1. Injuries

2. Signs and Symptoms Pain Swelling Heat Redness Loss of function
Depends on severity of injury

3. Treatment R.I.C.E. and possible NSAIDs Range of Motion (Stretching!)
Strength and Endurance
Neuromuscular Control & Balance
Functional and Sports Specific Progressions
Maintain Cardio Fitness
All depend on severity.
Begin rehab as soon as possible.

4. What are the two categories of acute muscle injuries?
Contusions
Strains

5. How does one receive a contusion?
Sudden traumatic blow to the body

6. What is typical in cases of severe contusions?
the athlete reports being struck by a hard blow
the blow causes pain and a transitory paralysis caused by pressure on and shock to the motor and sensory nerves
palpation often reveals a hard area, indurated because of internal hemorrhage
ecchymosis, or tissue discoloration, may take place

7. What is a strain?
A stretch, tear, or rip in the muscle or adjacent tissue such as the fascia or muscle tendon

8. How are strains most often produced?
Abnormal muscular contraction

9. What is the cause of abnormal muscular contraction?
It is fault in the reciprocal coordination of the agonist and antagonist muscles take place. The cause of this fault or un-coordination is a mystery. However, possible explanations are that it may be related to:
a mineral imbalance caused by profuse sweating
to fatigue metabolites collected in the muscle itself
to a strength imbalance between agonist and antagonist muscles.

10. What is a grade 1 (or 1st degree or 1°) strain?
Slight over-stretching to mild tearing (20%) of the muscle fibers. It is accompanied by local pain, which is increased by tension in the muscle, and a minor loss of strength. There is mild swelling, ecchymosis, and local tenderness.

11. What is a grade 2 (or 2nd degree or 2°) strain?
Moderate tearing (20% - 70%) of the muscle fibers. It is similar to a grade 1, but has moderate signs and symptoms (moderate loss of strength, moderate swelling, ecchymosis, and local tenderness).

12. What is a grade 3 (or 3rd degree or 3°) strain?
Has signs and symptoms that are severe (severe swelling, ecchymosis, and local tenderness) with a loss of muscle function and, commonly, a palpable defect in the muscle.

13. What does a tendon attach?
Muscle to bone

14. What does a ligament attach?
Bone to bone

15. What is a cramp?
A painful involuntary contraction of a skeletal muscle or muscle group.

16. Cramps have been attributed to what?
A lack of water or other electrolytes in relation to muscle fatigue.

17. What is a spasm?
A reflexive reaction caused by trauma of the musculoskeletal system

18. List and define the two types of spasms or cramps:
clonic – alternating involuntary muscular contraction and relaxation in quick succession
tonic – rigid muscle contraction that lasts a period of time.

19. What are the four specific indicators of possible overexertion?
acute muscle soreness
delayed muscle soreness
muscle stiffness
muscle cramping

20. List and define the two types of muscle soreness:
Acute-onset muscle soreness – which accompanies fatigue. This muscle pain is transient and occurs during and immediately after exercise.
Delayed-onset muscle soreness (DOMS) – becomes most intense after 24 to 48 hours and then gradually subsides so that the muscle becomes symptom-free after 3 or 4 days. (This second type of pain is described as a syndrome of delayed muscle pain leading to increased muscle tension, swelling, stiffness, and resistance to stretch).

21. What are the possible causes for delayed-onset muscle soreness?
It may occur from very small tears in the muscle tissue, which seems to be more likely with eccentric or isometric contractions.
It may also occur because of disruption of the connective tissue that hold muscle tendon fibers together.

22. What is muscle stiffness?
Muscle stiffness does not produce pain. It occurs when a group of muscles have been worked for a long period of time. The fluids that collect in the muscles during and after exercise are absorbed into the bloodstream at a slow rate. As a result, the muscle becomes swollen, shorter, and thicker and therefore resists stretch.

