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Sports and Exercise Medicine iBSc > Muscle Injuries in Sports > Flashcards

Muscle Injuries in Sports Flashcards

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1
Q

Muscle injuries in sports medicine

A

Most common, misunderstood + inadequately treated conditions

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2
Q

Muscle injuries account for what percentage of all injuries in sport

A

10-30%

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3
Q

Muscle injuries often occur during

A

Sport or training

Over 90% caused more often by indirect trauma (overloading) OR by direct trauma (impact)

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4
Q

What strains were most common injury occurence

A

PTM

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5
Q

What is most common muscle injury in track and field

A

Hamstrings- 20.4%

Followed by quads, then gastrocnemius calf injuries- depends on sport though

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6
Q

Which hamstring makes up 75% of the hamstring injuries

A

Biceps femoris

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7
Q

How much more likely are men to sustain a hamstring strain than women

A

64%

Men had significantly higher rates of hamstring strains than women during both games and practices

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8
Q

Hamstring injuries preseason

A

No differences between men and women

BUT men significantly more likely to sustain strain during in-season

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9
Q

Epidemiologically, muscles have been…

A

Increasing over the last 12 years despite assessing RFs and applying prevention controls

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10
Q

Depending on leg position and relationship to the ground, the hamstring can serve as a

A

Hip extensor
Knee flexor
External rotator of hip and knee

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11
Q

Short head of the biceps femoris innervation

A

Common peroneal nerve

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12
Q

Long head of the biceps femoris innervation

A

Tibial portion of the sciatic nerve

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13
Q

Hypothesis of discordant contraction in biceps femoris

A

Due to dual innervation

Can lead to injury

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14
Q

Two different types of acute hamstring strains

A

Most common injury type occurring during high-speed running

Other occurs during movements leading to extensive lengthening- e.g. high kicking, sliding tackle and sagittal split

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15
Q

High-speed running hamstring injury

A

Mainly located on long head of biceps femoris

Typically involves the proximal muscle-tendon junction

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16
Q

Extended lengthening hamstring injury

A

Stretching-type
Located close to the ischial tuberosity
Typically involves tendon tissue of the semimembranosus

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17
Q

High-speed running hamstring injury vs stretching type

A

Running one cause a more marked acute functional impairment
BUT requires a shorter rehab compared to stretching
Rule of thumb- the closer to the ischial tuberosity, the longer the rehab

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18
Q

Injury location hamstring

A

Determined both by maximal pain upon palpation by MRI during the first 2 weeks after injury occurrence

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19
Q

High speed running hamstring injury rehab

A

Common for athlete to experience a considerable improvement 4-6 days after the injury has happened, especially with respect to pain, strength and flexibility
BUT healing only at initial stage here and risk of re-injury evident, since injured tissue less able to absorb energy

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20
Q

Stretching type hamstring injury rehab

A

Important to inform the athlete that the rehabilitation period is likely to be prolonged, even though the initial symptoms are relatively mild in terms of pain and functional impairment
The athlete can undergo demanding rehabilitation training early on, as long as pain-provoking exercises are avoided. Passive stretching and heavy load exercises appear to provoke the stretching-type of injuries by increasing pain

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21
Q

Hamstring injuries definition

A

Acute Non-Contact Posterior Thigh Muscle injuries, with all the athletes reporting an incidence during training or competition, either structural or functional, presented with the Musculoskeletal triad, leading to a time loss more than a day

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22
Q

Muscle injury grading 2014

A

Classification based on extent (grades 0-4) 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

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23
Q

The first MR study that described findings with poor prognosis of muscle injury evaluated 14 patients and found that

A

muscle rupture and retraction, haemorrhage, ganglion-like fluid collections, and greater than 50% cross-sectional involvement were associated with convalescent periods of more than 6 weeks

24
Q

MRI imaging often reserved for

A

The more severe injuries where a rupture is suspected

25
Q

What decides if surgery needed

A

Determining the extent (partial vs complete) and location of rupture, as well as the extent of tendon retraction in the case of complete rupture

26
Q

Imaging Grade 0

A

Normal US

27
Q

Imaging Grade 1

A

Subtle US findings

Ill-defined hyperechoic or hypoechoic intramuscular areas or a swollen aponeurosis

