Nature of Injury In Sport Flashcards
What are some of the benefits to exercise?
- Mental health benefits
- Prevention and treatment of disease
- Social and recreational benefits
- Tend to be more aware of other factors of good health
What are the risks in sport, what sports have higher risk?
-Risks: injury, death due to nature of sport, sudden death during exercise
-Overall risk of death is low, only 1.3% accidental deaths in UK.
Injury risk is larger with over 20million sports injuries/year in UK.
-High risk sports have higher risk, usually sports involving height, water or speed.
What are the most common anatomical sites for sport injury?
- Lower leg
- Upper limb
- Head and neck
- Knee
- Chest/abdo
- Upper leg
What are macrotrauma injuries and give some examples?
Major trauma injury, characteristically sistained during sudden event/impact:
- Fractures/dislocations
- Muajor muscle, ligament and tendon injuries.
- Head and spinal injuries
- Chest and abdo injuries
What are microtrauma injuries and what may cause them to occur?
Overload injuries which will cause tissue damage, may be caused by:
- Increased participation
- Increased intensity and duration of training
- Extrinsic factors: training errors, poor technique, poor conditions, incorrect equipment)
- Intrinsic factors: anatomical and muscle imbalance
Describe the cycle of injury that tissue damage from microtrauma injuries can cause?
The tissue damage will cause inflammation and then pain.
At this point the athlete will either rest, heal and go through rehab to correct the cause of injury.
Or they will continue activity which will lead to further damage, inflammation and pain.
What may cause injury to bone?
- Direct trauma(tackle)
- Indirect trauma(twist or fall)
In what ways can bone injuries be classified?
- Open (skin is breached) -Closed (skin not breached)
- Tranvsverse
- Oblique
- Spiral
- Comminuted
- Avulsion (piece of bone attatched to tendon or ligament is torn away)
What are the clinical features of bone injury?
- Pain
- Tenderness
- Swelling
- Localised bruising
- Deformity
- Restriction of movement
How may bone injury be managed?
- Anatomical and functional reallignment
- Plaster cast or surgical stabilisation
What complications may arise in bone injuries?
- Infection (more likely in open fractures)
- Associated injury to nerve or blood vessel
- Delayed union/malunion/non-union
- DNT/pulmonary embolism (prevent with early movement)
- Acute compartment syndrome
What is acute compartment syndrome and how may it be treated?
-Secondary swelling in a muscle comparment with non-distensible fascial sheath. Gives severe pain.
Treated by fasciotomy.
What are some further problems that bone injuries could lead to?
- Immobilsation (if prolonged could lead to muscle wasting and joint stiffness.) Limit with early movement.
- Periosteal injury (uncommon)
- Soft tissue damage
- Growth plate fractures (kids): danger of interruption of obony growth eg.elbow, dital femur, tibia and fibula.
Where do we find articular cartilage and what does it do?
- Lines ends of long bones
- Absorbs shock and compressive forces, permits almost frictionless joint movment.
How would articular cartilage injury be diagnosed?
- Initial X-ray often normal
- Suspect if ‘sprain’ remains painful and swollen longer than expected.
- MRI can be used to diagnose
- Arthroscopy to confirm and remove loose fragments.
How may articular catilage injury come about and give some examples of common site?
- Usually with shearing forces such as dislocations (common sites: talus, femoral condyles, patella, humerus)
- Also associated with soft tissue injuries eg.ACL rupture
What may articular cartilage injury predispose a patient to?
-Osteoarthritis
Is healing usually good for articular cartilage injury and how can we aid this?
- Doesn’t heal fully
- Improve through:
- Perforation
- Cell transplantation
- Alteration of joint loading.
What injuries may occur to skin?
-Wounds, cuts, laceration
How may skin injuries be managed?
- Stop bleeding
- Prevent infection
- Immobilise if needed (if over moving joint)
- Check tetanus status
What may cause nerve injuries and are they common in sports?
- Uncommon
- Caused by direct blow (ulnar nerve at elbow or common peroneal at neck of fibula).
What may be symptoms of nerve injury?
- Tingling
- Numbness
- pain in distribution of nerve
What may severe neuropraxia lead to and how may this be helped?
- Paralysis and weakness of muscles innervated by nerve with assocaited sensory loss.
- Support in brace temporarily and until spontaneous resolution.
What are bursa and what is their role?
- Small fluid sacs, usually between a tendon and a bone.
- Role is to reduce friction
Where may bursa injuries occur, and what can cause them?
- Hip, knee, shoulder, feet, elbow
- Mostly from overuse but can be traumatic with bleeding
How can bursa injury be managed?
- Ice
- Compress
- Anti inflammatory
- Ocassionaly aspiration
What increases joint stability and how do they form ligaments?
- Capsule of connective tissue
- Thickened at points of stress to form ligaments
What grades can ligament injuries be classified into?
