INJURY REVIEW ACHILLES TENDON RUPTURE Weekend warrior injury

INJURY REVIEW

ACHILLES TENDON RUPTURE Weekend warrior injury quick acceleration/jumping-type sports MOI forceful PF of foot while the knee is extended Unexpected rapid DF of the foot, stepping into a hole or stepping on a curb violent dorsiflexion when jumping from a height and landing on a plantar flexed foot S/S report feeling a kick in the back of the calf and then severe sharp pain loud pop or snap sound and swelling. Limping, cant plantarflex TX Immobilize PRICE, crutches Refer

GRADE 1 INVERSION ANKLE SPRAIN MOI: Foot inversion, PF, with mild stretching of the ATF S/S: - Mild pain and disability - Weight bearing is not impaired - Mild point tenderness - Mild/slight swelling over ligament - No joint laxity (looseness) TX: - PRICE - Progressive Resistance Exercises (PRE’s)

GRADE 2 INVERSION ANKLE SPRAIN MOI: - Moderate force in inversion, PF - Complete tear of the ATF and stretch of the CF S/S: - c/o pop or snap - Moderate pain and disability - Weight bearing is difficult - Tenderness and edema w/blood in the joint - Ecchymosis - + talar tilt, + anterior drawer tests TX: - PRICE - x-ray, crutches - PF and DF exercises - ROM, PRE’s

GRADE 3 INVERSION ANKLE SPRAIN MOI: - Severe force in inversion, PF - Involving ATF, CF and PTF S/S: - c/o pain in region of lateral malleolus - Swelling is diffused along w/ discoloration - No possible weight bearing - Major loss of function (LOF) - Severe swelling - + talar tilt, + anterior drawer tests TX: - PRICE - Crutches, refer for x-ray - ROM, PRE’s

EVERSION ANKLE SPRAIN MOI: - Eversion, DF - Avulsion fx of the medial malleolus in 15% of cases S/S: - c/o pain over the foot and lower leg - Unable to bear weight on the foot - Ab/adduction causes pain TX: - x-ray to rule out fx. - PRICE - NSAIDS - PRE’s for posteromedial ankle muscle and for arch, could lead to pronation of the foot.

SYNDESMOTIC ANKLE SPRAIN (HIGH ANKLE SPRAIN) Relatively common in football MOI: - Forceful external rotation of the ankle - While lying on the field w/ ankle externally rotated, someone falls on the back of the leg and foot, forcing ER - Lateral blow to knee/leg with foot planted, forcing ER - External force can rupture ant. Tibiofibular lig. , posterior tibiofibular lig. , or fracture the posterior tibial tubercle. S/S: - c/o severe pain, loss of function - When ankle is passively externally rotated, major pain in lower leg - Pain along the antero-lateral leg TX: - Out of competition - PRICE - NSAIDS - X-ray can reveal fracture or widening of the ankle mortise

MENISCUS TEAR Medial has higher incident of injury because medial meniscus attaches to the tibia and to the capsular ligament. MOI: firm Foot fixation with rotary force (Torsion) while the knee is extended of flexed, cutting motion, squatting S/S: swelling, discoloration, pain along the joint line, loss of ROM, locking, clicking, knee is giving way, pain with squatting and stairs. TX: MRI, if locked may have to be put under anesthesia to unlock it, surgery, strengthening and ROM exercises, ice.

OTHER INJURIES

MCL SPRAIN Most common injured ligament in knee MOI: Valgus stress Lateral blow w/ foot fixation, severe twist. S/S: Swelling, limited ROM, pain, loss of function, instability TX: PRICE, strengthening/ROM exercises, functional activities.

LCL SPRAIN MOI: Varus stress medial blow S/S: Pain, inflammation, instability, loss of function and ROM TX: PRICE, strengthening and ROM exercises, functional activities.

ACL SPRAIN MOI: Torsion (Foot fixation w/twisting), or a blow. (EX: athlete running then turns suddenly. ) Highest incidence of tear = Female soccer players, then female basketball players S/S: pop, followed by disability, “feels like my knee is coming apart” rapid swelling, pain. TX: PRICE, surgery…then strengthening, ROM exercises, functional activities. Prevention: no single exercise can prevent ACL tears, but the chances of ACL injury can be lowered by performing training drills emphasizing power and agility and by improving muscular reactions with jumping and balance drills

PCL SPRAIN MOI: severe hyperextension, OR a fall w/knee flexed to 90 degrees. S/S: feeling a pop in back of knee, tenderness, little swelling, instability, pain. TX: PRICE, non-operative, strengthening quads, ROM exercises.

