Final 302- part 2

Cause of injury



•Inflammation of retrocalcaneal bursa



•Result of constant pressure and rubbing from heel counter of a shoe



•If inflammation continues for many months, an exostosis forms



•**Exostosis**: Bony outgrowth, which is also referred to as a pump bump when it forms on the back of the heel



Signs of injury

•Tenderness, swelling, warmth, and redness that may progress into a palpable and tender bony bump on the back of the calcaneus



Care



•Doughnut-type pad should be placed around the area of tenderness to disperse pressure



•Heel lift: Helps in changing the site of pressure



•Athletes may need to use footwear with heel counters higher than those presently worn

retrocalcaneal bursitis (pump bump)

Causes of injury



•Sports activities that demand sudden starts, stops, or changes from horizontal to vertical movements



•Thick skin layer and fat pad covering present in the heel unable to offer protection against sudden abnormal forces



Signs of injury

•Severe pain in heel and inability to tolerate stress of weight bearing

•Acute bruise may progress to chronic inflammation of the periosteum



Care



•Cold application and restriction of use of injured heel for at least 24 hours



•Moderate activity can be resumed using a heel cup or protective doughnut pad



•Athletes who are prone to heel bruises need to wear heel cups along with foam rubber pads

heel bruise

Causes of condition



•Leg length discrepancy, inflexibility of the medial longitudinal arch, tightness of the gastrocnemius-soleus unit, wearing shoes without sufficient arch support, a lengthened stride during running, and running on soft surfaces



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Sign of condition



•Pain in anterior medial heel



•Increases when foot is not used for a long period of time; decreases after first few steps



•Intensifies when toes and forefoot are forcibly dorsiflexed



Care



•Treatment may last for 8 to 12 weeks, depending on the persistence of symptoms

•Vigorous stretching of the gastrocnemius and soleus muscles and the Achilles tendon

•Use of a night splint

•Use of a heel cup

•Simple arch taping

•Orthotic therapy

plantar fasciitis

Causes of injury



•Direct force



•Torsional or twisting stresses

cture from a sprain



Signs of injury



•Difficult to distinguish a fra

•Swelling, pain, point tenderness, and possible palpable deformity



•X-ray examination will be necessary to distinguish a fracture from a sprain



Care

•Treatment is symptomatic

•POLICE is used to control swelling

•Once swelling has subsided, a short leg walking cast is applied for 3 to 6 weeks

•Ambulation is usually possible by the second week

•Fracture of the metatarsal with displacement of the fractured bone

•Surgery might be necessary

fractures of the metatarsals

Causes of injury



•Overuse, acute inversion, or high-velocity rotational forces



•Common consequence of a stress fracture



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Signs of injury



•Sharp pain on the lateral border of the foot usually associated with a popping sound

Possibility of a nonunion, requiring an extended period of rehabilitation



Care



•Six to eight weeks of wearing a non-weight-bearing short leg cast for nondisplaced fractures



•In cases of delayed union, nonunion, or displaced fractures, internal fixation may be required



•Surgical internal fixation is possible

fifth metatarsal fracture (jones fracture)

Also referred to as march fractures, which often occur in sports that involve running or jumping



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Causes of injury



•Structural deformities of the foot



•Training errors



•Changes in training surfaces



•Wearing inappropriate shoes



•Morton’s toe: First metatarsal is abnormally short, causing the second toe to appear longer than the great toe



Signs of injury

•Pain and point tenderness along the second metatarsal

•Pain while running and perhaps while walking

•Ongoing pain during non-weight-bearing movements

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Care

•Determine the cause of injury

•Modified rest

•Non-weight-bearing exercises for 2 to 4 weeks

•Pool running or using an upper-body ergometer or stationary bike

•Gradual return to running after 2 to 3 weeks using appropriate shoes

second metatarsal stress fracture

Cause of injury



•Hypermobility of metatarsals caused by laxity in ligaments, resulting in a splayed foot



•Gives the appearance of a fallen metatarsal arch



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Signs of injury



•Pain or cramping in metatarsal region



•Signs of inflammation and weakness in the area



•**Metatarsalgia**: Pain in the bottom of the foot



•Heavy callus may form in the area of pain



Care



•Pad placed behind the ball of the foot to elevate depressed metatarsal heads



•Strengthening of foot muscles and heel cord stretching

metatarsal arch strain

Cause of injury



•Subjecting musculature on plantar surface of foot to unaccustomed stress when playing on hard surfaces



•Flattening or depression of longitudinal arch (**pes planus**)



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Signs of injury



•Pain experienced below medial malleolus and posterior tibial tendon when running is attempted



•Accompanied by swelling and tenderness along medial aspects of the foot



•Prolonged strain involves calcaneonavicular ligament and first cuneiform with navicular

Tenderness in flexor hallucis longus



Care



•Immediate care using POLICE



•Appropriate therapy and reduction of weight bearing



•Arch taping

longitudinal arch strain

Causes of injury



•Kicking an object, stubbing a toe, or dropping a heavy object on toes



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Signs of injury



•Swelling and discoloration



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Care



•Refer to a physician if the fracture is to the proximal phalanx of the great toe or to the distal phalanx and involves the interphalangeal joint



•Adhesive tape is used if the break is in the bone shaft



•A cast is used if more than one toe is fractured



•Dislocation of phalanges: Reduction can be performed by a physician

fractures and dislocation of the phalanges

Exostosis of the first metatarsal head



•Great toe becomes maligned



•Moves laterally toward, and at times overlaps, the second toe



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Cause of injury



•Wearing shoes that are pointed, too narrow, too short, or have high heels



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Signs of injury



•Tenderness, swelling, and enlargement, with calcification of the head of the first metatarsal



Care

•Use of shoes that fit well

•Use of night splints for skeletally immature patients

•Use of doughnut pads or tape to disperse pressure 

•Use of a special orthotic device to help normalize foot mechanics

•Surgery if the condition progresses

bunions (hallux valgus deformity)

Cause of condition



•**Neuroma**: Enlargement of a nerve occurring commonly between the third and the fourth metatarsal heads



•Occurs in the common plantar nerve



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Signs of condition



•Severe intermittent pain radiating from the distal metatarsal heads to the tips of the toes



•Burning numbness in the forefoot, localized to the third web space and radiating to the toes



•Symptoms are intensified upon hyperextension of toes on weightbearing or wearing shoes with narrow toe boxes or high heels



Care

•Using a metatarsal bar or a teardrop-shaped pad

•Placing the metatarsal bar proximal to the metatarsal heads

•Placing the teardrop-shaped pad between the heads of the third and fourth metatarsals