23. What can be done to assist in reducing muscle stiffness?
Light exercise
Massage
Passive mobilization

24. What is muscle guarding?
Following injury, the muscle that surrounds the injured area contract, in effect, splint that area, thus minimizing pain by limiting movement. (Quite often this splinting is incorrectly referred to as a muscle spasm)

25. The suffix “itis” means inflammation:
Myositis/Fasciitis - inflammation of the muscle tissue
Tendinitis – inflammation of a tendon
Tenosynovitis - Inflammation of the synovial sheath surrounding a tendon
Bursitis – inflammation of the bursa
Periostitis – inflammation of the bone covering

26. What are the major acute injuries that happen to synovial joints?
Sprains
Subluxations
Dislocations

27. What is a sprain?
Stretching or total tearing of the stabilizing connective tissues (ligaments)

28. What is a grade 1 (or 1st degree or 1°) sprain?
Slight over-stretching to mild tearing (20%) of the ligament. It is characterized by some pain, minimum loss of function, mild point tenderness, little or no swelling, and no abnormal motion when tested.

29. What is a grade 2 (or 2nd degree or 2°) sprain?
Moderate tearing (20% - 70%) of the ligament. There is pain, moderate loss of function, swelling, and in some cases slight to moderate instability.

30. What is a grade 3 (or 3rd degree or 3°) sprain?
It is extremely painful, with major loss of function, severe instability, tenderness, and swelling.

31. What is a subluxation?
Partial dislocations in which an incomplete separation between two articulating bones occurs.

32. What is a dislocation (luxation)?
Total disunion of bone apposition between articulating surfaces

33. What are several factors that are important in recognizing and evaluating dislocations?
Loss of limb function
Deformity
Swelling
Point tenderness

34. What is an acute bone fracture?
A partial or complete interruption in a bone’s continuity

35. What is a stress fracture?
Rhythmic muscle action performed over a period of time at a sub-threshold level causes the stress-bearing capacity of a bone to be exceeded

36. What are the typical causes of stress fractures in sports?
Coming back into competition too soon after an injury or illness
Going from one event to another without proper training in the second event
Starting initial training too quickly
Changing habits or the environment

37. Strains Injury Mechanism of Injury (Etiology) Signs & Symptoms
Treatment
Groin Strain (Hip)
Running, Jumping, Twisting (ER)
Typical
Typical, May need crutches, compression wrap during activity
Quadriceps Strain (Thigh)
Sudden stretch from knee flexion
Hamstring Strain (Thigh)
Sudden stretch from knee extension
Gastrocnemius Strain (Leg)
Quick starts & stops, jumping, sudden knee extension.
Typical, heel wedge, compression wrap during activity
Achilles Tendon Strain (Ankle)
Usually after ankle sprains or sudden excessive ankle dorsiflexion.
Typical, heel lift, compression wrap during activity
Achilles Tendon Rupture (Ankle)
Sudden pushing-off action of the forefoot with the knee being forced into complete extension.
Typical, hears a pop, indentation at site, positive Thompson’s Test
RICE, X-ray to rule out fracture, possible surgical repair, immobilization for 4 to 6 weeks, begin rehab. Heel lifts in both shoes
Longitudinal Arch Strain
Repetitive contact with a hard playing surface. It may appear suddenly or slowly over time.
Typical, Reduce weight bearing activity, possible arch support taping
Metatarsal Arch Strain
Excessive pronation and weak intertarsal ligaments will allow the foot to abnormally spread resulting in a fallen arch
Typical, orthotic or pad to elevate the fallen arch.
Patellar Tendon Rupture
Sudden powerful contraction of the quadriceps
Typical, Defect can be palpated, athlete cannot extend the knee, swelling, initial significant pain followed by a feeling that the injury is not serious
Typical, surgery

38. Strains Injury Mechanism of Injury (Etiology) Signs & Symptoms
Treatment
Elbow strain
Excessive resistive motion, repeated microtears
Typical
Lumbar strain
Sudden extension on an overloaded, unprepared, or underdeveloped spine, usually in combination with trunk rotation; chronic strain, commonly associated with faulty posture that involves excessive lumbar lordosis.
Neck and Upper Back strain
Turn the head suddenly or forced flexion, extension, or rotation
Typical, muscle guarding and reluctance to move the neck in any direction
Typical, possible soft cervical collar
Cervical sprain (Whiplash)
Turn the head suddenly or forced flexion, extension, or rotation, but much more violently than the cervical strain
Typical, muscle guarding and reluctance to move the neck in any direction; this pain may persist much longer than that of the cervical strain.
Typical, X-rays to rule out fracture. and possible soft cervical