TROCHANTERIC BURSITIS MOI: Common at the greater trochanter, high in women w/ increased Q angle, or leg length discrepancy Inflammation of bursa, or insertion of gluteus medius, or IT band S/S: c/o pain on lateral hip Radiating pain down to the knee Tenderness over greater trochanter TX: PRICE, NSAIDS, ROM, PREs, no inclined running Special Tests: Obers,

HIP POINTER (CONTUSION) MOI blow to inadequately protected iliac crest Most handicapping injury in sports, difficult to manage S/S Immediate pain, spasms, transitory paralysis of soft structures Unable to rotate the trunk or to flex the thigh with out pn TX RICE, referral, x-ray, ice massage, ultrasound, injection Doughnut pad for return to play

HIP DISLOCATION MOI Rarely occur during sports Femur is adducted and flexed S/S Flexed, adducted, and internally rotated thigh Deformity, nerve damage TX Immobilization, ice, analgesics

, PRICE, NSAIDS, crutches • Moderate pain and swelling, limping, cannot flex knee Severe/Grade 4 TX: flx w/ice pack • deeper • Pain, swelling, cannot flex knee more then 90 degrees Grade 3 Direct blow to the thigh • Superficial bruise • Mild hemorrhage, mild pain, no swelling, mild pt tenderness • No game restrictions Grade 2 MOI Grade 1 QUAD CONTUSION • Disability, may split the fasciae • Severe pain, limited ROM, limp

AVULSION FRACTURE MOI: Most common: 1) ischial tuberosity (hamstrings), 2)AIIS(rectus femoris), ASIS (sartorius) Sudden acceleration/deceleration S/S: Sudden local pain Limited movement TX: X ray, PRICE, crutches, ROM, PREs Special Tests: Hip MMTs

SACROILIAC JOINT SPRAIN (S. I. JOINT) MOI Twists with both feet on the ground Stumbles forward, falls backward, steps in hole S/S Pain over joint, muscle guarding, radiating pain down back of gluteus and hamstring Asymmetrical ASIS/PSIS or leg length difference TX Modalities, brace, stability exercises Special Test: FABERS/Patricks

GROIN STRAIN (ADDUCTOR/HIP FLEXOR STRAIN) MOI The groin is the area between the thigh and the abdominals Torn during twist or pull while running or jumping S/S Felt as sudden twinge or feeling of tearing during an AROM, or may feel it the next day Pain, weakness, internal bleeding TX PRICE, analgesics, ROM and strengthening exercises Rest has been the best treatment, protective spica Special Tests: MMTs

HAMSTRING STRAIN MOI Most common injury to thigh, exact cause is not known Possible MOI: muscle fatigue, faulty posture, leg length discrepancy, tight hamstrings S/S Hemorrhage, pain, loss of function. 3 grades of strain TX PRICE, NSAIDS, very conservative, PREs Special test: MMTs

SNAPPING HIP Ø Excessive repetitive movement in dancers, gymnasts, hurdlers, sprinters MOI: Imbalance in muscle IT band moves over the greater trochanter S/S: c/o of snapping with pain TX: Ice, NSAIDS, ultrasound, then stretching

QUAD STRAIN MOI: sudden stretch/contraction EX; jumping, kicking S/S: pain, spasm, loss of function, TX: PRICE, analgesics, pain free ROM, strengthening, crutches, neoprene sleeve

HAMSTRING STRAIN MOI: muscle fatigue, faulty posture, leg length discrepancy, tight hamstrings, improper form S/S: discoloration, pain, loss of function, swelling. TX: Extremely conservative, PRICE, analgesics, reduced activity. Move towards, pain free stretching, pain free exercises, jogging, stationary bike.

SHOULDER IMPINGEMENT MOI: - acute: direct blow - Chronic: - Impingement - Tendonitis - Degeneration * Mostly supraspinatus S/S: - complains of diffuse pain - Overhead activities increase pain - Painful arc - Pain on insertion of supraspinatus TX: PRICE, Strength, ROM, NSAIDS Special tests: Neer, Hawkins Kennedy empty can test, drop arm

CLAVICLE FRACTURE - Most frequent fx. - In young athletes = greenstick fx. MOI: FOOSHA, direct impact, occurs in middle 3 rd S/S: athlete supports arm, swelling, deformity, point tenderness. tilts head to the injured side w/ chin toward opposite side. TX: sling and swathe, refer for x-ray. Special tests: piano key

HUMERUS FRACTURE Humeral Shaft: comminuted or transverse. MOI: direct blow or fall on arm Proximal Humerus: great danger to nerve and vessels MOI: direct blow, Most likely at the neck Can be mistaken for dislocation Epiphyseal fx: young athlete 10 years and younger MOI: direct blow, or indirect force applied to the length of the axis. S/S: , pain, inability to move arm, swelling, point tenderness, discoloration TX: splint, treat for shock, refer

SHOULDER SUBLUXATION MOI: brief translation of the humeral head without separation of the joint surfaces. Can occur: anteriorly, posteriorly, or inferiorly.