•Wearing shoes with wide toe box areas

morton’s neuroma

Cause of injury



•Hyperextension injury resulting in sprain of the great toe



•Result of repetitive overuse or trauma



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Care



•Increase rigidity of forefoot region in shoe



•Taping the toe to prevent dorsiflexion



•Severe sprains: Three to four weeks may be required for pain to subside

turf toe

Cause of condition



•Shoes that are too narrow or short



•Painful as fatty layer of foot loses elasticity and cushioning effect



•Callus becomes vulnerable to tears and cracks and infection



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Care



•Use of emery callus file after each shower



•Massaging small amount of emollient into devitalized callus



•Sanding or pumicing: Care must be taken not to remove the callus entirely



•Use of special orthotics in cases of faulty foot mechanics



•Prevention of excessive callus accumulation



•Wearing at least one layer of socks



•Wearing shoes that fit well and are in good condition



•Applying lubricant to reduce friction

calluses

Causes of injury



•Shearing forces on skin that result in development of fluid accumulation below the outer layer of skin



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Care



•Take action to reduce friction



•Use friction-proofing material to cover irritated skin



•Cover blister with an adhesive bandage



•Apply a doughnut pad to reduce friction



•Puncturing may be necessary if pressure is too great and is causing excessive pain

Care must be taken to avoid contamination

blisteres

Cause of injury



•Stepping on toe, dropping an object on toe, or kicking another object



•Repetitive shearing forces on toenail



•



Signs of injury



•Accumulation of blood underneath toenail



•Gentle pressure on toenail greatly exacerbates pain



•



Care



•Immediate application of ice



•Relieve pressure within 12 to 24 hours using a drill under sterile conditions

blood under toenail (subungual hematoma)

•When fracture is suspected, a gentle percussive blow is applied upward on the bottom of the heel



•Such blows set up a vibratory force that resonates at the fracture, causing pain

bump test

•Used to assess the extent of injury to the anterior talofibular ligament primarily and other lateral ligaments secondarily



•A positive anterior drawer sign occurs when the foot slides forward

anterior drawer test

Used to determine the extent of inversion or eversion injuries



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Excessive motion of the talus at 90 degrees indicates injury to the calcaneofibular ligament and possibly the anterior and posterior talofibular ligaments as well



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Excessive motion in inversion with the ankle plantarflexed indicates a sprain of the anterior talofibular ligament

talar tilt test

•Most common and often result in injury to the lateral ligaments



•Anterior talofibular ligament is injured in an inverted and plantarflexed position



•The calcaneofibular and posterior talofibular ligaments are also likely to be injured as the force of inversion is increased



•Increased inversion force is needed to tear the calcaneofibular ligament

inversion sprains

Less common than inversion ankle sprains, largely because of the bony and ligamentous anatomy



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May involve an avulsion fracture of the tibia before the deltoid ligament tears



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Deltoid ligament may also be contused in inversion sprains because of impingement between the medial malleolus and the calcaneus

eversion sprains

Initial treatment efforts should be directed toward limiting the amount of swelling



Apply horseshoe pad for focal compression in the injured area



Apply wet compression wrap to facilitate passage of cold from ice packs surrounding the ankle



Apply ice for 20 minutes and repeat every hour for 24 hours



Continue to apply ice over the next 72 hours



Keep foot elevated to a minimum of 45 degrees while icing

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Athlete should be placed on crutches to avoid weight bearing for at least 24 hours following injury

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Athlete should be encouraged to begin weight bearing as soon as tolerated

care for ankle sprains

Cause of injury



•Occur from several mechanisms that are similar to those that cause ankle sprains



Sign of injury



•Fracture of the malleoli generally results in immediate swelling



Care



•If the possibility of a fracture exists, the ankle should be splinted and the athlete should be referred to the physician for X-ray examination and immobilization



•Once near-normal levels of strength, flexibility, and neuromuscular control have been regained and the injured athlete can perform functional activities, full activity may be resumed

ankle fractures

Cause of injury



•Singular cause or collection of mechanisms



•Inappropriate or poor footwear that can create faulty foot mechanics, acute trauma to the tendon, tightness in the heel cord complex, or training errors



•



Signs of injury



•Pain with both active movement and passive stretching



•Swelling around the area of the tendon possibly caused by inflammation of the tendon



•Crepitus on movement



•Stiffness and pain following periods of inactivity but particularly in the morning



Care



•Techniques that help tendon healing, including rest, therapeutic modalities (ice), and possibly anti-inflammatory medications, should be used



•Use of an orthotic device to correct the biomechanics or taping the foot may also be helpful in reducing stress on the tendons

tendinosis

•Determines if there is a rupture of the Achilles tendon



•Performed by squeezing the calf muscle while the leg is extended and the foot is hanging over the edge of the table

thompson test

Cause of injury



•Result of direct blow or indirect trauma



•Fibular fractures are seen with tibial fractures or as the result of direct trauma



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Signs of injury



•Tibial fractures - Pain, swelling, and possible deformity and may be open or closed



•Fibular fractures - Usually closed and present with pain and point tenderness on palpation and with ambulation



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Care



•Immediate treatment should include splinting to immobilize the fracture along with ice, followed by immediate medical referral



•Restricted weight bearing for weeks/months depending on severity

tibial and fibular fractures

Cause of injury



•Result of repetitive loading during training and conditioning



•Attributed to shoes, or faulty foot and ankle biomechanics, both of which can be easily dealt with



•



Signs of injury



•Pain with activity that sometimes becomes worse when the activity is stopped



•Focal point tenderness on the bone helps differentiate a stress fracture from medial tibial stress syndrome



Care

•Athlete with a suspected stress fracture should be referred to a physician for diagnosis

•Recuperation for about a 2-week period during which the athlete can continue to be weight bearing but must not engage in the activity that caused the problem in the first place

tibial and fibular stress fractures

Cause of injury



•Increasing pain specifically at the distal two-thirds of the posterior medial aspect of the tibia



•Stress fractures, compartment syndrome, or tendinitis result  in pain in the anterior shin



Signs of injury



•Pain is usually diffuse about the distal medial tibia and the surrounding soft tissues



•As the condition worsens, daily ambulation may be painful, and morning pain and stiffness may also be present



•Can progress to a stress fracture if not treated appropriately



Cause of injury

•Increasing pain specifically at the distal two-thirds of the posterior medial aspect of the tibia

•Stress fractures, compartment syndrome, or tendinitis result  in pain in the anterior shin

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Signs of injury

•Pain is usually diffuse about the distal medial tibia and the surrounding soft tissues

•As the condition worsens, daily ambulation may be painful, and morning pain and stiffness may also be present

•Can progress to a stress fracture if not treated appropriately



Care



•Physician referral for ruling out the possibility of stress fracture via the use of bone scan and plain films



•Activity modification along with measures to maintain cardiovascular fitness are set in place immediately



•Correction of abnormal foot mechanics



•Ice massage to reduce pain and inflammation



•Stretching program for the Achilles complex

shin splints (medial tibial stress syndrome)

