Athletic Injury Care Prevention Midterm

Lectures 1-5

Musculoskeletal system

network of muscles, tendons, ligaments, bones and other tissues that provide the body with stability and enables movement

Acute injury

a sudden injury that occured within the last 3 weeks

Subacute injury

an injury that occurred between 3 weeks and up to 3 months ago

Chronic Injury

an injury that occurred 3 or more months ago

Sports Injury

injuries that commonly occur during sports or exercise. can be acute, subacute, or chronic

Things to consider with every type of injury

• Type of insult and area of contact(blunt, penetrating, crushed, etc)

• Magnitude of the force applied

• Direction of force 

• Area(s) of body affected 

• Wound contamation 

• General physical condition of patient 

What causes an injury?

• traumatic blows

• Incorrect techniques

• Overtraining 

• Changing intensity or frequency too quickly 

• Weakness in the area 

• previous injuries

• Certain medications 

Strain

a twist, pull, or tear of a muscle or tendon of a tissure connecting muscle to bone 

Sprain

stretches of tears of ligiments

A fracture

break in the bony integrity

Dislocation

When the two bones that come together to form a joint become separated

Subluxation

partial dislocation that can be caused by injury, repetitive motion or certain medical conditions

Tendonitis 

inflammation of a tendon

Bursitis 

Inflammation of a bursae

What are the 3 phases of an injury?

Phase 1: Destruction, Phase 2: Repair, Phase 3: Remodeling

What happens during Phase 1 of an injury?

• an injury to a muscle causes muscle fibres to tear and die 

• A hematoma(bruise) formes in the ruptured muscle 

• Inflammatory cells run to the injury site 

What happens during Phase 2 of an injury?

• removal of the dead tissue, muscle fiber regeneration, and scar tissue formation.

• Revascularisation and balance repair are important for optimal recovery

What happens during Phase 3 of an Injury? 

• Regenerated muscle fibres mature 

• Scar tissue shrinks and reorganizes 

• Remodelling occurs with everyday activities, and can be helped with rehab exercise. 

Why do muscles heal faster? 

Increased amount of blood flow 

What is PEACE & LOVE protocol used for?

immediate treatment of skeletal muscle or soft tissue injury

What does PEACE & LOVE stand for 

Protection 

Elevation 

Avoid Anti-inflammatories 

Compression 

Education 

Load

Optimism 

Vascularixation

Exercise 

Isometric

muscle tension without change in muscle length

Isotonic

muscle tension with change in muscle length

Concussion

A pathophysiologic process caused by acceleration or deceleration of the brain due to trauma. It results in a temporary, functional disturbance rather than a structural injury, often following a direct or indirect blow to the head. It falls under the umbrella of a mild traumatic brain injury.

Signs of a Concussion 

• Loss of consciousness

• Amnesia

• Confusion 

• Disorientation 

• Imbalance 

• Slowed verbal response 

• Emotional inappropriate 

Symptons of a Concussion 

• Headache

• Dizziness 

• Visual and auditory changes 

• Nasusea 

• Difficulty concentrating

• Drowsy

• Sleep disturbance 

• Neck Pain 

Red flags of a concussion 

1. Neck pain or tenderness 

2. Double vision 

3. Weakness of tingling/burning in arms and legs 

4. Severe/ increasing headache 

5. Seizures or convulsions 

6. Loss of consciousness 

7. vomiting 

8. Increasingly restless 

9. Agatatied behaviour 

Physical Exam For a Concussion

Mental Status Exam:

• Attention, awareness, memory, recall

Cranial Nerve Exam 

• Vision(H-pattern test), balance, hearing, smell, taste

Standing strength test

Can you dignose someone with a concussion?

No, a medical doctor is required for the official diagnosis 

What are the muscles of the rotator cuff?

Surpraspinatus, Infraspinatus, Subscapularis and Teres Minor

What is the function of the Rotator Cuff?

• Stabilizes the Glenohumeral joint

Partial Tear

Tendon is damageds but not completed severed

Complete Tear

Soft tissure is torn into two seprate pieces

Degenerative Tear

High levels of repetitive stress can wear down the tendons, causing them to tear

How can RC strains/tears happen?

