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Feb 1 - recognizing different sport injuries.doc

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University of Alberta
Physical Education and Sport
Brad Kern

Feb 3 – Recognizing Different Sport Injuries Load Characteristics • Bones can be stressed or loaded to fall by tension, compression, bending, twisting and shearing • Either occur singularly or in combination • Amount of load also impacts the nature of the fracture • More force results in a more complex fracture • While force goes into fracturing the bone, energy and force is also absorber by adjacent soft tissues • Some bones will require more force than others Dislocations and Sublaxations Dislocation • At least one bone in a joint is forced completely out of normal and proper alignment • High level of incidence in fingers, elbow, and shoulder. Sometimes seen in ankles. Elbows are more difficult to dislocate due to the bony makeup and the acromion process. Its pretty stable but it can still be dislocated. • Elbow dislocations can also cause fractures Sublaxation • Partial dislocation causing incomplete separation of two bones • Often occur in shoulder and females (patella) • It occurs higher in females patella due to their wider hips which widen the Q angle. As the Q angle increases, the patella becomes unstable and there is a greater chance of MCL injuries Male pelvis’s are more narrow • S&S of dislocations • Deformity – almost always present. If you have a shoulder dislocation, you should see your humerus stick. Most shoulders that dislocate, pop out anteriorly and inferiorly. Exterior rotation, abduction can cause shoulder dislocation. • Don't reduce (put it back in) the shoulder. X-ray it and see if you can see any damage to nearby tissues, nerves, or vessels. • Loss of function • Swelling, point tenderness • If you have common dislocations, your doctor may teach you how to reduce it. Additional Concerns • Avulsion fractures – sometimes the ligaments and muscles have such a strong junction, the bone will give before the muscle or tendon tears. This will cause avulsion fractures • Growth plate separation – always remember high school kids are growing. We don't want to ultrasound pre pubescent kids because this can close the growth plates. A fracture can cause the growth plate to close. • Once a dislocation, always a dislocation. This means you are more apt to get a dislocation once you initially get a dislocation. The tissues after a dislocation get weak and stretched so the joint isn’t stable at all anymore. The only way to fix this is by surgery. The joint capsules don't heal naturally. Treatment • Dislocations (particularly first time) should always be considered and treated as a fracture until ruled out • X-ray is the only absolute diagnostic technique • Return to play is often determined by extent of soft tissue damage. When you dislocate something, you are most likely to damage soft tissue damage as well. Ligament Sprains Sprain: damage to a ligament • Ligaments provide support to a joint Sprains usually happen to synovial joints Synovial Joint Characteristics • 2 or more bones • Capsule or ligaments • Capsule is lined with synovial membrane • Hyaline cartilage • Joint cavity with synovial fluid • Blood and nerve supply with muscles crossing joint • Mechanoreceptors within joint structures provide feedback relative to position • Some joints will have meniscus (thick fibrocartilage) for shock absorption and stability Ligaments • Thickened portions of the capsule or totally separate bands • Dictates partially the motions of the joint • MCL is probably part of the joint capsule • The LCL is all by itself and not part of the joint capule • The joint capsule secrete fluid into the synovial membrane to produce good articulation Sprains • Result of traumatic joint twist that causes stretching or tearing of connective tissue • Graded based on severity of injury Grading System • Grade 1 – some pain minimal loss of function, no abnormal motion, and mild point tenderness, slight swelling and joint stiffness. This ligament has become stretched. No tearing, just stretched. It doesn’t have the same stability as it once did. When doing a stress test on a grade 1 sprain, there will be no problem with laxity but there will be pain. • Grade 2 – pain moderate loss of function, swelling, and instability, some tearing of ligament fibers, and joint instability. Can range from one fiber being ripped to only fiber being left. Will have an endpoint. Grade 2 will present us with problems with laxity and lots of pain. The extent of laxity can give us an idea of how severe is the injury • Grade 3 – extremely painful, inevitable loss of function, severe instability and swelling, and may also represent sublaxation. This is a complete rupture of the tissue. Someone with an ATFL ligament that is gone wont feel it if they dislocated their leg. Theres nothing to stretch due to no fibers being present. There will be general pain due to swelling. The insertion pint for the LCL is the head of the femur Grade 3 sprains are very unstable • Restoration of joint stability is difficult with grade 1 and 2 injuries. With a grade 3, you can at least get surgery to repair it. • must rely on other structures around the joint • rely heavily on muscles surrounding joint • must strengthen the muscles and tissues around the grade 1 and 2 sprains • ligament has been stretched/ partially torn causing development of the inelastic scar (lligament will not regain original tension) • increased muscle tension due to strength training will improve joint stability Contusions • result of a sudden blow to body • can be both deep and superficial • hematoma results from blood and lymph flow into surrounding tissue • minor bleeding results in discoloration of skin • may be painful to the touch with active movement • areas that receive multiple blows should be padded • if you are in a sport where you get contusions a lot, you should let your contusions heal. Or else there could be bone in the muscle due to blood pooling in your muscle. • must be cautious and aware of more severe injuries associated with repeated blows • calcium deposits may form with fibers of soft tissue • myositis ossifications is the above • prevention relies on protection and padding (particularly when dealing with myositis ossifications) • protection and rest may allow for calcium re-absorption (surgery would not be necessary to remove) • quadriceps and biceps are very susceptible to developing myositis ossifications Muscle Strains and Injuries Causes • stretch, tear, or rip to muscle or adjacent tissue • lots of times happens with eccentric muscle action. Graded the same way we grade ligament injuries. Muscle Strain Grades • grade 1 - some fibers have been stretched or actually torn resulting in tenderness and pain on active ROM, movement painful, but full ROM present. Full strength but painful • grade 2 – number of fibers are torn and active contraction is painful usually a depression or divot is palpable, some swelling and discoloration result. There should be decent strength but it will be painful • grade 3 – a complete rupture of muscle or musculotendinous junction, significant impairment, with initially a great deal of pain that diminishes due to nerve damage Tendon Ruptures • large tendon ruptures will require surgery Rehabilitation • lengthy process regardless of severity • will generally require 6-8 weeks. Return to activity too soon may result in re-injury Muscle Guarding
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