Cause of injury



•Skin is exceedingly vulnerable and sensitive to blows or bumps



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Signs of injury



•Intense pain, swelling, and increased warmth



•Hematomas may increase to the size of a golf ball



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Care



•Compressive wrap along with ice and elevation should be applied immediately to minimize swelling



•A protective doughnut pad constructed to disperse pressure away from the contusion should be worn to protect the area from additional injury

shin contusions

Cause of injury



•Conditions in which increased pressure within one of the four compartments of the lower leg causes compression of muscular and neurovascular structures within that compartment



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Signs of injury



•Increased intracompartmental pressure associated with compartment syndromes



•Lead to deep aching pain, tightness, and swelling of the involved compartment



•Reduced circulation and sensory changes can be detected in the foot



Care

•Immediate first aid should include application of ice and elevation

•Acute compartment syndrome and acute exertional compartment syndrome

•Emergency surgical procedure needs to be done to release the pressure within that compartment

•Surgical procedure for anterior or deep posterior compartment

•May require 2 to 4 months postsurgery

•Conservative management of chronic compartment syndrome includes activity modification, icing, and stretching of the anterior compartment musculature and Achilles complex

•Fasciotomy of the affected compartment is required if conservative measures fail

compartment syndromes

Cause of injury



•Inflammatory condition involving the tendon



•Repetitive stresses and strains placed on the tendon such as with running or jumping activities



•Repetitive weight-bearing activities



•Running or early season conditioning in which the duration and intensity are increased too quickly with insufficient recovery time worsens the condition



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Signs of injury



•Generalized pain and stiffness and stiffness about the Achilles tendon just proximal to the calcaneal insertion



•May progress to morning stiffness



Care

•Limiting or restricting the activity that caused the initial inflammation

•Aggressive stretching and use of heel lift may be beneficial

•Use of anti-inflammatory medications is recommended

Achilles tendinitis/tendinosis

Cause



•Occurs due to a sudden, forceful plantarflexion of the ankle



•Commonly seen in athletes above the age of 30 years



•Occurs in activities requiring dynamic movement



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Signs of injury



•Athletes may feel or hear a pop



•Palpable defect will be noted along the length of the tendon



Care

•Surgical repair of the tendon

•May require a period of immobilization for 6 to 8 weeks to allow for proper tendon healing

•Athlete must work to regain full range of motion and normal muscle function

achilles tendon rupture

most frequently injured joint

knee

a medially directed force

valgus

a laterally directed force

varus

•Most commonly used test for checking the integrity of the anterior cruciate ligament



•Administered by positioning the knee in approximately 30 degrees of flexion with the athlete lying on his or her back



•Unchecked anterior movement of the tibia indicates damage to the anterior cruciate

lachman’s test

•Cause of injury



•Occurs either as a result of a medially directed valgus force from the lateral side or from the lateral rotation of the tibia



•Care

•POLICE for at least 24 hours

•Use crutches or knee immobilizer, if necessary

•Progress from isometrics to stationary biking, stair climbing, and resisted flexion/extension exercises

•Use tape or a hinged brace when attempting to return to running activities

•Conservative nonoperative treatment is recommended for isolated grade 2 and grade 3 M C L sprains

•Athlete is allowed to return to full participation when the knee has regained normal strength, power, flexibility, endurance, and coordination

•Usually, 1 to 3 weeks is necessary for recovery

MCL sprain

•Cause of injury



•Result of a laterally directed varus force from the medial side or from medial rotation of the tibia



•A severe blow can cause bony fragments to be avulsed from the femur or tibia



•Signs of injury



•Pain and tenderness over ligament



•Swelling and effusion around the L C L



•Joint laxity with the varus stress test



•Pain is greatest with grade 1 and grade 2 sprains



•In grade 3 sprains, pain is intense initially, then subsides to a dull ache



•Care



•Management of the L C L injury should follow the same procedures as for M C L injuries

LCL sprain

•A C L tears are more likely to occur in females than in males due to biochemical differences



•Most likely to occur with deceleration, rotation, and valgus stress to the knee



•The most common noncontact mechanism for tearing the A C L is when the athlete decelerates with the foot planted on the ground



•A C L is at risk of being injured in a contact injury because the athlete is decelerating and usually changing directions



•May be linked to the athlete’s inability to decelerate valgus and rotational stresses



•Signs of injury



•Audible pop followed by severe pain and disability



•Rapid swelling at the joint line



•Initial pain followed by some relief



•Positive Lachman’s test



•Care

•Immediate POLICE

•May require joint reconstruction to replace the lost anterior cruciate support

•Involves 3 to 5 weeks in some type of brace and 4 to 6 months of rehabilitation

•Many physicians feel that the braces can provide some protection during activity

•The use of knee braces following an A C L injury is not supported by scientific research

acl sprain

•Cause of injury



•Falling with full weight on a bent knee with the ankle and foot in plantar flexion



•Can also be injured as a result of a rotational force



•Signs of injury



•Pop in the back of the knee



•Tenderness and swelling in the popliteal fossa



•Demonstration of laxity in a posterior drawer test



•Care



•POLICE



•Nonoperative rehabilitation of grade 1 and 2 injuries should focus on quadriceps strengthening



•Controversy exists as to whether a grade 3 P C L tear should be treated nonoperatively or with surgical intervention

PCL sprain

•Cause of injury



•Results from weight bearing combined with a rotational force while extending or flexing the knee



•The meniscus is pulled out of its normal bed and pinched between the femoral condyles



•The medial meniscus is more prone to disruption through rotational and valgus forces



•Signs of injury



•Absolute diagnosis is difficult



•Effusion developing over 48–72 hour period



•Joint-line pain and loss of motion



•Intermittent locking and giving way

Pain when squatting



•Care



•Immediate care involves POLICE



•If the knee is not locked, but indications of a tear are present, further diagnostic testing may be required



•A knee that is locked by a displaced meniscus may require unlocking with the athlete under anesthesia so that a detailed examination can be conducted



•Treatment should follow a course similar to that of an M C L injury



•If discomfort, disability, and locking of the knee continue, arthroscopic surgery may be required



•A torn meniscus can be repaired using sutures in some cases



•Surgical management of meniscal tears should make every effort to minimize loss of any portion of the meniscus

meniscus injuries

•Cause of injury



•Blow to the muscles crossing the knee joint



•Signs of injury



•Present as knee sprain, severe pain, loss of movement, and signs of acute inflammation



•Swelling and discoloration



•Care



•Management depends on the location and severity of the contusion



•Apply compression bandages and cold until resolution has occurred



•Recommend inactivity and rest for 24 hours

If swelling occurs, continue cold application for 72 hours

•If swelling and pain are intense, refer the athlete to the physician

•Once the acute stage has ended and the swelling has diminished, cold application with active range-of-motion exercises should be conducted

