SPORTS MED Flashcards
Classification of direct injury
Direct injury - caused by an external force applied to the body
Include: fractures, dislocations, sprains and bruises
Signs and symptoms - pain, tenderness, swelling, decreased function and deformity
E.g. bruise, contusion or haematoma - a cork where the knee collided with the body
Bone fracture caused by impact from a hockey stick
Ligament or tendon damage from over extension at a joint due to external impact - basketball hitting the top of fingers
A shoulder dislocation caused by a tackle in footy
Classification of indirect injury
Indirect- caused by an intrinsic force from within an body
Result from: poor technique, lack of fitness and fatigue and poor equipment
Signs and symptoms - pain, tenderness, swelling decreased function and instability
E.g shoulder dislocation from incorrect technique in a handstand
Rolling ankle on uneven surface and over stretching the joint beyond its normal flexibility range
Classification of overuse injuries
Caused by: repeated force on body parts such as bones, tendons and muscles
Signs and symptoms: persistent pain, tenderness, swelling, decreased function
E.g tendonitis - repeated low intensity activity causing tiny tears in the tendon
Doing too much too soon - insufficient rest and recovery time
Stress fractures - small cracks in the bone usually caused by repeated stress which often occurs in the lower leg for instance shin splints
Classification of direct, indirect and overuse injuries
Low impact and repetitive exercise can cause these injuries
Soft tissue injury
Injuries to all tissue except bones and teeth
Muscles, tendons, ligaments, Cartilage, Skin, Blood vessels, Nerves, Organs
Include: tears - sprains and tears
contusions, skin abrasions, lacerations and blisters
Hard tissue injury
Include:
fractures - broken bone, various types of degrees
Classification of fractures:
closed = remains inside the body and doesn’t pierce the skin
open= a break that does pierce into the skin so that the bone can be seen aka compound fractures
complicated = bones cause further damage to major nerves, organs and blood vessels - can be life threatening
dislocations - joint is displaced - always result in various soft tissue injuries as well
loss of teeth
MANAGEMENT of soft tissue injury
The management of soft tissue injuries focuses on controlling the inflammatory response and minimising pain. The management of ricer should be applied for at least the first 48 hours.
R = REST - stop playing the sport or doing the exercise and then rest the area injured. Rest means the soft tissue injury occurred remains still. if an ANKLE, The joint should not be moved. rest is better if the athlete does not engage in any physical activity as this allows the body to focus on healing the injured area.
Rest helps to prevent further damage to the injured site which ultimately insures the inflammatory response is not stimulated again.
I = ICE - ice should be applied over the first 48 hours. 20 minutes on and 20 minutes off is a good method.
Ice helps reduce the pain decreases, inflammation and speeds up recovery.
The ice it self causes vasoconstriction (narrowing of the arteries) around the area, reducing inflammation.
When the ice comes off, the vessels dilate (vasoconstriction) allowing blood to flow through with a momentary increase in the inflammatory response, which allows waste removal a new nutrients to be delivered for repair.
C = COMPRESSION - vital. Helps to reduce or control the inflammatory response and stabilises the joint (if injured). Involves the application of a compression bandage or garment around the injured site. The pressure applied helps force fluid away from the area, reducing inflammation. The bandage can also help produce movement limiting re-injury and providing support for the injured area.
E = ELEVATION - elevation is very important to get correct. Elevation of the injured soft tissue must be above the heart E.G.an injured elbow could be rested on the chest as a personalise down or an ankle needs to be placed on a pillow or two, while the athlete lies flat.
Elevation only works in the management of soft tissue injuries if the site injured is above the heart.
Elevation above the heart assists in the removal of fluid from information, the gravity helps to move the blood and other fluid back towards the heart, reducing or controlling the inflammatory response.
R= REFERRAL - referral of an athlete to a health or medical profession should be done in the management of soft tissue injuries. Allows for proper diagnosis and rehabilitation to be applied if needed.
Will help improve recovery and prevent future injury to the site. Often GPs will provide an anti-inflammatory drug to help reduce pain and improve the recovery of the athlete.
It’s crucial to control the inflammatory response after suffering soft tissue injury because of left to its own devices, the inflammatory response will cause further damage to the area. If too much information increases the pressure around the injury which could lead to damage of cells therefore delaying recovery.
Treatment of deep soft tissue injuries
Soft tissue injuries all stimulate the same inflammatory response from the body which can result in further damage if not controlled through RICER.
Tears sprains and contusions are three types of soft tissue injuries
Strain - occurs in muscle - “pulled muscle”
Strains - muscle tears are caused by internal forces, poor technique or over training
3 grade levels:
1. Grade 1 tear/strain is a small tear to a muscle
2. Grade 2 -tear/strain is much larger tear around 50% or more torn
3. Grade 3 tear/strain refers to a complete tear, surgery is needed to join muscle back together.
Tear e.g. pulled hamstring
Sprain - occurs to a ligament (joining bone to bone around joints)
Caused by: external force being transferred through body often to other side of joint - caused by bent joint action which isn’t meant to move
3 grades: Lateral ankle sprain for example
1. Normal
2. Grade 1 sprain - stretching, small tears
3. Grade 2 sprain - larger but incomplete tear
4. Grade 3 sprain - Complete tear
E.g. a third degree tear is a ligament that has been torn in half and needs surgery to repair. Rolled ankle in netball, or ACL rupture in the knee.