- 1: fibres stretched but normal range on stressing
- 2: more fibres involved, laxity on stressing nut definite end point
- 3: complete tear, excessive laxity and no end point. May be pain free as nerve fibres torn.
Generally, initially how can ligament injuries be managed?
-Initially minimise bleeding and swelling.
How can grade 1 and 2 ligament injuries be managed?
- Promote tissue healing
- Prevent joint stiffness
- Protect against further damage
- Strenghten muscle to provide addtional joint stability
(eg. soft tissue massage, electrotherapeutic therapies, joint mobilisation).
How can grade 3 ligament injuries be managed?
- Conservative
- Potentially surgical (direct repair or reconstruction)
What injuries can be common at joints?
-Dislocation/subluxation
Define dislocation?
-Trauma produces complete dissociation of articulating surfaces.
Define subluxation?
-Some contact of articulating surfaces remains.
Why is joint stability important and what does it depend on?
- Important as more stable joints will need more force to dislocate
- Dependant on anatomy
What do joint injuries result in?
-Damage to joint capsule and surrounding ligaments.
What are some complication involved in joint injuries and what can be done to exclude fractures?
- Associated nerve or blood vessel damage
- X-ray to exclude fracture
How can joint injuries be treated?
- Protect to allow soft tissue to heal
- Rebuild muscle strength
- Early protected mobilisation
- Muscle relaxants may be needed
- Reduction
How do injuries to muscle most commonly occur and what are some of the most commonly affected muscles?
- Occurs when demands exceed muscle capacity
- Common if 2 joints cross
- Common during sudden acceleration and decceleration
- Commonly affected; hamstring, quadriceps, gastrocnemius
What 3 grades can muscle injuries be classified into?
- 1: few fibres, localised pain and no loss of strength
- 2: significant no. of fibres, selling, pain on contraction, reduced strength and limitation of movement
- 3: complete tear, most common at musculotendinous junctions
How can muscle injuries be managed?
- 1st aid to minimise bleeding and swelling and inflammation
- Electrotherapy eg. ultrasound
- Soft tissue therapy
- Stretching
- Strenghtening
What are some predisposing factors that may lead to muscle injury?
- Inadequate warmup
- Insufficient joint range of motion
- Poor technique
- Previous injury
- Excessive muscle tightness
- Fatigue/overuse/inadequate recovery
- Altered biomechanics
List some common muscle injuries?
-Contusions
-Quadriceps rupture
Hamstring rupture
What may cause a quadriceps rupture?
-Direct impact against contracted muscle
OR
-Sudden vigorous contraction
-Normally on rectus femoris as its close to quads tendon
What may cause a hamstring rupture and what are some symptoms and signs?
- Overload and forceful contraction
- Symptoms and signs: -sudden intense pain
- muscle spasm
- tenderness and swelling
- sometimes palpable gap
How may hamstring ruptures be treated?
- PRICES
- NSAIDS
- Electrotherapy
- Surgery in sportspeople
- Strength and stretching eexercises
What may cause contusions?
-Results from direct blow from opponent or contact with equipment. This will result in local damage and bleeding.
How should contusions be managed?
- Manage bleeding and swelling
- Electrotherapy
- Stretching and strengthening
- Avoid heat, alcohol and vigorous massage initally
How may a contusion have been prevented?
Wearing protective equipment.
What is myositis ossificans and when is it most common?
- Occurs when haematoma calcifies
- Most common when there is a severe contusion
How should myositis ossificans be diagnosed and what is recovery like?
- Suspect if slow resolution and diagnose on x-ray after 10-14 days.
- Most resolve spontaneously and recovery is slow
What do normal tendons consist of?
-Tight paralell bundles of collagen fibres
Where do tendon injuries tend to occur?
-Usually at point of least blood supply eg. achilles tendon at musculotendinous joint.
What types of tendon ruptures may occur and how do ruptures usually occur?
- Complete
- Partial
- Usually occur without warning (more common in older athlete).
What are the most commonly injured tendons?
Achilles and supraspinatus
Anatomically, where does the achilles tendon run?
-From calf muscle (gastrocnemius) to insert into posterior aspect of heel (calcaneum).
What type os injury is achilles tendonopathy?
- Chronic repetitive overload injury
- Common with sudden increase in activity or change in technique.
What ae some of the symptoms of achilles tendnopathy?
- Pain esp. uphill
- local swelling
- local tenderness
- crepitus on ankle movement
How can achilles tendonopathy be prevented?
- Proper warm up and stretching
- Good shoes with no heel tabs
- Heel wedge
How may achilles tendonopathy be treated?
- Heel wedge
- NSAIDs
- Active rest
- No steroid injections
- Alter training (no hills, decrease pace)
- Immobilisation
- Surgery for chronic tendonitis or rupture
What are some complications that may arise in an achilles tendonopathy patient?
- Achilles bursitis
- Rupture
- Chronic tendonitis