•Allow the athlete to return to normal activity, with protective padding, when pain has subsided

joint contusions

•Cause of injury



•Plicae are folds of synovial membrane



•The medial patellar plica is thick, nonyielding, and fibrotic, which can cause a number of symptoms



•Signs of injury

•Patient may or may not have a history of knee injury

•Painful feeling that the knee is locked after sitting for a period of time

•Pain while ascending or descending stairs or when squatting

•Care

•Rest, anti-inflammatory agents, and local heat

•If the condition recurs, causing a chondromalacia of the femoral condyle or patella, the plica will require surgical excision

knee plica

•Cause of injury



•Acute, chronic, or recurrent



•The prepatellar bursa becomes inflamed from continued kneeling or falling directly on the knee



•The deep infrapatellar bursa becomes irritated from overuse of the patellar tendon



•Signs of injury



•Prepatellar bursitis results in localized swelling above the knee that is similar to a balloon



•Swelling outside the joint, some redness, and increased temperature



•Inflamed bursae may be painful and disabling

Swelling in the back of the knee may indicate a Baker’s cyst



•Care



•Usually follows the pattern of eliminating the cause, prescribing rest, and reducing inflammation



•Elastic compression wraps and anti-inflammatory medication



•If the synovial lining of the joint capsule has thickened, a physician may cautiously use aspiration and a corticosteroid injection

bursitis

•Causes



•Repeated trauma



•Osteochondritis dissecans (fragments of bone and cartilage)



•Fragments from the menisci



•Pieces of torn synovial tissue



•Torn cruciate ligament



•Signs of injury

•Loose bodies may move and become lodged in the joint space, causing locking or popping

•Pain, instability, and a feeling that the knee is giving way

•Care

•If not surgically removed, loose bodies can create conditions leading to joint degeneration

loose bodies

•Cause of injury



•Malalignment and structural asymmetries of the foot and lower leg caused by overuse

Repeated knee flexion and extension



•Signs of injury



•Tenderness, some mild swelling, increased warmth, and possibly some redness over the lateral femoral condyle



•Pain increases during running or cycling activities



•Care involves:



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•Stretching the iliotibial band and performing techniques for reducing inflammation



•Correction of foot and leg alignment problems



•Cold packs or ice massage before and after activity



•Proper warm-up and stretching



•Avoiding activities that aggravate the problem, such as running on inclines



•Administering anti-inflammatory medications, if required



•Transverse friction massage to eliminate chronic inflammation

**Iliotibial band friction syndrome** (runner’s knee)

•Cause of injury



•Indirect trauma, which involves a severe pull of the patella tendon



•Direct trauma, which produces fragmentation with little displacement



•Forcible contraction, falls, jumping, or running



•Signs of injury



•Hemorrhage, resulting in generalized swelling



•In indirect fractures, tearing of the joint capsule, separation of bone fragments, and possible tearing of the quadriceps tendon



•Direct fractures involve little bone separation



•Care



•X-ray is necessary for confirmation of findings



•Cold wrap should be applied, followed by an elastic compression wrap and splinting

Refer to a physician and recommend 2–3 months of immobilization

fracture of the patella

•Cause of injury



•Deceleration with simultaneous cutting in the opposite direction (valgus force at knee)



•The quadriceps muscle pulls the patella out of alignment



•More commonly seen in female athletes



•Signs of injury



•Complete loss of knee function along with pain and swelling



•A first-time patellar dislocation should always be suspected of being associated with a fracture



•Care

•Immobilize knee and apply ice around the joint

•Refer to a physician for reduction

•Following reduction, immobilize for at least 4 weeks with the use of crutches

•All the muscles of the knee, thigh, and hip should be strengthened

•After immobilization period, neoprene brace with a horseshoe-shaped felt pad should be used to support the patella medially

Acute patellar subluxation or dislocation

•Cause



•Softening and deterioration of the articular cartilage



•Abnormal patellar tracking



•Bony alignment



•Quadriceps weakness



•Pelvis width in female athletes



•Signs of injury



•Pain while walking, running, ascending and descending stairs, or squatting



•Possible recurrent swelling, grating sensation in the knee during flexion and extension



•Care includes:

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•Avoiding irritating activities such as stair climbing and squatting

•Doing pain-free isometric exercises that concentrate primarily on strengthening the quadriceps muscles

•Wearing a neoprene knee sleeve

•Surgery

chondromalacia patella

•Cause of injury



•Jumping, kicking, or running, which places tremendous stress and strain on the patellar or quadriceps tendon



•Sudden or repetitive extension may begin an inflammatory process that leads to tendon degeneration



•Signs of injury



•Pain and tenderness generally around the bottom of the patella on the posterior aspect that worsens when engaging in jumping or running activities



•Care



•Several approaches including rest, the use of ice, transverse friction massage, and anti-inflammatory medications



•Brace or strap may also be used



•A rolled-up prewrap or elastic tape around the knee just below the patella over the patellar tendon may be used as an alternative

jumper’s knee (patellar tendinosis)

•Cause of condition



•Common to the rapidly growing immature adolescent’s knee



•Repeated pulling by tendon



•Formation of a bony callus and enlargement of the tubercle



•Larson-Johansson disease is a similar condition, which involves the inferior pole of the patella



•Resolves when the athlete reaches the age of 18 or 19



•Signs of condition



•Repeated irritation, which causes swelling, hemorrhage, and gradual degeneration at the tibial tubercle



•Severe pain when kneeling, jumping, and running



•Point tenderness over the anterior proximal tibial tubercle



•Care

•Stressful activities are decreased for approximately 6 months to 1 year

•Severe cases may require padding to protect the tibial tubercle from additional trauma

•Ice is applied to the knee before and after activities

•Isometric strengthening of quadriceps and hamstring muscles is performed

osgood-schlatter disease

Cause of injury



•Quadriceps group continually being exposed to traumatic blows





Signs of injury



•Pain, temporary loss of function, and immediate bleeding of affected muscles



•Early detection and avoidance of profuse internal bleeding are vital



•Increase recovery rate and prevent muscle scarring



•Palpation may reveal a swollen area that is painful to the touch

Degree of weakness and decreased range of motion indicate the extent of injury



Care



•Compression



•Knee flexed to 120 degrees



•POLICE followed by a gentle static stretch



•Use of crutches when a limp is present



•Use of padding for additional protection when engaged in sports activities



•Begin performing isometric quadriceps contractions as soon as they can be tolerated

quadriceps contusions

Cause of injury



•Myositis ossificans traumatica: Formation of ectopic bone within muscle



•Caused by a severe blow or repeated blows to the thigh



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Signs of injury



•Formation of bone noted in X-rays taken 2 to 4 weeks after occurrence of injury



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Care



•Treatment must be conservative



•May require surgical removal if condition is too painful and restricts motion



•Surgery must be performed after one year to avoid possibility of recurrence



•Recurrent myositis ossificans may indicate problem with clotting

myositis ossificans

Cause of injury



•Strained rectus femoris due to sudden stretch



•Associated with weakened or overly constricted muscle





Signs of injury



•Deep tear: Pain, point tenderness, spasm, loss of function, and little discoloration



