Acute Injuries

Acute Joint Injuries

• Types of Injuries

  • Traumatic injuries to joint structures:

  • Ligament damage

  • Meniscal injury

  • Labral injury

  • Cartilage damage

  • Bone damage

  • Long-term implication: osteoarthritis

• Clinical Signs

  • Increased intra-articular fluid leads to joint effusion

  • Assessment Tests:

  • Milking test

  • Sweep test

  • Increased fluid indicates damage

• Haemarthrosis

  • Presence of blood in the joint

Acute Articular Cartilage Injuries

• Nature of Injury

  • Chondral fragments shear off articular surfaces due to high-impact trauma

• Detection

  • MRI and CT scans used for detection

• Surgical Intervention

  • Arthroscopic options: micro-fracturing

  • MRI is the gold standard for diagnosis

• Repair Techniques

  • Mosaicplasty for cartilage repair

  • Link to osteoarthritis development

  • Poor long-term results in knee microfracture and ACI (Andia & Maffulli, 2018)

Acute Chondral Injuries

• Characteristics and Causes

  • Result from extreme forces

  • Poor healing capacity due to limited regenerative ability

• Statistics

  • Osteochondral fracture incidence in ACL injuries: up to 80%

  • Lateral patellar dislocation osteochondral fractures: 40%-78%

Acute Muscle Contusions

• Definition and Causes

  • Result from forceful impacts or blunt trauma

  • Symptoms: pain, bruising (ecchymosis), edema, hematoma

• Classification of Muscle Contusions by Severity

  • Mild "Cork":

  • RTP in 1-3 weeks

  • Soreness post-activity

  • Moderate "Cork":

  • RTP ~4 weeks

  • Minimal stiffness; up to 50% reduced range of motion

  • Severe "Cork":

  • RTP up to 8 weeks

  • Rapid swelling and significant movement loss

• Bruising Progression

  • Initial red → Blue/purple/black (1-2 days) → Yellow/green (5-10 days) → Yellowish-brown (10-14 days)

• Commonly Affected Areas

  • Vulnerable: vastus lateralis, biceps brachii

  • Less common: thigh adductors, medial gastrocnemius

Management and Treatment of Acute Muscle Contusions

• Immediate Care Protocol

  • Use ICE, not HARM (Heat, Alcohol, Running, Massage)

  • Place muscle in a stretched position to aid healing

  • Avoid massage to limit bleeding

Myositis Ossificans Traumatica

• Definition

  • Bone deposition in muscle during healing, typically 2-4 weeks post-injury

• Mechanism

  • Fibroblasts differentiate into osteoblasts

  • Local factors: calcium reserve, hypoxia, vascular stasis

  • Systemic factors are unclear

• Progression Timeline

  • Repeated injuries may exacerbate development

  • Time to development: 4 weeks to 12 months

Severe Complication: Compartment Syndrome

• Case Study Example

  • Jarryn Geary had compartment syndrome post-quadricep strain

Exercise-Associated Muscle Cramps (EAMC)

• Symptoms

  • Painful, spasmodic, involuntary contractions (1-3 mins)

  • Often occurs late in games or after exercise

• Affected Muscle Groups

  • Gastrocnemius (calf), intrinsic foot muscles, quadriceps, hamstrings

• Causes of EAMC

  • Not necessarily due to dehydration/electrolyte imbalance

  • Linked to altered neuromuscular control

  • No significant underlying diseases found

• Management of EAMC

  • Effective Treatment:

  • Passive stretching for relief

  • Pickle juice may reduce cramp duration

Delayed Onset Muscle Soreness (DOMS)

• Definition

  • Soreness after vigorous exercise, peaking 24-48 hours post-exercise

  • Associated with eccentric actions

• Signs and Symptoms

  • Intense pain, local swelling, stiffness, strength deficits, elevated plasma creatine kinase levels

• Management of DOMS

  • Modify exercise, cryotherapy, stretching, active recovery, turmeric for inflammation reduction

  • Repeated eccentric exercises may protect against future DOMS incidents

• Proposed Pathway for DOMS

  • Bradykinin release during eccentric exercises upregulates NGF leading to muscle hyperalgesia

  • Cyclooxygenase-2 (COX-2) activation stimulates nociceptors, developing an adaptive mechanism to reduce future incidences.