Sports-Related Injury

Fractures

• Interruption or disruption in the normal continuity of a bone

  • Broken bones

• caused by trauma or repetitive force

Open Fracture

• Bone breaks skin

• Compound fractures

• Longer to heal, Increased risk of infections and complications

Closed Fracture

• Bone stays inside

• Easier to manage, quicker to heal

Displaced Fracture

• Fractured bone pieces moved

• Gap formed around the fracture

• More likely to need surgery

Non-Displaced Fracture

• Fractured bone pieces did not move too far out of alignment

Stress Fracture

• 20% of all sports-related injuries

• Hairline fractures

• Starts as bone bruises that become very small cracks

• Very common when there is repetitive trauma

Avulsion Fractures

• Bone attached to a ligament or tendon gets pulled away from the main bone

• Usually caused by sudden, quick movements and changes in direction

Buckle Fracture

• Impacted or torus fractures

• Very common incomplete fracture in kids under the age of 12

• Compression fracture caused by sudden pressure on a bone, such as falling on outstretched arms

Compression Fractures

• Small breaks or cracks in vertebrae due to pressure, causing the spine to curve or collapse and affecting posture

• Very common, 1 - 1.5M cases/year (USA)

• Usually due to osteoporosis, trauma, tumors

Clavicular Fracture

• One of more common fractures

• Due to trauma on the shoulder, including FOOSH

• Middle of bone shaft is most common

Galeazzi Fracture

• Not so common fracture

• Distal radial fracture w/ dislocation of distal radioulnar joint

• Due to FOOSH

• “Fracture of necessity”

Monteggia Fracture

• Not so common fracture

• Proximal ulnar fracture w/ dislocation of radial head at the elbow joint

• Due to FOOSH

Colles’ Fracture

• Distal radial fracture due to FOOSH

• Extended hand

Reverse Colles’ Fracture

• Distal radial fracture due to FOOSH

• Flexed hand

Bennett Fracture

• Generally uncommon

• Metacarpal base of the thumb

• 2 pc., oblique, 80%

• Due to axial force applied to a thumb in flexion (punch, fall)

• “Fractures of necessity”

Rolando Fracture

• Generally uncommon

• Metacarpal base of the thumb

• 3 pc. or comminuted, T- or Y-shaped; 10-20%

• Due to axial force applied to a thumb in flexion (punch, fall)

• “Fractures of necessity”

Scaphoid Fracture

• Most common carpal bone fracture

• Due to FOOSH

• Leads to swelling and tenderness in the anatomic snuff box

• Difficult to diagnose and treat

  • Occult scaphoid fracture

  • Poor blood supply

Watson’s Test

• Positive test: Palpable or audible reduction of subluxed scaphoid, pain on dorsal side

• Negative test: Scaphoid moves normally (push against examiner’s thumb), no pain

Hip Fracture

• One of more common fractures

• Break in proximal portion of femur, bone, near the hip joint

  • Head, neck , intertrochanteric

• MC in elderly, women, those with osteoporosis or osteopenia, athletes in contact sports

Ankle Fracture

• One of more common fractures

• Break in one or more bones at the ankle joint (tibia, fibula, talus)

  • Many types depending on bone part affected

Immobilization

• Hold bones in place while the fracture heals

• For non-displaced or minor fractures

• Splinting for 3-5 weeks

• Casting for 6-8 weeks

Closed Reduction

• Realign or set back the bone

• For more severe fractures

• Clinical procedure needing anesthesia or sedation

• Physically push and pull bone parts from the outside to line up the broken bone inside 

Bone Fracture Surgery

• For more severe fractures

• Open reduction and internal fixation

  • Align bones and place rods, pins, plates, wires, and screws on the bone to hold them together

• Some live with these, while some have follow-up surgeries to remove them

External Fixation

• Temporarily stabilize a fracture before it is safe to do internal fixation surgery

• Put screws in the bone on either side of the fracture and connect these to a brace or bracket around the bone from outside the body

Joint Replacement

• Needed if the bones in a joint are severely damaged

• Replace some or all of the natural joint with artificial joint (prosthesis)

  • Made with metal, ceramic, or heavy-duty plastic

Bone grafts

• Needed if the fracture is severely displaced or the bone doesn’t heal correctly

• Insert donor bone tissue (from the top of the hip, femur, or upper tibia) to rejoin the fractured bone, then perform internal fixation while the bone regrows

Acute compartment syndrome (ACS)

• Build-up of pressure in muscles impair circulation → permanent muscle and nerve damage.

Bone Stress Injuries

• Overuse injuries associated with repeated or increased load on bone due to strenuous weight-bearing activities

  • Rate of bone damage > rate of bone remodeling

• 20% of all sports-related injuries

• Commonly affects: pelvis, leg bones, bones of the feet

Oteitis Pubis

• Non-infectious, chronic inflammation of pubic symphysis and surrounding soft tissues

• Leads to groin or lower abdominal pain

Periostitis

• Inflammation of the periosteum

Apophysitis

• Inflammation at attachment of tendon to bone

Osgood-Schlatter

• Type of Apophysitis

• Patellar tendon - tibial tuberosity

Sinding-Larsen-Johansson

• Type of Apophysitis

• Patellar tendon - bottom of kneecap

Dislocation and Subluxation

• Complete or partial dissociation of the articulating surfaces of joints due to trauma

• Most common in fingers, elbows, shoulders, hips, knees, and jaw

• Associated with sprains and fractures

Shoulder Dislocation

• Most commonly dislocated joint

• Most vulnerable when in abduction and external rotation

• 95% is anterior dislocation (pushed forward)