•Peripheral tear of quadriceps rectus femoris causes fewer symptoms than deeper tear



•More centered partial muscle tear causes more pain and discomfort than a peripheral tear



•Complete tear may cause little disability and discomfort and deformity of the anterior thigh



Care

•On-site care: Rest, cold application, and pressure to control internal bleeding

•Determine extent of injury as soon as possible

•Neoprene sleeve assists with the healing process

quadriceps muscle strain

Cause of injury

•Sudden change in hamstring muscle function from knee stabilization to hip extension



•Possible causes: Fatigue, sciatic nerve irritation, faulty posture, leg-length discrepancy, tight hamstrings, use of improper form, and strength imbalance between hamstring muscle groups



Signs of injury



•Internal bleeding, pain, and immediate loss of function along with discoloration that occurs after 1 or 2 days



Care

•Initial treatment: Ice pack and compression using an elastic wrap

•Restricted activity until soreness subsides

•Rehabilitation includes eccentric strength training exercises

hamstring muscle strain

Cause of injury



•Fractures are common in automobile accidents and falls from great heights and less common in sports



•In sports, fractures often occur in the shaft



•Often in the middle third of the bone due to anatomical structure and point of contact



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Signs of injury



•Deformity, with the thigh rotated outward



•A shortened thigh caused by bone displacement



•Loss of thigh function



•Pain and point tenderness



•Swelling of the soft tissues



Care

•Immediate emergency assistance and medical referral

•Prevention of shock and a life-threatening situation

acute femoral fracture

Cause of injury



•Violent twisting action



•Impact force delivered by another participant



•Forceful contact with another object



•Action involving foot being planted and trunk being forced in the opposite direction



Signs of injury



•Circumduction of the thigh will not be possible



•Significant pain in the hip region



•Similar to those of a stress fracture



Care

•X-ray examination to rule out fracture

•Use of POLICE and analgesics when required

•Restricted weight bearing based on the grade of sprain

•Crutch walking for grade 2 and 3 sprains

hip sprain

Cause of injury



•Injury rarely occurs in sports



•Result of traumatic force along the long axis of the femur



Signs of injury



•Flexed, adducted, and internally rotated thigh



•Palpation reveals that the head of the femur has moved to a position posterior to the acetabulum



•Serious pathology: Tearing of capsular and ligamentous tissue



•**Avascular necrosis**: Tissue death caused by lack of circulation



Care

•Immediate medical attention is required

•Two weeks of bed rest and use of a crutch for at least one month

\
Complications

•Muscle paralysis as a result of nerve injury in the area

•Later development of degeneration of the femoral head

dislocated hip

Cause of injury



•Result of repetitive movements that cause degeneration and breakdown of the labrum



•May occur due to an acute injury



Signs of injury



•Injury is often asymptomatic



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



•Pain in the hip or groin

Feeling of stiffness or limited motion



Care



•Exercises to maximize hip range of motion (R O M), strength, and stability



•Pain medications and a corticosteroid injection can be used if required



•Surgery might be required if pain persists for more than 4 weeks

hip labral tear

Cause of injury



•Overextension of the groin musculature



•Running, jumping, or twisting with external rotation



\


Signs of injury



•Sudden twinge or feeling of tearing during a movement



•Pain, weakness, and internal hemorrhaging





Care



•Rest



•Use of a protective spica bandage until normal flexibility and strength returns



•Medical attention is required if pain is severe

groin strain

Cause of condition



•May occur during periods of accelerated growth, after onset of puberty



•Related to effects of a growth hormone



•Both hips are affected in 25 percent of cases



•Femoral head or proximal femoral epiphysis slips posterior and inferior relative to the femoral neck or femoral metaphysis



Signs of condition



•Pain in groin that due to trauma or due to weeks or months of prolonged stress

Advanced stages: Hip and knee pain, limitations on movement, and limping



Care



•Minor displacement: Rest and no weight bearing may prevent further slippage



•Major displacement requires corrective surgery



Complications



•If displacement is undetected or if surgery is unsuccessful, severe hip-related problems may occur later in life

slipped capital femoral epiphysis

Cause of injury



•Contusion to the iliac crest causing bleeding in the transversus abdominus and oblique muscles that attach to the iliac crest



•Result of direct blow



•Greater trochanter and the tensor fascia lata muscle are also affected in some cases



Signs of injury



•Immediate pain, muscle guarding, and transitory paralysis of soft structures

Inability to rotate trunk or flex the thigh without pain



Care



•Immediate cold application with pressure



•Maintained intermittently for least 48 hours



•Bed rest of 1 to 2 days in severe cases



•Referral to a physician and X-ray examination



•Padding should be used upon return to play

Minimizes chances of recurrent injury

iliac crest contusion

Cause of injury



•Prevalent among athletes participating in distance running



•Repetitive stress on pubic symphysis and adjacent bony structures



\


Signs of injury



•Pain in the groin and symphysis pubis



•Point tenderness on pubic tubercle



•Pain while executing movements such as running, sit-ups, or squats



\


Care



•Rest, use of oral anti-inflammatory agent, and gradual return to activity

osteitis pubis

Cause of injury



•Result of direct trauma



Signs of injury



•Severe pain, loss of function, and shock



Care



•Immediately treat for shock



•Refer to physician



•Seriousness of injury dependent on extent of shock and possibility of internal injury

acute fracture of pelvis

Cause of injury



•Repetitive abnormal overuse forces



Signs of injury



•Pain in groin pain along with aching sensation in thigh that increases with activity



•Pain subsides with rest



Care



•Referral to physician for assessment and X-ray examination



•Rest for 2 to 5 months

stress fracture

Cause of injury



•Avulsion fracture: Tendon pulling part of a bone away from corresponding muscle during a sudden and forceful contraction of the muscle



•Common sites



•Point of attachment between sartorius muscle and anterior superior iliac spine (A S I S)



•Point of attachment between rectus femoris muscle and front anterior inferior iliac spine (A I I S)

\


Signs of injury



•Sudden localized pain along with limited movement



•Swelling and point tenderness



\


Care: Rest, limited activity, and graduated exercise

avulsion fracture

___-__

•Lasts from the first movement until the ball leaves the gloved hand



•Lead leg strides forward while both shoulders abduct, externally rotate, and horizontally abduct



\


\------



•Hands separate and ends when maximum external rotation of the humerus has occurred



•Foot comes in contact with the ground



\


\-----

•Lasts from maximum external rotation until ball release



•The humerus abducts, horizontally abducts, and internally rotates at velocities approaching 8,000 degrees per second