SHOULDER ANTERIOR DISLOCATION MOI: Forced abduction, external rotation and extension. direct impact to the posterior or posterorlateral aspect Arm is held in abduction & ER S/S: Anterior - flat deltoid - Feel humeral head - Athlete carries the affected arm in slight abduction and ER - Unable to touch opposite shoulder TX: - immediate immobilization - PRICE - Refer

SHOULDER POSTERIOR DISLOCATION MOI: - forced adduction and IR, - or fall on an extended and internally rotated arm - Labrum damage S/S: posterior - severe pain and disablitity - Held in adduction and IR - Flat anterior deltoid - Acromion and coracoid processes - Limited ER & elevation TX: - immediate immobilization - PRICE - Refer

AC SPRAIN Grade 1: - point tenderness Grade 3: - Discomfort during movement - rupture of the AC &coracoclavicular lig - No deformity - Dislx of the clavicle - Mild stretching of AC lig. - Gross deformity - Severe pain - LOF - instability Grade 2: - tearing or rupture of AC lig Stretching or tearing of coracoclavicular lig Displacement of distal end of clavicle Moderate pain Unable to abduct arm through full ROM Can’t bring arm across chest horizontally TX: Price, refer for x-rays Special tests: Piano Key, Compression

SHOULDER SPRAIN MOI: forced abduction, external rotation, direct blow S/S: pain with movement and palpation, decreased ROM TX: PRICE, Special tests: load and shift, Sulcus, Apprehension Crank

BICIPITAL TENOSYNOVITIS MOI Overuse in overhead activity S/S Pain in the anterior upper arm over bicipital groove while performing overhead activity Some swelling, crepitus TX Complete rest for a few days, NSAIDS, gradual PRE program Special Tests: Yergasons, Speeds

SHOULDER BURSITIS MOI: build up of fluid - chronic inflammation - Overuse - Direct impact - Fall on tip of shoulder * Subacromial bursa is most inflamed. S/S: - pain with movement ( ab, add, IR) - Pain, tenderness TX: - RICE - NSAIDS - Strengthening, ROM Special tests: Neer, Hawkins-Kennedy

THORACIC OUTLET COMPRESSION SYNDROME (TOCS) “Stingers” Nerve damage by impingement or compression.

UCL SPRAIN MOI Valgus force from repetitive trauma Tennis, golfing, throwing S/S Pn. On medial aspect of elbow Parasthesia, and laxity TX Rest, NSAIDs, strengthening, correct form

EPICONDYLITIS MOI Lateral (tennis elbow) Tennis, baseball, swimming, golfing Repeated forearm flexion and extension Medial (pitchers or golfers elbow) Repetitive wrist flexion, valgus stress on elbow S/S Aching pn. During and after activity decreased ROM hand weakness TX RICE, NSAIDS ROM, PRE, Deep friction massage Elbow sleeve or band just below the bend of the elbow

OLECRANON BURSITIS MOI Direct blow S/S Pain, severe swelling, point tenderness TX Acute= ice, compression Chronic = compression, modalities, aspiration Padding for play

VOLKMANN’S CONTRACTURE MOI Complication of serious elbow injury Muscle spasm, swelling, or bone pressure on the brachial artery S/S Pn. In the forearm that is worse when fingers are passively extended Decreased or absent brachial and radial pulses TX Removal of constricting casts, wraps or braces, elevation Can become permanent

SKULL FRACTURE MOI Blunt trauma to head ie ball to head S/S Sever headache, nausea, skin indentation Blood in ear or nose CSF (cerebrospinal fluid) may seep from ears and nose TX 911!!

CONCUSSION MOI Direct or indirect trauma to head Impulsive force transmitted to head S/S Confusion, headache, dizziness, nausea, nystagmus, trouble concentrating, abnormal pupil response TX Take out of practice/game, determine LOC, watch for symptoms to worsen, assess memory *no longer grading concussions, or classifying as simple or complex*

INTRACRANIAL HEMORRHAGE MOI Blow to head May be a slow bleed S/S Show signs of mild headache but then has severe head pains, dizziness, nausea, unequal pupils TX Referral to ER

EPIDURAL BLEEDING MOI Blow to head S/S Extremely fast bleeding In 10 -20 min. athlete will go from fine to having major symptoms! TX ER, surgery

SUBDURAL BLEEDING MOI Veins are torn that bridge the dura matter to the brain contrecoup S/S Bleeding is slow, s/s may not appear for many hours TX 911 after s/s appear

INTRACEREBRAL BLEEDING MOI Force trauma to brain Bleeding within the brain S/S Deterioration of neurological function TX ER, 911

SECOND IMPACT SYNDROME MOI Second head injury before s/s of initial injury go away Caused 30 -40 deaths over the last decade S/S Appear stunned, within short time athlete may collapse, dilated pupils, loss of eye movement, respiratory failure TX Prevention