Sports Injuries

Question 1

What is bursitis?

Answer 1

Inflammation of the bursa that presents with redness, pain and swelling
Affects the joints

Question 2

What is tendinitis?

Answer 2

Repetitive or overuse, improper training techniques that causes inflammation of tendons (attach bone to muscle), causing pain during movement
Affects areas near joints

Question 3

What is a strain?

Answer 3

A tear in the muscle/tendon due to over-exertion/stretching, repetitive movement or trauma
Disrupts ability to move, causes pain and swelling

Question 4

What is a sprain?

Answer 4

Tear in the ligament that disrupts stability

Caused by trauma from twisting/falling, which causes pain, swelling, tenderness and bruising

Question 5

What is a stress fracture?

Answer 5

Micro-breaks in the bone caused by over-use (a load injury)

Question 6

What is plantar fasciitis?

Answer 6

Inflammation of the periosteum of the bottom of the foot that causes pain while walking.
Can be caused by overuse or poorly fitting footwear

Question 7

What are shin splints?

Answer 7

Inflammation of the muscles and surround tissues of the lower leg around the tibia that causes pain during and after exercise
Often caused by high impact exercise that overloads the tibia

Question 8

What are red flags of an emergency sports injury?

Answer 8

Severe pain
Obvious fracture
Joint deformity
Inability to bear weight on injured limb

Question 9

How do we treat an injury during the first 2 days?

Answer 9

RICE Method
Rest for at least 24 hours
Ice for 10-30 minutes q3-6h x 48h
Compress using an elastic bandage
Elevate above heart level to drain fluid and reduce swelling

Question 10

How do we treat an injury from days 2-14?

Answer 10

Can treat with heat

20-30minutes q2-4h prn

Question 11

How do we treat an injury after 14 days?

Answer 11

Refer to a physician

Question 12

What signs during treatment warrant referral?

Answer 12

Visible joint changes
Pelvic/abdominal pain
Pain present >2 weeks or >7 days after starting treatment
No swelling/bruising
Symptoms not attributable to overexertion/injury

Question 13

How many days can you use OTC NSAIDs to treat pain?

Answer 13

Up to 5 days

Question 14

How do NSAIDs affect the kidneys? How can we reduce risk?

Answer 14

Can cause pre-renal injury (dehydration) and intra-renal injury (actual damage to the organ)
Reduce risk:
Stop NSAIDs if they can’t eat/drink
Avoid combining ACE/ARBs + diuretics + NSAIDs
Start with the lowest effective dose and go slow

Question 15

How do NSAIDs affect the stomach? How can we reduce this risk?

Answer 15

Disrupt the mucous layer, inhibit bicarbonate secretion and can cause epithelial necrosis. NSAID use can lead to dyspepsia, heartburn, ulcers and death.
How to reduce risk:
Don’t use for long periods
Avoid drug interactions
Choose -coxibs, especially if they have a prior bleed
Add misoprostol/a PPI as a proactive gastroprotector

Question 16

How do NSAIDs affect the heart? How can we reduce the risk?

Answer 16

Increase blood pressure.
Reduce risk:
Avoid NSAID use in high risk patients
Avoid administering with ASA as they have a theoretical interaction– take ASA 30 minutes before or 8 hours after ibuprofen
Choose non-selective NSAIDs (better to risk the stomach than the heart)
Monitor BP

Question 17

What are the downsides of COX-1/2 selectivity?

Answer 17

COX-1 selectivity (naproxen and ibuprofen) increases gastrointestinal risk
COX-2 selectivity increases cardiovascular risk
Better to have drugs that are in the middle for most people, like celecoxib and diclofenac