Scapula elevates, abducts, and rotates upward

wind-up, cocking, acceleration

\----- ----



•Lasts from ball release until maximum shoulder internal rotation



•The external rotators of the rotator cuff contract eccentrically to decelerate the humerus



•The rhomboids contract eccentrically to decelerate the scapula



\


____-______



•Lasts from maximum shoulder internal rotation until the end of the motion, when there is a balanced position

deceleration, follow-through

Clavicle fractures



•Cause of injury



•Result from a fall on the outstretched arm, a fall on the tip of the shoulder, or a direct impact



•Occur primarily in the middle one-third of the clavicle



•Signs of injury



•Athlete supports the arm on the injured side and tilts his or her head toward that side, with the chin turned to the opposite side



•Injured clavicle may appear lower than the unaffected side



•Palpation reveals swelling, point tenderness, and mild deformity



•Care

•Clavicle fracture is cared for immediately by applying a shoulder immobilizer and by treating the athlete for shock, if necessary

•If X-ray examination reveals a fracture, a closed reduction should be attempted by the physician, followed by immobilization for 6 to 8 weeks with a clavicle strap

•Following this period, gentle isometric and mobilization exercises should begin with the athlete using a sling for an additional 3 to 4 weeks to provide protection

•Occasionally clavicle fracture requires surgical management

clavicle fracture

•Cause of injury



•Fractures of the humerus happen occasionally in sports, usually as the result of a direct blow, a dislocation, or the impact of falling onto the outstretched arm



•Signs of injury



•Prevalent signs - Pain, inability to move the arm, swelling, point tenderness, and discoloration of the superficial tissue



•X-ray is positive for fracture



•Care



•Immediate application of splint or immediate support with a sling, treatment for shock, and referral to a physician



•Athlete will have to be out of competition for 2 to 6 months, depending on the location and severity of injury

fracture of the humerus

•Cause of injury



•Indirect force transmitted through the humerus, the shoulder joint, and the clavicle, or a direct impact to the clavicle



•Signs of injury



•Grade 1 - Little pain and disability



•Grade 2 - Subluxation of the sternoclavicular joint with visible deformity, pain, swelling, point tenderness, and an inability to abduct the shoulder through a full range of motion or to bring the arm across the chest, indicating disruption of the stabilizing ligaments



•Grade 3 - Severe, presents a picture of complete dislocation with gross displacement of the clavicle at its sternal junction, swelling, and disability, indicating complete rupture of the sternoclavicular ligament



•Possibly life-threatening injury if clavicle dislocates posteriorly



•Care

•POLICE should be used immediately, followed by immobilization

•Immobilization for 3 to 5 weeks followed by graded reconditioning exercises

•High incidence of recurrence of sternoclavicular sprains

Sternoclavicular joint sprain

•Cause of injury



•Fall on outstretched arm or direct impact to the tip of the shoulder that forces the acromion process downward, backward, and inward while the clavicle is pushed down against the rib cage and



•Signs of injury



•Grade 1 - Point tenderness and discomfort during movement at the junction between the acromion process and the outer end of the clavicle



•Grade 2 - Tearing or rupture of the acromioclavicular ligament and associated stretching of the coracoacromial ligament



•Grade 3 - Involves rupture of the acromioclavicular and coracoclavicular ligaments with dislocation of the clavicle



•Care

•Basic procedures - Application of cold and pressure to control local hemorrhage, stabilization of the joint by a shoulder immobilizer, and referral to a physician for definitive diagnosis and treatment

•Immobilization ranges from 3 to 4 days with a grade 1 to approximately 2 weeks with a grade 3

•Aggressive rehabilitation program is required for all grades

•Joint mobilization, flexibility exercises, and strengthening exercises should begin immediately following the recommended period of protection

•Progression should be as rapid as the athlete can tolerate without increased pain or swelling

acromioclavicular sprain

Cause of injury



•Head of humerus is forced out of its joint capsule in an anterior direction past the glenoid labrum and then downward to rest under the coracoid process



•Mechanism for an anterior dislocation is abduction, external rotation, and extension that forces the humeral head out of the glenoid cavity



•Arm tackle in football or rugby or abnormal forces created in executing a throw can produce a sequence of events resulting in dislocation



•On rare occasions, the humerus dislocates in an inferior direction



Signs of injury



•Flattened deltoid contour, prominent humeral head is revealed by palpation of the axilla, arm carried in slight abduction and external rotation, and moderate to severe pain and disability



Care

•immediate immobilization in a position of comfort using a sling; immediate reduction by a physician; and control of the hemorrhage by cold packs

•Muscle reconditioning should be initiated as soon as possible

•Protective sling immobilization should continue for approximately 1 week after reduction

•Athlete is instructed to begin a strengthening program, progressing as quickly as pain allows

•Protective shoulder braces may help limit shoulder motion

glenohumeral dislocations

Cause of injury



•Mechanical compression of supraspinatus tendon, the subacromial bursa, and long head of the biceps tendon, all of which are located under the coracoacromial arch



•Repetitive compression eventually leads to irritation and inflammation of these structures



Signs of injury



•Diffuse pain around the acromion whenever the arm is in an overhead position



•Decreased strength of external rotators compared to internal rotators; tightness in the posterior and inferior joint capsule



•There usually is a positive impingement test, and the empty can test may increase pain



Care

•Restore normal biomechanics

•POLICE can be used to modulate pain initially

•Strengthening of rotator cuff muscles and those muscles that produce movement of the scapula

•Stretching of the posterior and inferior joint capsule

•Activity that caused the problem in the first place should be modified so that the athlete has initial control over the frequency and the level of the activity, with a gradual and progressive increase in intensity

shoulder impingement

Cause of injury



•Most common rotator cuff tendon strain involves the supraspinatus muscle, although any of the rotator cuff tendons are subject to injury



•Primary mechanism - Involves dynamic rotation of the arm at a high velocity, as occurs during overhead throwing or any other activity in which there is rotation of the humerus



•Most rotator cuff tears occur in the supraspinatus in individuals with a long history of shoulder impingement or instability and are relatively uncommon in athletes under the age of 40



Signs of injury

•Rotator cuff strains present pain with muscle contraction, some tenderness on palpation, and loss of strength because of pain

•Pain, loss of function, swelling, and point tenderness

•With complete tear of the supraspinatus tendon, both the impingement tests and the empty can test are positive

\
Care

•POLICE can be used for modulation of pain

•Progressive strengthening exercises of the rotator cuff muscles

•Frequency and level of activity should be reduced initially, with a gradual and progressive increase in intensity

rotator cuff strain

Cause of injury



•Shoulder joint is subject to chronic inflammatory conditions resulting from trauma or overuse



•May develop from a direct impact, a fall on the tip of the shoulder, or as a result of shoulder impingement



\


Signs of injury



•Pain when trying to move the shoulder, especially in abduction or with flexion, adduction, and internal rotation