• Trama

• Overtraining

• Natural degeneration 

• Postural abnormalities 

• Glenohumeral instability

Physical exam for a RC strain/tear

Observe: 

• Clavicle(side to side comparation)

Palpation:  

• RC muscle bellies and tendons 

• bony tenderness along the scapula 

ROM + resisted ROM

• test in each position 

Rotator Cuff Resisted ROM

Subscapularis 

• Resisted Internal Rotation

Infraspinatus and teres minor 

• Resisted External Rotation

Supraspinatus

• Resisted Shoulder Abduction 

prevention of a RC sprain/tear?

Strengthen!

RC Sprain Rehabiliation

isometrics and Farmer’s carry

when pain and function improves, start eccentric then progress to concentrics

What is the Acromioclavicular Joint?

Where the acromion of the shoulder blade and the end of the clavicle meet on the outermost tip of the shoulder.

What is the function of the AC joint?

helps maintain the posture of the shoulder and supports movement.

Allows the scapula to rotate on the thorax

How does a AC joint sprain happen?

• direct trauma to the lateral aspect of the shoulder 

• direct trauma to the acromion process with the arm in adduction 

• landing on an outstretched arm

Physical exam of a AC sprain

Observe

• compare clavicles(symetry and painful bumps)

Palpiation

• Extremely tender AC joint

  • May be hot and swollen

Shoulder ROM 

• Limited in various ROM - especially horizontal adduction and overhead movements 

Scarf test

• Stabilize scapula and bring arm across body(horizontal adduction) 

• positive with pain 

Diagnosis of AC joint sprain

Pinpoint tenderness

x-ray, depending on pain and severity 

InGame Support for AC joint sprain

• remove player and start rehab

• mild - k tape(x over where pain is)

Rehab for AC joint sprain

Acute:

• Ice, avoid overhead movements and horizontal adduction 

Scapular retraction when pain decreases 

What is Glenohumeral Joint Instability?

The inability to keep the humeral head centered in the glenoid fossa

What is the glenoid labrum?

The fibrocartilage of the shoulder joint

• acts as a suction cup

How does Glenohumeral Joint Instability happen?

• Major of repetitive shoulder trauma 

• labral tear 

• Increased mobility 

Glenohumeral Joint Instability due to labral tear Physical Exam

Observe:

• clavicles(symmetry and painful bumps 

Palpatation

• RC muscles and joints for tenderness

Shoulder ROM 

• Excessive internal and external rotation 

Glenohumeral Joint Instability prevention 

• limit overhead movements 

• limit excessive internal and external rotation 

• continue rehab

the short head of the bicep attaches…

to the scapula and helps with supination of the elbow, stabilizing the shoulder joint and adduction of the arm

the long head of the bicep attaches….

directly to the labrum of the shoulder and helps supinate and flex the arm 

Biceps Tendinitis

Inflammation of the tendon areound the longhead of the biceps muscle

Bicipital Tendinitis

Inflammation of the long head tendon with in the bicipital groove

Bicep tendinosis

bicep tendinitis that causes degeneration over time and overuse

Bicep Tendinitis Rish Factors

• throwing and contact sports 

• Swimming 

• Gymnastics 

• Martial Arts 

• Volleyball 

how does Bicep Tendinitis happen

• Usually after trauma

  • direct blow to the shoulder

  • Fall of outstretched arm

  • Repetitive overhead movements

Bicep Tendinitis Physical Examination

Palpation:

• Pain in the bicipital groove

ROM

• Full ROM but pain overhead

Tests:

• Yergason’s test

• Speeds test

Yergason’s test

Resisted Supination

Speed’s Test 

Resisted Shoulder Flexion 

What is epicondylitis?

pain at the humeral epicondyles due to strain of the common wrist flexor or extensor

Medial epicondylitis is strain of the

wrist flexors

lateral epicondylitis is strain of the

wrist extensors

Medial epicondylitis is commonly referred to as

Golfer’s Elbow

Lateral epicondylitis is commonly refered to as

Tennis elbow

How can epicondylitis happen?