28
Q

Imaging Grade 2

A

Partial muscle tears

Haematoma formation

29
Q

Imaging Grade 3

A

Complete muscle tears

Haematoma formation

30
Q

MRI and hamstrings

A

70% of hamstring injuries seen in professional football

showed no signs of fibre disruption on MRI

31
Q

Muscle injury Grade 1 tissue damage

A

Few muscle fibres involved

32
Q

Muscle injury Grade 1 symptoms

A

Not apparent until conclusion of activity

Very little swelling and pain only with activity

33
Q

Muscle injury Grade 2 tissue damage

A

Moderate number of fibres involved with intact fascia

34
Q

Muscle injury Grade 2 symptoms

A

Immediately painful and moderately sore to palpation

35
Q

Muscle injury Grade 3 tissue damage

A

Many fibres involved with incomplete fascial injury

36
Q

Muscle injury Grade 3 symptoms

A

Immediately painful and sore to palpation
Patient may limp to avoid pain
Severe pain with flexion vs, resistance and/or full extension

37
Q

Muscle injury Grade 4 tissue damage

A

Complete dissociation of fibres and fascia

Complete rupture

38
Q

Muscle injury Grade 4 symptoms

A

Immediate severe pain
Ecchymosis below area
Palpable defect

39
Q

Clinical Anatomical classification- 1st grade

A

Mild

Partial number of injured fibres

40
Q

Clinical Anatomical classification- 2nd grade

A

Moderate

Incomplete number of injured fibres

41
Q

Clinical Anatomical classification- 3rd grade

A

Severe

Complete number on injured fibres

42
Q

Classifications based on

A 
Within 6h detailed history & thorough clinical examination
48 hours post injury re evaluation
Active range of motion
Ultrasonographically findings
Recorded time to full rehabilitation
43
Q

Clinical evaluation at 48 hours

A

Palpation of the posterior aspect of the thigh with the athlete prone to elicit tenderness if present
Provocation of pain on isometric contraction of the posterior thigh muscles
Provocation of pain on passive hip flexion with the athlete supine

44
Q

Triad for inclusion in study

A

Tenderness to palpation
Pain with resisted movement (knee flexion, extension of hip)
Pain with passive stretching flexion of the hip with the knee extended

45
Q

Total ham ruptures in elite athletes

A

Not common

46
Q

Posterior thigh muscle injuries- 1st and 2nd degree

A

Functional injuries

47
Q

Posterior thigh muscle injuries- 3rd and 4th defree

A

Structural injuries

48
Q

Most of Ham injuries are

A

Functional

49
Q

Operative intervention

A

Severe injuries, e.g. complete rupture, either at insertion or origin, typically result from extreme and forceful hip flexion with knee fully extended (e.g. water skiing)
Often may require operation with extensive rehab

50
Q

Hamstring strain injury common signs and symptoms

A

Sudden onset
Minimal to severe pain
Difficulty walking or running
Local haematoma likely with more severe injuries
Substantial local tenderness possible
Defect at site of injury
Substantial decrease in strength
Substantial decrease in flexibility
Negative slump test
Palpation of gluteal trigger points doesn’t influence hamstring symptoms
Occasionally abnormal lumbar/sacroiliac exam
Abnormal local ultrasound, except for very mild strains

51
Q

Posterior thigh referred pain from another source (not hamstrings)

A 
Sudden or gradual onset
Minimal to moderate pain
May describe tightness or cramping
Able to walk or run with minimal change in symptoms during activity
No haematoma
Minimal to no tenderness on palpation
Minimal to none decrease in strength
Minimal to none decrease in flexibility
Frequently +ve slump test
Palpation of gluteal trigger points may reproduce hamstring symptoms
Frequently abnormal lumbar/sacroiliac exam
Always normal ultrasound
52
Q

Hamstring reinjury definition

A

Injury at same site as index injury
Early= within 2 months
Late= 3 to 12 months

53
Q

Reinjury- athletes with acute grade II hamstring injuries

A

Experience higher risk of re-injury than athletes with grade I, III, IV straings

54
Q

Re-injury recurrence rate

A

12-31%

55
Q

High risk of reinjury

A

Early return to sport

Poor rehab programme

56
Q

high rate reinjury factors

A

Persistent weakness in injured muscle
Reduced extensibility of musculotendon unit due to residual scar tissue
Adaptive changes in the biomechanics and motor patterns of sporting movements following original injury
RFs that contributed to original injury (e.g. strength + control lumbopelvic muscles + quad tightness)
Previous injury
Age

Sports and Exercise Medicine iBSc (13 decks)

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