Athletic Injury Treatment & Prevention Final

Front 1

Quadriceps Contusion

Back 1

“Charley Horse”
Location: Anterior Thigh
MOI: Direct blow (to relaxed thigh)Continual blows to the thigh compressing the quad muscle against the femur. The worse the blow and the deeper into the muscle the injury occurs will depend on the structural and functional disruption. There are 3 grades of contusion: mild, moderate and severe. Pain, swelling and ROM or decreased ROM will depend on the grade of injury.
Signs/Symptoms: Pain, edema, ecchymosis, pain, tenderness, temporary loss of function, immediate bleeding in the muscle, limping in grades 2 & 3 is possible.
Grade 1: “Superifical Intramustular” - mild point tenderness, mild loss of range of motion.
Grade 2: “Moderate” – Range of knee flexion diminished to less than 90 degrees.
Grade 3: “Deep Intramuscular – Severe” – Major limitation to range of motion. May split the fascia surrounding the quadriceps causing a muscle herniation.
Tx: Conservative approach: Price, gentle static stretching, Compression with elastic bandage with knee flexed to 120 degree range of motion for first 12 hours. Crutch walking if limp is present. Isometric quadriceps contractions as soon as they can be tolerated. Prevention afterwards of great importance, use protective pads held in place by elastics.Compression with ice. Wrapping bandage around thigh and then bringing knee to 120 degrees and wrapping. This prevents loss of ROM and helps to stretch the injured quad muscles. Conservative approach to rehab, and crutch walking if limp prevents walking properly. Quad contractions may begin when the athlete can handle them. No heat or massage is advised.

Front 2

Myositis Ossificans:

Back 2

MOI: Severe or repeated blows to the thigh/quad muscle. Can cause ectopic bone formation within the muscle -- A.K.A. Myositis Ossificans Traumatica.
S/S: positive acute edema and ecchymosis following the hemorrhage, formations that resemble bone or cartilage (can be seen over x-ray about a month after injury).
Tx: rehab should be very conservative, if ossification is very painful and restricts ROM it can be removed after approximately 1 year. (is possible for it to return if it is removed too early). Athlete should not attempt to run off the injury or massage the area directly. Heat is not advised. If repeated myositis ossificans is a problem, there could be an issue with the athletes blood clotting properly.

Front 3

Muscle Strain

Back 3

Locations: Quads and *Hamstring (most commonly strained in entire body)*
MOI: over-stretching or too forceful contraction 2 grades of tearing; Hamstrings and quadriceps contract together
Change from hip extender to knee flexor
Fatigue
Posture
Leg length discrepancy
Lack of flexibility
Strength imbalances
S/S: Pain in muscle belly or point of attachment
Capillary hemorrhage
Severe hemorrhage
Disability
Edema
Loss of function
Ecchymosis
Palpable mass or gap
Tx:
RICE,
Analgesics pain killers
Modalities
When soreness is eliminated, focus on eccentrics strengthening
Recovery may require months to a full year
Scaring increases risk of injury recurrence

Front 4

Femoral Fx:

Back 4

MOI: Direct Blow (thigh bone)
S/S: pain, deformity, ecomossis, decrease ROM, edema, point tenderness, possibility of shock, shortening of muscle possibility of open wound, bleeding (Femoral artery) shorten of the hip
Tx: Splint and send, pain killers or Analgesics, ice or PRICE

Front 5

Femoral stress Fx:

Back 5

Location: Stress Fx of the femoral neck are fairly uncommon and femoral shaft stress Fx rarely occur
MOI: Over use, usually in endurance athletes, more common in females
S/S: Occur several weeks after, pain in groin or anterior thigh, pain increases with activity, pain can become constant, present with a limp
Tx: rest with no running, non-weight bearing activities, possible surgery if it turns into a fracture which can be up to 12 months of recovery

Front 6

Pelvic stress Fx:

Back 6

MOI: Repetitive abnormal overuse forces occurring in Intensive training or competitive racing
S/S: Pain in the groin with a achy sensation in the thigh, pain increases with activity
Tx: Referral to physicians for X-rays, If confirmed 2-5 months rest

Front 7

Femoral Stress Fracture:

Back 7

Location: Femur (Thigh Bone)
MOI: Overuse (rarely occurs, more prevalent in women than in men), occurs after increasing intensity of activity.
S/S: Pain in groin or anterior thigh, pain increases with activity and decrease when at rest, after a while it becomes constant. Athlete walks with a limp.
Care: Rest, no running. Maintain cardio through non-weight bearing exercise. If not managed properly it can result in an acute fracture, send to physician and x-ray.(12 months rehab)