39. Sprains Injury Mechanism of Injury (Etiology) Signs & Symptoms
Treatment
Hip Sprain
Sudden stretch from knee flexion
Typical
Typical, May need crutches
MCL Sprain (Knee)
Direct blow (valgus force), severe outward twist
Typical, positive valgus stress test
LCL Sprain (Knee)
Direct blow (varus force)
Typical, positive varus stress test
ACL Sprain (Knee)
Direct blow, rotation, hyperextension
Typical, positive anterior drawer test, positive Lachman’s test
Typical, crutches, immobilization, physician referral, possible surgery
PCL Sprain (Knee)
Direct blow, knee flexion, landing on a flexed knee
Typical, positive posterior drawer test
Inversion (Lateral) Ankle Sprain
Foot inversion, plantar flexion, adduction
Typical, positive anterior drawer test, positive Talar tilt test
Typical, possible crutches, possible immobilization, possible physician referral, possible surgery
Eversion (Medial) Ankle Sprain
Foot pronation, hypermobility, depressed medial longitudinal arch
Syndesmotic (High) Ankle Sprain
External rotation, forced dorsiflexion
Typical, may take months to heal
Sprained Toes or Turf Toe
Force against an unyielding object
Typical, Valgus & Varus Stress Tests, Anterior & Posterior Drawer Tests
Typical, tape
Acromioclavicular (AC) Sprain
Direct Impact
Typical, immobilization, possible physician referral

40. Sprains Injury Mechanism of Injury (Etiology) Signs & Symptoms
Treatment
Elbow sprain
Hyperextension or valgus forces
Typical
Wrist sprain
Fall on hyperextended wrist; any abnormal, forced movement of the wrist
Finger sprain
Finger fractures
Direct trauma or violent twisting
Lumbar sprain
Forward bending and twists while lifting or moving some object
Sacroiliac sprain
Twisting with both feet on the ground, stumble forward, fall backward, step too far down and lands heavily on one leg, or bends forward with the knees locked while lifting
Typical, associated muscle guarding. Possible asymmetry with the ASIS and/or PSIS, difficulty with forward bending, straight leg raising increases pain after 45º, as well as side bending toward the painful side.
Typical, Bracing may be helpful. Joint should be mobilized to correct existing asymmetry

41. Bursitis Injury Mechanism of Injury (Etiology) Signs & Symptoms
Treatment
Trochanteric Bursitis
Repetitive
Typical, pain may radiate to the knee causing a limp
Typical, May need crutches, NSAIDs and analgesics.
Patellar Bursitis
Continual kneeling, overuse
Typical, ballotable
Typical, eliminate the cause, NSAIDs
Shoulder bursitis
Overuse
Typical, positive impingement test
Typical
Olecranon Bursitis
Direct force, overuse

42. Dislocations and Subluxations
Injury
Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Shoulder dislocation/subluxation
Forced abduction, external rotation, direct blow
Typical, possible deformity, unable to touch opposing shoulder (Apley’s scratch test
Typical, Immediate immobilization, RICE, pillow under the arm for comfort, physician referral, x-rays to rule out a fracture
Elbow dislocation
Fall on the outstretched hand with the elbow in a position hyperextension; or a severe twist while it is in a flexed position.
Typical, Rupturing or tearing most of the stabilizing ligaments, profuse hemorrhage and swelling. Severe pain and disability, possible radial head fracture.
Typical, sling, physician referral
Lunate Dislocation
Forced hyperextension
Typical, difficulty in executing wrist and finger flexion. There may be numbness or even paralysis of the flexor muscles because of lunate pressure on the median nerve
Typical, possible physician referral
Finger dislocations/subluxations
Direct trauma or violent twisting
Typical
Lumbar Vertebrae Dislocation
Compression fracture may occur as a result of hyperflexion of the trunk; falling from a height and landing on the feet or buttocks; direct impact from a sudden blow
Typical, X-ray, physician referral, put athlete on a spine board
Cervical dislocation
Violent flexion and rotation of the head
Point tenderness, restricted movement, cervical spasm, cervical pain and pain in the chest and extremities, numbness in the trunk and/or limbs, weakness or paralysis in the trunk and/or limbs, loss of bladder and/or bowel control
C-spine, Physician referral