\


Care



•Cold packs and anti-inflammatory medications to reduce inflammation



•Correct impingement mechanism that precipitates bursitis



•Maintain full R O M so that muscle contractures and adhesions do not immobilize the joint

subacromial bursitis

Cause of injury



•Repeated stretching of the biceps in highly ballistic activities may eventually cause an inflammation of both the tendon and its synovial sheath



\
Signs of injury



•Tenderness in the anterior upper arm and swelling, increased warmth, and crepitus caused by the inflammation



•Pain when performing dynamic overhead throwing activities

\
Care



•Rest and combined with daily applications of cold to reduce inflammation



•Anti-inflammatory medications



•Gradual program of strengthening and stretching the biceps muscle

bicipital tenosynovitis

Cause of injury



•Repeated contusions to the lateral aspect of the upper arm can lead to myositis ossificans



•



Signs of injury



•Bruises to the upper arm area can be particularly handicapping, causing pain and tenderness, increased warmth, discoloration, and difficulty in achieving full extension and flexion of the elbow



\


Care



•POLICE should be applied for a minimum of 24 hours after injury



•Key to treatment is to provide protection to the contused area to prevent repeated episodes that increase the likelihood of myositis ossificans

contusion of upper arm

•Cause of injury



•Direct blow



•Falling on the tip of the bent elbow



•Signs of injury



•Pain, marked swelling, and point tenderness



•Swelling will appear almost spontaneously and without the usual pain and heat



•Care



•In acute conditions, ice and compression should be applied



•Chronic cases require protective therapy



•Aspiration may be necessary to accelerate healing in rare cases



•Site of injury should be well protected by padding while the athlete is engaged in competition

olecranon bursitis

Cause of injury



•Hyperextension or a force that bends or twists the lower arm outward



\


Signs of injury



•Pain



•Inability to grasp objects



•Point tenderness over the medial collateral ligament



\


Care



•Cold pack and a pressure bandage should be applied for at least 24 hours, with sling support fixed at 90 degrees of flexion



•Progressively aid the elbow in regaining a full range of motion



•Athlete should gradually progress the number of throws in throwing activities



•Surgical procedure called “Tommy John” is used to repair the medial collateral ligament and joint capsule

elbow sprains

Cause of injury



•Repetitive forceful extension of the wrist



•Causes irritation and inflammation to the insertion of the extensor muscle of the lateral epicondyle



Signs of injury



•Aching pain in the region of the lateral epicondyle during and after activity



•Gradual increase in pain, with weakness in the hand and wrist



•Tenderness at the lateral epicondyle

Pain on resisted extension of the wrist and full extension of the elbow



Care



•POLICE, nonsteroidal anti-inflammatory agents (N S A I D’s), and analgesics as needed



•Rehabilitation



•Range-of-motion exercises



•Progressive resistance exercises



•Deep friction massage



•Hand grasping while in supination



•Avoiding pronation movements



•Mobilization and stretching within pain-free limits



•Use of a counterforce brace or a neoprene sleeve for 1 to 3 months



•Proper skill techniques and equipment instruction is critically important

lateral epicondylitis (tennis elbow)

Cause of injury



•Repeated forceful flexion of wrist



\


Signs of injury



•Pain occurs around the medial epicondyle of the humerus during forceful wrist flexion and may radiate down the arm



•Point tenderness and mild swelling



•Passive movement of wrist seldom elicits pain, but active movement does



\


Care



•Rest, cryotherapy, or application of heat through ultrasound



•Analgesics and N S A I D’s may be prescribed by a physician



•A counterforce brace can be applied just below the bend of the elbow

Severe cases may require elbow splinting and complete rest for 7–10 days

medial epicondylitis

Cause of injury



•Cause is unknown



•Impairment of blood supply can lead to fragmentation and separation of a portion of the articular cartilage and bone, creating loose bodies within the joint





Signs of injury



•Sudden pain and locking of the elbow joint



•Range of motion usually returns in a few days



•Swelling, pain, and crepitus may also occur





Care



•Repeated episodes of locking may warrant surgical removal of the loose bodies



•Without removal, traumatic arthritis may develop

elbow osteochondritis dissecans

Cause of injury



•Pronounced outward angle (cubitus valgus) of the elbow may develop a nerve friction problem



•Ulnar nerve can also become recurrently dislocated because of a structural deformity or can become impinged by a ligament during flexion-type activities



\
Signs of injury



•Ulnar nerve injuries usually respond with a **paresthesia** to the fourth and fifth fingers



•Burning and tingling in the fourth and fifth fingers



Care



•Conservative management, which includes avoiding aggravation of the nerve



•Surgery may be necessary if stress on the nerve cannot be avoided

ulnar nerve injuries

Cause of injury



•High incidence in sports is caused by falling on an outstretched hand with the elbow extended or by a severe twist while the elbow is flexed



\


Signs of injury



•May be displaced backward, forward, or laterally



•Rupturing and tearing of most of the stabilizing ligamentous tissue accompanied by bleeding and subsequent swelling



•Severe pain and disability



•Complications may include injury to the major nerves and blood vessels



•Wrist should be checked for a pulse





Care



•Immobilize with a splint and refer the athlete to a physician for reduction



•After reduction, the elbow should remain splinted in flexion for 3 weeks

dislocation of the elbow

Cause of injury



•Fall on the outstretched hand or the flexed elbow



•Direct blow to the elbow



•Fall on the outstretched hand can often fracture the humerus above the condyles or the bones of the forearm or wrist



Signs of injury



•May or may not result in visual deformity



•Hemorrhaging, swelling, and muscle spasms in the injured area



Care



•Ice and sling for support, followed by a referral to a physician



•Fractured elbow is associated with rapid swelling that may cause an irreversible condition called Volkmann’s contracture

fractures of elbow

Cause of injury



•Ulnar side receives the majority of blows in arm blocks



•Acute contusion can result in a fracture



•Chronic contusion develops from repeated blows to the forearm



Signs of injury



•Pain, swelling, and accumulation of blood (hematoma)



•Extensive scar tissue may replace the hematoma, and in some cases a bony callus replaces the scar tissue



Care



•Proper attention in the acute stages by application of POLICE for 20 minutes every 1.5 waking hours, followed the next day by cold and exercise

Protection consists of providing a full-length sponge rubber pad for the forearm early in the sports season

contusion to forearm

Cause of injury



•Forearm strains occur from repeated static contractions



•Forearm splints occur from static muscle contractions



•Static muscle contraction causes minute tears in the deep connective tissues of the forearm



\


Signs of injury



•Dull ache in the extensor muscles crossing the back of the forearm



•Muscle weakness



•Palpation reveals an irritation of the deep tissue between the muscles



\


Care



•Treatment of symptoms



•Strengthening of forearm through resistance exercises

Rest, cold or heat, and use of a supportive wrap during activity

forearm splints and other strains

Cause of injury



•Blow or a fall on the outstretched hand



•Common among active children and youths



•Fractures to the ulna or radius singly are rarer than simultaneous fractures to both