Contusion - capillaries are ruptured causing internal bleeding.
Referred to as: bruise
Caused by : external force upon the soft tissue that results in the capillaries bursting. Contusions are also caused through internal forces being imbalanced resulting in capillaries bursting.
Soft tissue injuries - SKIN
Skin abrasions, lacerations and blisters three other soft tissue injuries, but all occur at the skin level and result from external forces.
Skin abrasion - skin abrasion is a scraping or wearing away of the skin and is usually not very deep. Usually an abrasion is referred to as a graze. The treatment for skin abrasions is normally to clean the wound, washing it with a disinfectant, and then covering it with a nonstick dressing. In the case of a more severe abrasion, the management of blood loss will become the priority, though this is very rare for an abrasion.
An example of an abrasion is a grazed knee from a slide tackle in soccer.
Laceration - A laceration is a deep cut or tear to the skin of resulting from contact with a sharp device. A cut from the kitchen knife is a laceration, but also a cut from an ice hockey skate, bobsled, or a tear from a stud in rugby. Lacerations often result after a head clash or contact with other sport specific equipment.
example is an ice hockey player who gets hit with a stick, cutting his skin open.
Treatment - the treatment for a skin laceration is to manage bleeding. Applying pressure to the area. Depending on the severity of the laceration medication, attention and stitches or surgery may be needed for self managed lacerations, cleaning the wound and applying a nonstick dressing with pressure to control as much bleeding. If bleeding does not stop quickly, ice can be used and further medical treatment is needed.
Blister - a blister is caused by friction or burning that leads to a buildup of serum in the skin athletes often get blisters on their feet due to friction from their shoes. Most often blisters are caused by equipment such as a tennis racket or soccer boot.
The treatment for a blister is to cover it with padding often in the form of a Band-Aid and remove the object, causing the friction/burning. Do not pop the blister, but allow it to heal.
Treatment of skin injuries
Treatment required.
Prevent - primary concern is to prevent infection for victim and first aider.
Stop - stop any associated bleeding by applying pressure to injured part and elevate.
Prevent - prevent infection by cleaning the wound thoroughly with a sterile irrigation.
Apply - apply a non adherent dressing.
Immobilise - immobilise the wound, if it is over a constantly moving part, like the knee or elbow.
Refer - if necessary, refer the person to medical attention.
Skin injuries requiring immediate medical attention
Wounds that require suturing
Wounds that cannot be properly cleaned of foreign material
Head wounds (because even minor injuries to the head might be accompanied by concussion).
Inflammatory response
The inflammatory response is the bodies natural reaction to injury and infection. The inflammatory response involves vasodilation (widening of blood vessels) allowing more blood to the area and more fluid to exit the vessels into the surrounding tissue. Increases the white blood cells (electrolytes) entering the area to clean up debris and fight infection (if injury is open)
Inflammatory response has 3 phases:
Signs of inflammation: 
pain due to chemicals released by damage cells
Swelling or oedema, due to an influx of fluid into the damage region
Redness due to vasodilation the widening of blood vessels and bleeding in the joint, or Structure
Heat - due to an increase in blood flow to the area
Loss of function due to increased swelling and pain
Main functions of inflammatory response:
To protect the injured tissue from further damage
To remove dead cells that have been injured
To enable the tissue to regrow through the production of new blood cells and tissue .
Tissue damage
Stage 1 - healing (inflammation)
Stage 2 - healing (scar tissue formation)
Stage 3 - healing (tissue remodelling)
Injury repair process
PHASE 1 - Acute inflammation
During the cute inflammatory stage, inflammation is fast and painful. The inflammatory response during this phase involves the vasodilation of blood vessels, and the transfer of fluid into the surrounding tissue. The inflammatory response causes secondary (additional) damage to the area, the athlete loses function as inflammation (swelling) is large. New blood vessels begin to be developed in this phase and the area is swollen red and painful the acute inflammatory phase last 48 to 72 hours (2-3 days) and it is during this time that RICER management is most important.
PHASE 2 - Remodelling Inflammation
Modelling phase of the inflammatory response continues to rebuild the injured area. More scar tissue is produced during this phase of the inflammatory response, but also new functional body tissue is developed and strengthened. This tissue can replace scar tissue if proper treatment is sought from health professionals during this phase of the inflammatory response, balance, exercise and rest is important as to much exercise will cause further injury, but not enough. Exercise will result in too much weak scar tissue, this phase of the inflammatory response can last many months and athlete will not be back to full health until this phase is completed, (though they often have already returned to play).
