Mechanisms and Characteristics of Sports Trauma

1. Mechanisms and Characteristics of Sports Trauma

2. Basic Injury Terms (please note that some pictures may be graphic) • Soft Tissue Trauma • The skin = wounds • Abrasion • Incision • Friction blister • Laceration • Avulsion • Puncture • Contusion

3. Abrasion - skin is scraped away against a rough surface. The epidermis and dermis are worn away, exposing numerous capillaries Incision - skin is sharply cut

4. Laceration - a wound where the flesh has been irregularly torn • Avulsion - skin is completely ripped from its source

5. Skin bruise - a blow compresses or crushes the skin surface producing bleeding under the skin - called a contusion • Puncture - penetration of skin by a sharp object

6. Friction blister - continuous rubbing over the surface of the skin causes a collection of fluid below or within the epidermal layer

7. Care for blisters • Prevention: • Talcum powder or petroleum jelly can protect skin against abnormal friction • Wearing tubular socks or 2 pairs of socks • Correct size shoe • Shoes must be broken in • Treatment: • Leave intact first 24 hrs. • Popping a blister depends on pain and severity • Avoid infection by cleaning with antiseptic soap • May use 2nd skin or moleskin • Doughnut pad may decrease pain

8. Soft Tissue Trauma • Skeletal Muscle Trauma • Contusions: Superficial to deep • Hematoma may be formed by localization of the bleeding into a clot

9. Strains - stretch, tear or rip in the muscle tissue or tendon • Possible causes: abnormal muscle contraction due to a strength imbalance, electrolyte imbalance • May range from a minute separation of connective tissue and muscle fibers to a complete tendinous avulsion or muscle rupture

10. Soft Tissue Trauma • Strains Grade I = Some muscle fibers stretched or torn, mild tenderness, pain on active motion but full range of motion (ROM) is possible, no discoloration, mild loss of strength Grade II = Some muscle fibers torn, extremely painful, loss of strength and movement, discoloration due to capillary bleeding, possible divot felt Grade III = complete rupture, significant impairment or total loss of movement, pain is intense but quickly diminishes due to complete nerve separation

11. Soft Tissue Trauma • Muscle Soreness • 2 Types: • Acute-Onset Muscle Soreness - usually accompanies fatigue, during and immediately after exercise • Delayed-Onset Muscle Soreness (DOMS) - appears 12-24 hrs after exercise. Most intense 24-48 hrs later. Takes about 72 hrs to go away

12. Soft Tissue Trauma • Tendon - attaches muscle to bone • Tendonitis - inflammation of the tendon-muscle attachments, tendon or both due to overuse • Gradual onset, diffuse tenderness, swelling, pain • Grade I = pain before, no pain during, pain after • Grade II = pain before, during and after but sill functional • Grade III = pain all the time and debilitating

13. Joint Trauma • Ligaments • Connect 2 bones • Primary Function = motion control and stability • Sprain = stretching or tearing of ligaments, joint capsule, or both

14. Cartilage • Connective tissue that provides firm and flexible support • Because of its great strength, cartilage can be deformed without damage and still return to its original shape • Occurs throughout body and consists of 3 types: • Hyaline - nasal septum, trachea, larynx, articular ends of bones of the synovial joints • Fibrous - vertebral discs, meniscus • Elastic - external ear, eustachian tube

15. Hyaline • no direct blood supply • Receives nourishment from synovial fluid • Acts like a sponge • Articular cartilage • Motion control • Stability • Load transmission

16. Joint Trauma • Sprains • Grade I = some pain, mild pt. tenderness, mild loss of function, little to no swelling, little to no discoloration, no instability • Grade II = pain, moderate loss of function, swelling, and moderate instability • Grade III = extremely painful, major loss of function, severe instability, swelling, rupture of the ligament

17. Joint Trauma • Dislocations: complete joint disruption • 2nd to fractures in terms of disabling the athlete • Highest incidence = fingers, shoulder, elbow • 1st time dislocations (all except finger) should always be treated as emergencies and 911 called (finger should be referred but not an emergency)

18. Skeletal Trauma • Acute Bone Fractures: disruption in the bone’s continuity • Depressed • Greenstick • Impacted • Longitudinal • Spiral • Transverse • Comminuted • Avulsion • Open or compound

20. Skeletal Trauma • Stress Fractures • Weakened areas of bone • Starts as stress reaction and progresses to stress fracture • Causes - theories include: • Coming back from injury too soon • Going from one event to another without proper training • Starting too quickly • Changing environment (running surfaces, shoes, etc.) • Postural and foot mal-alignments

21. Skeletal Trauma • Stress Fractures • Common areas: tibia, fibula, metatarsals (3rd and 4th), calcaneus, femur, lumbar vertebrae (extension athletes), ribs, humerus • Signs and symptoms: progression of pain from intermittent to constant, more intense at night, focal to one spot, swelling, does not respond to treatment • Management: send athlete for xray to rule out fx; possible bone scan may be necessary if pain persists and xray is negative, usu. walking boot is recommended