Hip Dislocation

• Most vulnerable when leg is in:

  • Flexion, adduction, internal rotation -> posterior dislocation (85%)

  • Flexion, abduction, external rotation -> anterior dislocation (10%)

  • Co-occurs with acetabulum fracture -> central dislocation

Knee Dislocation

• Kneecap pops sideways out of its vertical groove, no longer tracking up and down

• Occurs with an audible pop, then locking of the knee

Sprains

• Stretched or torn ligament

  • Ranges from mild to complete tears

• Leads to mechanical instability

Grade 1

• Sprain Grading

• Some fibers attached

• Normal range on stressing ligament

Grade 2

• Sprain Grading

• Significant amount of fibers affected

• Lax feel, definite endpoint

Grade 3

• Sprain Grading

• Complete tear

• No firm endpoint

• May be pain-free

Anterior Cruciate Ligament

• Blow to the lateral side of the knee (valgus)

• Rotation in which the tibia is in external rotation on a planted foot

• Has an audible pop and giving way of the leg

• More common in females

Posterior Cruciate Ligament

• Less common than ACL

• Blow to the anterior tibia when knee is flexed

• With posterior drawer and posterior sag sign

Medial Collateral Ligament

• Valgus stress to knee in partial flexion

Lateral Collateral Ligament

• Severe varus stress to knee

• Less common than MCL sprain or tear

Meniscus Tears

• Shear stress in the knee due to flexion and femoral rotation

  • Compresses the menisci

  • Slow, twisting injury

• Medial meniscus tears are more common

• No immediate symptoms

  • Pain, restricted motion, locking, joint line tenderness

Turf Toe

• Plantar capsule and ligament of 1st MTP is damaged

• Due to forced hyperextension of the big toe

Strains

• Pulled, injured, or torn muscles

• Common but painful injury in sports

  • Strains, tears, contusions/bruise

• Common causes:

  • Overuse or overexertion

  • Not stretching or warming up before exercise

  • Lack of flexibility

• Usually occurs in the hamstrings, quadriceps, or gastrocnemius

Grade 1

• Strain grading

• Most common

• Small number of muscle fibers

• Stretched but not torn through

• Localized pain

• No strength loss

Grade 2

• Strain grading

• Significant number of fibers torn

• Pain and swelling

• Pain on contraction

Grade 3

• Strain grading

• Complete tear

• Most common at musculotendinous junction

Cramps

• Painful, spasmodic, involuntary muscle contractions

• Occur suddenly but only temporarily debilitating

  • Common, involuntary, unpredictable

  • Idiopathic 

Tendinopathies

• Any condition affecting a tendon, making it painful to use and reducing its functionality

  • Begins when a tendon injury cannot heal

• Common in the heel, foot, ankle, knee, shoulder, elbow, wrist

Tendinitis

• Acute response to injury

• Leads to chronic condition if it does not heal or if it lasts too long

  • Scars or micro-tears, calcium deposits, tendiosis

Tendinosis

• Chronic stage of tendon injury

• Breakdown of collagen in the tendon results in loss of strength and elasticity

• Progressive and lasting degeneration

• If untreated, may lead to:

  • Tender rupture, muscle atrophy, disability

Tennis Elbow

• One of the most common causes of elbow pain

• Repeated grip, twist, and swing of the forearm with wrist flexion

Golfer’s Elbow

• Repeated bend, grasp, and twist of the arm with wrist flexion

swimmer’s shoulder

• Issues causing shoulder pain, weakness, and other symptoms

• Repeated use of shoulders to move arms overhead

• Includes:

  • Shoulder impingement syndrome

  • Rotator cuff tendinopathy

  • Shoulder labrum injury

  • Shoulder muscle strain

  • Pinched nerves 

De Quervain’s Tenosynovitis

• Repetitive awkward positioning and movement of the wrist and thumb 

Jumper’s Knee

• Repeated stress on patellar tendon

• Due to jumping activities and excess load 

Runner’s Knee

• Repeated knee-bending and extending motions leading to ITB irritation, and pain at lateral

Achilles’ Tendinopathy

• Overuse of Achilles tendon

• Higher risk when the person has increased foot pronation

• Caused by repetitive excessive loading of the tendon

  • Such as jumping, sprinting, rapid movements

• “Morning pain or stiffness”

Plantar Fasciitis

• Overuse, excessive load on feet leading to inflammation and thickening of plantar fascia, increased pressure on the fat pads of the feet

  • Common in running, soccer, gymnastics, and dance

• Most common cause of heel pain

  • Difficulty walking due to pain at big toe dorsiflexion

• “Morning pain or stiffness” and “First step phenomenon”

Face and scalp contusions and lacerations

• Common in sports

• Usually results from direct trauma

• Needs to be assessed ASAP

Nasal Fracture

• Symptoms such as: pain, nosebleed, swelling, crepitus, deformity, mobility of the nose

• Management:

  • Control bleeding

  • Remove obstruction in nasal passage

  • Do not perform reduction as it can cause arterial damage and severe acute hemorrhage

Nosebleed

• Associated with nasal injuries

• Management:

  • Cold compress on bridge of the nose, with patient seated

  • 20 minutes of digital pressure on lower nose

  • Check for CSF or clear discharge using urine dipstick (changes with increased glucose)

Tooth Avulsions

• Retain tooth fragment in milk or saline solution

• Reposition or reattach tooth immediately

  • Within 2 hours

TMJ Dislocation

• Caused by trauma to the jaw while the mouth is open

• Reduction of the jaw

  • Place thumbs along lower teeth and apply downward and backward pressure