\


Signs of injury



•Pain, swelling, deformity, and nonunion



•The older the athlete, the greater the danger of extensive damage to soft tissue and the greater the possibility of paralysis



\


Care



•Cold pack must be applied immediately to the fracture site, the arm splinted and put in a sling, and the athlete referred to a physician

The athlete usually is incapacitated for about 8 weeks

forearm shaft fractures

Cause of injury



•Fall on the outstretched hand with an extended wrist, forcing the forearm backward and upward into hyperextension



•Distal fracture fragment is displaced backward



•Sometimes called a dinner fork deformity



Signs of injury

•Visible deformity to the wrist

•When no deformity is present, injury may be passed off as a bad sprain

•Profuse bleeding and extensive swelling

•Tendons may be torn away from their attachment, and there may be median nerve damage

\
Care

•Applying ice, splinting the wrist, and putting the limb in a sling

•Athlete should be referred to a physician

•X-ray examination and immobilization of the injured arm

•Without complications, a Colles’ fracture will keep an athlete out of sports for 1–2 months

colle’s fracture

Cause of injury



•Any abnormal, forced movement of the wrist



•Falling on the hyperextended wrist



•Violent flexion or torsion



\


Signs of injury



•Pain, swelling, and difficulty moving the wrist



•Tenderness, swelling, and limited range of motion



\


Care



•Refer to a physician for X-ray if the sprain is severe



•POLICE, splinting, and analgesics for mild and moderate sprains



•Have athlete begin wrist-strengthening exercises soon after injury

Taping for support can benefit healing and prevent further injury

wrist sprains

Cause of injury



•Repetitive wrist accelerations and decelerations



\


Signs of injury



•Pain with use or pain in passive stretching



•Tenderness and swelling over the tendon



\
Care



•Acute pain and inflammation treated with ice massage for 10 minutes 4 times a day for the first 48–72 hours, N S A I D’s, and rest



•Use of wrist splint may protect the injured tendon



•Range of motion is stressed when swelling has subsided



•When pain and swelling have subsided, progressive resistance exercise can be instituted

wrist tendinitis

Cause of injury



•Compression of median nerve due to inflammation of the tendons and synovial sheaths of carpal tunnel



•Repeated wrist flexion or direct trauma to the anterior aspect of the wrist



\


Signs of injury



•Sensory and motor deficits, including tingling, numbness, and paresthesia



•Weakness in thumb movement



\


Care



•Conservative treatment initially



•Rest, immobilization, and N S A I D’s



•If symptoms persist, corticosteroid injection may be necessary or surgical decompression of the transverse carpal ligament

carpal tunnel syndrome

Cause of injury



•Fall on an outstretched hand, compressing the scaphoid bone between the radius and the second row of carpal bones



\


Signs of injury



•Swelling in the area of the carpal bones



•Severe point tenderness over the scaphoid bone in the anatomic snuffbox



\
Care



•Cold pack should be applied, the area should be splinted, and the athlete referred to a physician for X-ray and casting



•Immobilization for 6 weeks followed by strengthening and protective taping



•Wrist requires protection against impact loading for 3 additional months



•Scaphoid often fails to heal, necessitating surgery

scaphoid fracture

Cause of injury



•Fall or more commonly from contact while an athlete is holding an implement





Signs of injury



•Wrist pain and weakness and point tenderness



•Tingling, numbness, and weakness in the little and ring fingers because the ulnar nerve may be compromised due to of its close proximity to the hamate





Care



•Casting of the wrist



•The hook of the hamate can be protected with a doughnut pad to take pressure off the area

hamate fracture

Cause of injury



•Repeated forced hyperextension of the wrist



\


Signs of injury



•Ganglions generally appear on the back of the wrist



•Occasional pain and a lump at the site



•Pain increases with wrist extension



\


Care



•Old method was to first break down the swelling through distal pressure and then apply a pressure pad to encourage healing



•New approach includes aspiration and chemical cauterization, with subsequent application of a pressure pad



•Surgical removal is the most effective way

wrist ganglion

Cause of injury



•Direct axial force caused by punching the wall or another person



•Fractures of the fifth metacarpal are associated with boxing and martial arts (boxer’s fracture)



\


Signs of injury



•Point tenderness and likely a palpable defect in the shaft of the fifth metacarpal



•Knuckle appears depressed or sunken when making a fist



•Swelling is rapid



\


Care

Suspected boxer’s fracture should be referred to a physician for reduction and immobilization for a period lasting 3 to 4 weeks

fifth metacarpal fracture (boxer's fracture)

Cause of injury



•Blow from a thrown ball that strikes the tip of the finger, jamming and avulsing the extensor tendon from its insertion



\


Signs of injury



•Pain at the distal interphalangeal joint (D I P)



•X-ray shows a bony avulsion from the dorsal proximal distal phalanx



•Inability to extend the finger (carrying it at a 30-degree angle)



•Point tenderness at the sight of the injury



\


Care



•POLICE for the pain and swelling



•If there is no fracture, the distal phalanx should immediately be splinted in a position of extension 24 hours a day for a period of 6 to 8 weeks

mallet finger

Cause of injury



•Rupture of the extensor tendon over the middle phalanx



•Trauma to the tip of the finger forces the D I P joint into extension and P I P into flexion



\


Signs of injury



•Severe pain and inability to extend the D I P joint



•Swelling, point tenderness, and an obvious deformity



\


Care



•Cold application, followed by splinting of the P I P joint



•Splinting must be continued for 5–8 weeks

Athlete is encouraged to flex the distal phalanx

boutonniere deformity

Cause of injury



•Rupture of the flexor digitorum profundus tendon from its insertion on distal phalanx



•Often occurs in the ring finger when the athlete tries to grab a jersey of an opponent



\


Signs of injury



•D I P joint cannot be flexed, and the finger remains extended



•Pain and point tenderness over the distal phalanx



\


Care



•Must be surgically repaired



•Rehabilitation requires 12 weeks, and there is often poor gliding of the tendon, with the possibility of re-rupture

jersey finger

Cause of injury



•Sprain of the ulnar collateral ligament (U C L) of the M C P joint of the thumb



•Forceful abduction of the proximal phalanx occasionally combined with hyperextension



\


Signs of injury



•Pain over U C L in addition to a weak and painful pinch



•Tenderness and swelling over the medial aspect of the thumb



\


Care



•Immediate follow-up must be performed



•If the joint is unstable, athlete should be referred to an orthopedist



•If the joint is stable, an X-ray should be performed to rule out fracture



•Thumb splint should be applied for protection for 3 weeks or until pain free

gamekeeper’s thumb