more in women).

Signs and Symptoms: Pain or prolonged discomfort from a previous blow or strain to the groin; Superficial protrusion that is increased by coughing or reported feeling of weakness and pulling sensation in the groin.

Management: Surgical management.

Question 26

Quais as considerações clínicas de contusão no rim?

Answer 26

Mechanism of Injury: External force applied (usually to the back of the athlete).

Signs and Symptoms: May display signs of shock, nausea, vomiting, rigidity of the back muscles, and hematuria; May have referred pain - costovertebral angle posteriorly, around the trunk into abdominal region.

Management: Instruct athlete to urinate 2-3 times and note appearance of any blood; Usually a 24-hour hospital stay; gradual increase in fluids.

Question 27

Que considerações clínicas acerca de bladder contusion?

Answer 27

Mechanism of Injury: Blunt force to lower abdominal region (injury occurs only if bladder is distended by urine); Intra-abdominal pressure during long distance running (runners bladder).

Signs and Symptoms: Pain and discomfort in lower abdominal region; May display signs of shock, nausea, vomiting, abdominal rigidity, and hematuria; If bladder is ruptured, athlete won’t be able to urinate; Refers pain to lower trunk and upper thigh anteriorly.

Management: Instruct athlete to urinate 2-3 times and note appearance of any blood; To prevent irritation - empty the bladder before sporting activity.

Question 28

Descreve as considerações clínicas em caso de contusão do fígado.

Answer 28

Mechanism of Injury: Results from blunt trauma; Hard blow to the right side of the rib cage.

Signs and Symptoms: Hemorrhage and shock; Referred pain just below right scapula, right shoulder and substernal area.

Management: Immediate medical attention for diagnosis and treatment.

Question 29

Considerações clínicas da apendicite?

Answer 29

Etiology: High incidence in males (ages 15-25); Caused by a variety of conditions: fecal obstruction, lymph swelling, carcinoid tumor.

Signs and Symptoms: Mild to severe pain in abdomen in lower right abdomen; Associated with nausea, vomiting, and low grade fever; Rigidity and tenderness upon palpation - McBurney’s point (between ASIS and 1-2 inches above the umbilicus).

Management: Surgical management.

Question 30

What considerations about Splenic Ruptures?

Answer 30

Etiology: Fall or direct blow to upper left quadrant of the abdomen when some other condition has caused splenomegaly; Mononucleosis is most likely cause of spleen enlargement.

Signs and Symptoms: Possibly signs of shock, abdominal rigidity, nausea and vomiting; Reflex pain may occur 30 minutes after injury (Kehr’s sign) which radiates to left shoulder and 1/3rd down the left arm.

Management: Conservative non-op treatment; Return to play 3-4 weeks post-injury if asymptomatic.

Question 31

What about Spermatic Cord Torsion?

Answer 31

Mechanism of Injury: Testes revolving in the scrotum after a direct blow to the area.

Signs and Symptoms: Acute testicular pain and nausea/vomiting; Inflammation.

Management: Immediate medical attention to prevent irreparable complications.

Question 32

Testicular Contusion?

Answer 32

Mechanism of Injury: A direct blow to the testicles.

Signs and Symptoms: Acute testicular pain; Nausea/vomiting; Inflammation/swelling.

Management: Immediate medical attention; Ice; Referral dependent.

Question 33

Pelvic Avulsion?

Answer 33

Mechanism of Injury: An aggressive muscular contraction; Direct blow.

Signs and Symptoms: Pain at the attachment site; Limited mobility in the lower extremity; Limited weight bearing.

Management: Immediate medical attention; Ice; Immobilization and referral; Weight bearing limitations.

Question 34

You are the sports physical therapist assigned to ABC High School. Upon arrival in the locker room, you notice the coach lying prone in the locker room. He is unresponsive to verbal stimuli. Upon finding the coach unresponsive, what is the most appropriate response?

Answer 34

The victim must be evaluated to see if they have an intact airway, proper breathing, and a pulse. A phone call to 911 should be made as soon as possible. One round of CPR is acceptable if there is no one to place a call to 911. The AED should be attached as soon as possible as well.

Question 35

You are the sports physical therapist assigned to ABC High School. Upon arrival in the locker room you notice the coach lying prone in the locker room. He is unresponsive to verbal stimuli. You determine the coach is breathing and call 911, after which he regains consciousness. What should you do now that he is conscious?

Answer 35

Assess for a stable cervical spine while waiting for EMS, but continue to have EMS spine board the coach, stabilize his cervical spine, and bring him to the ER.

Question 36

You are the sports physical therapist assigned to ABC high school. Upon arrival in the locker room you notice the coach lying prone in the locker room. He is unresponsive to verbal stimuli. While awaiting the arrival of EMS, you should conduct the following assessment of the coach:

Answer 36

Secondary survey with cervical stabilization from a reliable individual such as a co-worker or coach who has been trained in immobilization.

Question 37

You are the sports physical therapist assigned to ABC High School. Upon arrival in the locker room you notice the coach lying prone in the locker room. He is unresponsive to verbal stimuli. During your secondary survey, you notice the coach’s blood pressure is 220/110 and his pulse is 120. What should you do next?

Answer 37

Notify EMS when they arrive of the coach’s situation, including blood pressure and pulse.

Question 38

You are the sports physical therapist assigned to cover a high school football game. While watching the game you watch a wide receiver catch a pass across the middle of the field and get hit in the chest by the helmet of the defensive back. The receiver goes down and holds on to the ball. The defensive back from your team is prone and not responding. What is the best course of action in the situation?

Answer 38

Direct your attention to the downed player who is not moving. You have seen the mechanism of injury and are concerned about a possible spinal cord injury. Even if you have not seen the mechanism of injury, an athlete who is down and not moving is your utmost consideration. If they are unconscious, a spine injury is suspected and should be managed appropriately. His C-spine should be immobilized, ABC checked and managed appropriately, and a call placed to 911.

Question 39

The player from the other team regains consciousness and removes himself from the field without assistance. The other team doesn’t have a health care professional on their sidelines. The coach from the other team comes to you to inform you that their player is complaining of nausea, dizziness, and lightheadedness and looks very pale. What do you suspect is the problem with the opposing player based on what his coach has told you?

Answer 39

This athlete is showing classic signs and symptoms of shock, which are nausea, dizziness, lightheadedness, and pallor.

Question 40

Who is the person in charge of stabilizing the neck of the suspected spine injured athlete on the field?

Answer 40

The decision should made prior to the injury occurring and a mutual understanding is reached by all parties involved.

Question 41

The defensive back from your team is prone and not responding. After, the receiver sits up and shakes his hand as if it is asleep. What would you first assess in this situation?

Answer 41

The symptoms demonstrated by the athlete in his hand indicate that his nerve function may have been affected.

Question 42

The defensive back from your team is prone and not responding. The unconscious linebacker is removed from the field and brought to the emergency department. As a physical therapist, what is your diagnoses hypothesis for the unconscious linebacker?

Answer 42

Cervical Spine Injury or Unstable Cervical Spine. Always suspect the worst first and manage what you find. These symptoms suggest neurological changes related to trauma.