Front 8

Stress Fracture of the Pelvis

Back 8

MOI: Overuse, repetitive abnormal factors, happens in intensive training, and competitive racing.
S/S: Groin pain, aching dull pain in the thigh, increases activity and decreases with inactivity, pelvic pain following intense exercise.
Care: Refer to physician, X-ray, maintain cardio through non-weight exercise, if managed improperly acute fracture can occur. Surgery is then needed. (2-5 months rehab)

Front 9

Hip Pointer:

Back 9

Structures: Iliac Crest
MOI: Direct Blow to iliac crest
S/S: Immediate Pain, spasms, inability to rotate trunk, cannot flex thigh without pain
T: RICE (48hrs), bed rest, x-ray, ice massage, ultrasound, steroid, anti-inflamatory

Front 10

Osteitits pubis

Back 10

from repeated stress on the pubis symphisis. Chronic inflammation of the pubic symphisis. Normally seen in long distance runners and soccer players. Pain is present in the groin, including point tenderness during running, squats, and sit-ups. rx- anti-inflammatories (including injectables), rest, and gradual return to play.

Front 11

Legg-Calve Perthes Disease

Back 11

 Avascular necrosis of the femoral head
 Disruption of circulation at the femoral head
 MOI: not sure what causes it but the theory that blood supply does not reach that part of the femur but that is just a theory
 S/S: pain in the groin, also can be referred to the knee or abdomen, limping, decreased ROM
 TX: may need a brace to avoid direct on weight on the hip joint, needs rest and non-weight bearing
 Develops slowly
 Most common in children, boys age 4-10
 More prone to dislocations because the femoral head becomes misshapen when the bone dies and does not fit in the hip joint like it should

Front 12

SLIPPED CAPITAL FEMORAL EPIPHYSIS

Back 12

A slipped capital femoral epiphysis is a separation ball of the hip joint from the thigh bone (femur) at the upper growing end (growth plate) of the bone. SCFE happens in about two out of every 100,000 children. It is more common in growing children between the ages 10 to 17, especially boys who are tall and thin or very fat. Children with hormonal misbalance in ¼ of the cases happen in both hips. The cause of SCFE is unknown. In many cases is overweight
The symptoms are difficulty walking, walking with a limb, knee pain, hip pain, and hip stiffness outward, and turning leg, decrease range of motion and restricted hip movements.
The treatment for SCFE is as follows:
• In case minor displacement, rest and no weigh bearing may prevent further injury.
• In major cases the treatment is mostly immediate, most likely; surgery is usually performed with in 24 to 48 hours. Surgery stabilizes the bone with pins and screws which prevent further, slippage or displacement at the ball of the hip joint.

Front 13

Pelvic Fracture:

Back 13

Close circuit- bilateral fx = fracture on one side results in fracture on both sides.
MOI: Direct blow results in bones being displaced.
S/S: obvious deformity, pain, no ROM, ecchymosis, edema, shock
T/X: Splint & send to the hospital for x-rays.

Front 14

Dislocated Hip:

Back 14

Bone: acetabulum
Hip fractures are common with dislocated hip.
Falling on bent knee of falling on the side, severe twisting motion.
S/S: Flexed abducted, internally rotated. Pain, muscle guarding,positive deformity, ecchymosis. edema, decrease ROM, complications include damage to sciatic nerve, nutrient loss to artery = avascular necrosis
Tx: medical emergency. O.R.I.F. = open reduction internal fixation. immobilize 2 wks. crutches for one month or longer.

Front 15

Piriformis Syndrome:

Back 15

Muscle in butt.
nerve gets compressed or irritated by tightness or muscle spasm of piriformis.
MOI: Muscle spasm
S/S: pain, numbness, tingling in butt, & can extend to the knee & foot. May worsen due to sitting long periods of time, stairs, walking or running,
Tx: stretching, massage, NSAID's, stop activity of running, bicycling, climbing, corticoid steroid injection, possible surgery.

Front 16

Herniated Lumbar Disc:

Back 16

4 degrees/ levels
MOI: lifting & twisting in the a.m. & there is increased risk with age.
Sx: Depends on the level of damage. Only on one side may not have signs or symptoms. pain, spasms, decreased rom, decreased strength.
Tx: degree I & II, rehab, conservative
degree III = conservative or surgery, rest, core strength, traction
degree IIII = surgery

Front 17

Spondylolysis:

Back 17

stress fx of vertebrae on one side of PARS articularis,
MOI: compression, shearing forces, torsion, -> broad options for MOI.
Sx: achy constant pain in low back, no specific MOI.
Tx: MRI or bone scan, proper mechanics, stretching, strengthen.