It is crucial to remember that while the inflammatory response is necessary for repair of the injury, too much information causes further damage. There are five signs and symptoms of information: redness, swelling, pain, heat, and loss of function.
Fractures and dislocations
Fractures and dislocations
How much a tissue injuries need to be assessed and manage to quickly.
Best done by immobilising and supporting the injured site in order to:
Reduce pain, reduce serious bleeding or external damage, prevent further internal or external damage, prevent a closed fracture becoming an open fracture.
Fractures - 3 types
Complete - where bone is broken in 2 parts
Incomplete - the break is only part-way through the bone (green stick)
Comminuted - where there are more than 2 breaks in the bone.
Can also be classified as:
Closed - broken bones doesn’t pierce through skin
Open - where the broken bone protrudes through the skin
Complicated - the broken bone damages a nerve, organ or blood vessel
Causes of fractures:
Direct or indirect force
E.g a batter in cricket missed the ball, hits arm and breaks the radius - direct force
Person on rollerblades falls over, extends arm to break fall and breaks wrist - indirect force
Signs and symptoms - swelling, pain, limited movement, deformity
Dislocations - bones displaced from joint
Signs and symptoms - loss of movement at joint, pain at the injured site, obvious deformity and swelling and tenderness
MANAGEMENT of hard tissue injuries
Immobilise fracture important to lessen the pain, reduce bleeding, shock and prevent further damage
Follow DRSABCD
Control any bleeding
Identify type of fracture
Immobilise fracture with broad bandage
Ensure bandages do not cut off circulation
Handle gently
Call for medical help
Because hard tissue injuries can be accompanied by damage to muscle. Blood vessel surrounding organs are nerves. Immediate medical treatment is required.
For serious hard tissue injuries, the person should not be moved and an ambulance should be called.
Immediate management:
Immobilise and support injured site with splint or sling
Check for impaired circulation and other complication
Arrange for transport to hospital and professional medical assessment
Implement RICER procedure if it does not cause pain
Managing hard tissue injuries
1. Aims to minimise movement, achieved by immobilisation of the joint above and below the injury site.
2. If injury site is a long bone injury can be supported with a sling or splint.
3. should be long enough to extend beyond the nearest joints of the injured site.
4. A splint can involve: another limb, another part of the body, a firm straight object when correctly applied.
Management of dislocations
Follow DRSABCD
Do not attempt to put joint back in place (this must be done by a sports specialist as there is risk of nerve damage if the bone is not put that correctly)
Try to support the dislocation in a comfortable position
Seek medical advice
Assessment of injuries:
DRSABCD
Once this procedure has been completed, next step is to apply STOP procedure
1. Stop - get the injured athlete to stop what they are doing and stop the game to avoid further damage.
2. Talk - ask the injured athlete. What happened? Where does it hurt? And did you hear anything?
3. Observe - observe the injured area to see if there is any abnormality.
4. Prevent - prevent further damage by conducting a more comprehensive assessment using TOTAPS
Assessment of injury: TOTAPS and the entire assessment procedure
TOTAPS:
TALK - Talk to the injured athlete and ask questions like:
What happened?
Where does it hurt?
Did you hear anything?
Has this injury happened before?
Are you allergic to anything?
The sports medicine practitioner is then able to gain a greater understanding of the injury.
OBSERVE - Observe the injured body part. The sports medicine practitioner can then compare it to other similar body parts to see if there’s swelling, deformity or discolouration.
Note: if during observing the injury you suspect or see a fracture, stop assessment here and manage as a hard tissue injury.
TOUCH - Ask the athlete if you can examine the injured body part. When examining injured site:
Ask athlete to rate the pain on a scale of 1-10 (1=no pain and 10 = excessive pain)
Start by touching away from inured site and work your way towards the injury.
Locate the exact location of injury.
Feel for tenderness, heat and abnormality
Note: if suspect a soft or hard tissue injury, stop assessment and treat with either soft or hard tissue management.
ACTIVE MOVEMENT - ask the athlete is the inside part by themselves until it becomes painful. Well, the athlete is doing this. The sports medicine practitioner can observe the range of movement at the injured site and the pain response from the athlete.
Note: if there is pain, stop assessment and treat as soft tissue management.
PASSIVE MOVEMENT - if there was no pain during the active movement, the sports medicine practitioner will slowly move the injured body part through the normal range of movement. The aim is to see if there is pain while the part is ongoing the full range of movement.
Note: if there is pain, stop assessment and treat as soft tissue management
SKILLS TEST - if no pain was experience during passive movement, then the athlete should undertake a skills test specific to the sport to ensure the injured area is able to move through its full range of movement without pain. If no pain is experience during the skills tests and full range of movement is evident, the athlete can return to the game.
Note: if at any stage during the skills test, the athlete experiences pain, stop and treat with soft tissue management.
Children and young athlete demands