Repetition

overuse of forare extensors, flexors and supinator muscles 

Epicondylitis Physical Exam

Observe:

• look for swelling

• palpate the extensor tendon, the lateral/medial epicondyle and the radial head OR commom wrist flexor tendon

ROM

• Elbow movement (compare) 

Tests: 

• Resisted extension and supination(lateral) OR flexion(medial) 

What is the UCL?

Ulnar Collateral Ligament (a  thick ligament on the side of the elbow)

What is the function of the UCL?

supports the medial aspect of the elbow against valgus stress

If resisted wrist flexion is positive, what should you suspect?

Medial Epicondylitis

Diagnosis of UCL Sprain

• Pain at medial elbow 

• + Valgus Stress test 

• - resisted wrist flexion test

• MRI

What is the Tommy John Surgery?

a sugren remove the toren ligament, ad drills tunnels in the two bones. then threads the tendon from forearm or leg through tunnels to secure ends 

What is Little League Elbow?

disruption of the medial epicondyle groth plate

At what age does little league elbow occur?

between the ages of 5-14 years 

What are the risk factors of little legues elbow?

• pithing with arm fatigue

• Competitively pitching for more than 8 months a year 

• averaging more than 80 pitches a game 

What bone lies directly underneath the anatomical snuffbox?

the Scaphoid bone

Why is it important to know the scaphoid bone?

• the most common wrist bone that gets fractured

• has EXTREAMLY poor blood supply

What does FOOSH stand for?

Falling On Outstretched Hand

What is the function of the hip?

Provides stability to the trunk and lower limb

Ambulation

Stabilizes the pelvis and postural control

What causes a Femoroacetabular Impingement?

Hip bones that did not form properly, and sports that involve excessive internal rotation of the hip.

Physical Exam of a FAI

Observe:

• Acess the area of complaint for swelling, redness, bruising

Palpate:

• Muscles above and below the hip joint

• Muscles of the groin

• Anterior thigh musculature may be hypertonic and painful to touch

Test:

• FADDIR TEST

What is the FADDIR test?

Flexion, Adduction, Internal Rotation.

(+) test ig painful in hip/groin area

Rehab for FAI

• mobility exercises with pain-free ROM

• Avoiding internal rotation

• Strengthen surrounding muscles for stabilization

FAI prevention

Avoid movements that involve excessive internal rotation of the hip

Function of the hip labrum

• Provides stability to the hip joint\

• serves as a shock absorber and distributes force equally

• resists laterat motion of the femoral head

• When under tension the labrum acts as a seal

Common causes of the hip labrum tears

• FAI predisposes the labrum to tearing or injury

• Sports that require hip movement

Symptoms of a hip labrum tear

Many are asymptomatic

• Pain in the hip groin area

• locking, clicking, or catching sensation in the hip joint

• Stiffness or limited ROM

Physical Exam of a Hip Labrum Tear (observe, palpate, tests)

Observe:

• Assess the area of complaint foe swelling, redmess or brusing

Palpate:

• Muscles abouve and below the hip joint

• Muscles of the groin

Tests:

• Scour test

• FABER test

Scour test

Moving affected hip through ROM from hip flexion and adduction, while adding compressive force

FABER Test

Placing the affected leg in a figure 4 position, stabilizing the opposite side and applying mild force to the knee downwards

Rehab for a hip labrum tear

Soft tissue of sourrounding muscles that are tight

Maximize pain free

avoid excessive ROM that irritates hip joint

Surgical options for hip labrum tear

Arthroscopy -edges of tear are cleaned up and suture ancors are placed

What is Snapping Hip Syndrome (internal and External)

Internal:

Iliopsoas tendon snapping over the bony prominence of the pelvis

External:

IT band snapping over the greater trochanter of the femur

Causes of Snapping hip Syndrome

Gradually onset, and from overuse

External - gradual onset or minor mechinism injury

Physical exam for Snapping hip syndrome (observe, palpate, tests)

Observe:

• Look for swelling, redness or discoloration in the hip

• compare hips

Palpate:

• Muscles above and below the hip joint

Tests:

Internal: Stinchfield test

External: Obers test

Stinchfield’s test

Laying supine, restricted hip flexion

(+) if pain in the anterior hip or snapping

Ober’s Test

Patient side lying, extends and abducts the hip, then lowers to the table