Front 18

Spondylolisthesis

Back 18

fx on both sides of PARS articularis, 5 degrees. grade 5 is when there is an over gap.
MOI: slip over time.
Sx: depends on the level of severity. can damage nerves, constant local pain, point tender.
Tx: grade I & II = conservative
grade III = conservative or surgery
grades 4 & 5 = aggressive, surgery, fuse vertebrae together or fuse slipped (as is)

Front 19

Sacroiliac sprain:

Back 19

MOI: improper mechanics.
Sx: pelvis is rotated
Tx: muscle energy used to put perlvis back in correct position, strengthen, fix bio-mechanics problems.

Front 20

Coccyx Injuries:

Back 20

MOI: direct blow, common in gymnasts.
Sx: deep pain, in middle of butt & not possible to palpate.
Tx: send for x-rays, doughnut circle to comfort, improve ROM, core strength, stretch muscles.

Front 21

Spine

Back 21

7 Cervical vertebrae: top region, C1= atlas, C2=axis, 8 cervical nerves
12 Thoracic vertebrae, 12 thoracic nerves
5 lumbar vertebrae: 5 lumbar nerves.
Sacrum: 5 fused vertebrae
Coccyx: 3-4 fused vertebrae.

Front 22

Spine anatomy:

Back 22

Intervertebral Discs: in between vertebrae, outside firm, inside not firm, protects nerves
Ligaments: anterior longitudinal - to prevent hyper extension. posterior longitudinal - to prevent hyper flexion.
Muscles: Abs flex lumbar spine. Erector spinae will extend spine.
Rotation & lateral movement.

Front 23

Spinal Nerves

Back 23

Front 24

Cervical Fracture:

Back 24

MOI:axial load is most common & it is a direct blow from the top of head.
Sx: burning, tingling, numbness bilaterally, muscle spasms, point tenderness.
Tx: head between knees & palpate w/ fingers & hands. palpate down & back up. start @ C2 & look for point tenderness @ the same vertebrae. Wait for EMS, helmet, mask & shoulder pads all have to come off together. Fx of C2 is a hangman fracture & is put in halo collar. Controversial tx: injection of cold fluid to lower core temp.

Front 25

Cervical Dislocation

Back 25

MOI: axial load plus a rotation of neck
Sx: rotation position, ecchymosis, edema, point tenderness, burning, tingling, numbness.
Tx: Surgical, anterior surgery is the most successful. DQ'd from official sport.

Front 26

Cervical Sprain:

Back 26

MOI: whiplash. common with soccer, football & rugby. anterior & posterior ligament hyper extension & hyper flexion.
Sx: dull achy pain, decrease ROM, pain, muscle spasms.
Tx: cervical collar, limit ROM, decrease muscle spasms w/ ice, heat after 72 hours, gentle stretching, strengthen,

Front 27

Cervical Sprain

Back 27

Front 28

Acute Torticollis: Rye or Stiff Neck

Back 28

MOI: holding head in an unusual position for an extended period of time. Most common in athletes after the weekend due to athletes passing out.
Sx: decreased ROM, pain, stiffness, muscle spasms.
Tx: stripping muscle (type of massage), stretching, heat, ice, e-stimulation.

Front 29

Brachial Plexus Neurapraxia:
stinger, burner, dead arm.

Back 29

MOI: brachial plexus (group of nerves on both sides of neck) stretched due to traction or compression.
Sx: burning, tingling & numbness on injured side.
Tx: never diagnose bilateral because it could be a fx. send for x-rays. wait & see, feeling should return within few minutes. Full strength & full ROM required to return to play.

Front 30

Low Back Pain: L.B.P.

Back 30

80%:of population effected
Pre-Disposing Factors:poor posture, tight hamstrings, weak core, poor biomechanics.
MOI: Improper lifting mechanics, not using core, direct blow, axial load.

Sx: muscle spasms, achy pain, decrease ROM, burning, tingling, numbness.

Tx: stretch hamstrings, strengthen core, transverse abdominus & multivitus. work on uneven surface ex. bosu ball. chiropractor.

Front 31

Lumbar Fracture:

Back 31

MOI: not common. compression fx due to axial load force.

Sx: point tenderness, decrease ROM, muscle spasm, burning, tingling, numbness in both legs.

Tx: immobilize w/ vacuum splint or back board & protect on both sides of the body. Surgery by fusing bones together, bone graft or plating with titanium, rehab after surgery.

Front 32

Lumbar Sprain/Strain

Back 32

MOI: Improper lifting

Sx: spasms, dull achy pain, decrease ROM, decrease strength,

Tx: rest, ice, NSAID's, core strength, belt, reinforce proper lifting, proper mechanics.

Front 33

Contusions:

Back 33

MOI: direct blow. low back & therefore there is a concern for damage to kidneys

Sx: ecchymosis, edema, tender, blood in urine.

Tx: pad.

Front 34

Sciatica:

Back 34

compression of sciatica nerve
Pre-Disposing Factors: females w/ wide hips, runners & cyclists.
MOI: compression

Sx: burning, tingling, numbness on back of the legs.

Tx: stretch, figure 4 stretch, & ball massage

Front 35

This injury results in bone being laid down in the muscle belly:

Back 35

Myositis Ossificans

Front 36

This injury results in femoral head shaping incorrectly due to a poor blood supply:

Back 36

Legg Calve Perthes Disease

Front 37

The most commonly strained muscle in the body is:

Back 37

Hamstrings

Front 38

What is the #1 sign/symptom of a concussion:

Back 38

Headache

Front 39

Where will a lacerated spleen refer pain?

Back 39

Left shoulder

Front 40

Which of the following head injuries is due to an arterial bleed within the brain?

Back 40

epidural hematoma

Front 41

This injury results in the pleural cavity filling with blood:

Back 41

Hemothorax

Front 42

The leading cause of sudden athlete death in the U.S. is:

Back 42

Hypertrophic Cardiomyopathy

Front 43

McBurney's point is referred pain site from what structure?

Back 43

Appendix

Front 44

This injury results in the diaphragm becoming paralyzed:

Back 44

Solar Plexus Blow

Front 45

Which of the following injuries will occur due to holding one's head in an unusual position for an extended period of time?

Back 45

Acute Torticollis

Front 46

What is hematuria?

Back 46

Blood in urine

Front 47

This injury is a stress fracture on one side of the vertebrae:

Back 47

Spondylolysis

Front 48

Head Anatomy:

Back 48

Brain does not regenerate
Bones: skull, temporal, poreatals, frontal, occipital -> all fused together.

Brain
Cerebrum
Cerebellum
Pons
Medulla Oblongata
Meninges
Cerebrospinal Fluid: fluid in the spine & skull, protects, lubricates, & provides nutrients. Leaking fluid from nose, ears, etc is a medical emergency.

Front 49

Skull Fracture:

Back 49

Depression fx is the most common
MOI: direct blow.

S/S: swelling, point tenderness, edema, crepitis, raccoon eyes, battle sign (bruising behind ears)

Tx: palpate for crepitis, 911 & send to hospital to monitor pressure on brain.

Front 50

Epidural Hematoma:

Back 50

MOI: Artery. Arterial bleed, fast & spurting. Direct blow.

S/S: develop quickly, fast spurting bleed, dizziness, nausea, headache, pupil on side of bleed dilates.


Tx: Hospital. Medical emergency. install shunt to release pressure.

Front 51

Subdural Hematoma

Back 51

MOI: Direct blow. Venous bleed. Takes a while to develop.

S/S: slow bleed.


Tx: Hospital, install shunt to release pressure. Is a medical emergency.

Front 52

Scalp Injuries

Back 52

MOI: Direct blow, torsion forces, shearing forces, laceration, incision, avulsion, rupture.

S/S: a lot of blood, tender to palpation.

Tx:control bleeding, facial or scalp injuries always refer for sutures.

Front 53

Concussions:

Back 53

MOI: direct blow to head or body. If body it's from shearing forces or whiplash in the brain stem.
Grading: NOT GRADED. A concussion is simply a concussion.MRI & CAT scan are done to rule out hematomas.
S/S: headache in 94%, nausea, disorientation, dizzy, sensitive to light, emotional changes, sleep problems, cognitive disturbances.
Tx: rest, no stress, NO MEDS!
Return to play guidelines: 5 steps, 24 hours in between each step, called A-symptomatic for 24 hours between each step. 7 days of minimum rest. 3 concussions increase risk for alzheimers, lou gherig diseas, clinical depression & ADD.
Testing: neuro-cognitive tests memory & reaction time.

Front 54

Second Impact Syndrome

Back 54

MOI: return to play too quickly following injury & re-injure head. 2nd injury is less severe than the 1st.

S/S: coma, lose consciousness & dies.

Tx: send to hospital to relieve pressure on brain. If a person lives they will have permanent brain damage.

Front 55

Post Concussion Syndrome:

Back 55

MOI:multiple concussions

S/S: psychological & physical. sleep apnea, insomnia, decreased knowledge, personality changes, clinical depression - all 6 mos. or longer.

Tx: medication, can't return to play, happens in 20-30% of athletes.