43. Contusions Injury Mechanism of Injury (Etiology) Signs & Symptoms
Treatment
Hip Contusion (Hip Pointer)
Direct blow
Typical, spasms, transistory paralysis, unable to rotate the trunk or to flex the thigh without pain
Typical, physician referral to r/o fracture, 1 to 2 days bed rest, ice massage, ultrasound, NSAIDs
Quadriceps Contusion
Typical, transitory loss of function
Typical, RICE with the knee in flexion, NSAIDs
Joint Contusion
Typical
Typical, possible physician referral, return to activity with protective padding when initial pain and irritation subsides.
Shin contusion
Blow to the anterior aspect of the lower leg.
Typical, rapid hematoma formation, can be associated with compartment syndrome or fracture.
Typical, NSAIDs and analgesics, maintaining compression is critical (may have to aspirate hematome), ROM exercises and PRE within pain limits, doughnut padding and orthoplast shell for protection.
Calcaneal Contusion
Occurs by impact from running or jumping
Typical, moderate activity with the protection of a heel cup or doughnut may resume if pain when walking has subsided by the 3rd day, shock absorbent footwear shoe be worn.
Finger contusions
Direct trauma
Rib contusion
Typical, Sharp pain during breathing, point tenderness, pain when the rib cage is compressed
Typical, possible bed rest and cessation of sports activities

44. Fractures Injury Mechanism of Injury (Etiology) Signs & Symptoms
Treatment
Femoral Stress Fractures
Repetitive
Typical, Groin pain along with an aching sensation in the thigh that increases with activity and decreases with rest. Standing on one leg may be impossible
Typical, Rest, for 2 to 5 months, x-rays and possible bone scan, swimming
Acute Femoral Fracture
Direct Trauma
Typical, pain over the fracture site, deformity
Ice, Treat for shock, verify neurovascular status, splint, physician referral
Patellar Fracture
Direct or indirect trauma
Typical, Hemorrhage and joint effusion
Typical, physician referral
Acute Leg Fracture
Direct traumatic blow
Typical, Soft tissue insult and hemorrhaging, intense pain and disability, leg appears hard and swollen.
Splint and ice, refer to a physician
Tibia or Fibular Stress Fracture
Repetitive or Overuse
Typical, positive percussion or compression test, positive x-ray or bone scan
Typical, NSAIDs, no activity for at least 14 days, possible cast and/or crutches, weight bearing when pain subsides, correct biomechanics, running may resume when the athlete is completely pain free.
Ankle Fracture (misnomer)
Forced abduction or planting in combination with forced internal rotation, trauma.
Typical, possible deformity
Typical, x-ray examination, a walking cast or brace may be applied once swelling is reduced, for 6 to 8 weeks, PNF exercises, isometrics (during immobilization), PRE, and balance activites up to 4 weeks.

45. Fractures (cont.) Injury Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Talus Fracture
Occurs either laterally from a severe inversion and dorsiflexion force or medially from an inversion and plantar flexion force with external rotation of the tibia on the talus.
Typical, History of repeated trauma to the ankle, feels pain on weight bearing, complaint of snapping or catching, intermittent swelling, anteromedial or anterolateral joint line of the talar dome is tender when palpated.
Typical, X-ray is essential for an accurate diagnosis, non-surgical management for a non-displaced sub-chondral compression fracture, protective immobilization, non-weight bearing progression to full weight bearing depending on symptoms, if conservative treatment fails surgery may be required, expect to resume activity 6 to 8 months after surgery.
Calcaneal Fracture
Occurs most often after a jump or fall from a height. An avulsion fracture can also occur with this injury
Typical, inability to bear weight
Typical, X-ray is essential for an accurate diagnosis, non-surgical management for a non-displaced fracture, protective immobilization, non-weight bearing progression to full weight bearing depending on symptoms,
Calcaneal Stress Fracture
Occurs from repetitive impact during heel strike and characterized by a sudden onset of constant pain in the plantar-calcaneal area.
Typical, Feels pain on weight bearing, pain tends to continue after exercise stops, bone scan may be required.
Typical, Conservative management for the first 2 to 3 weeks, rest, active ROM exercises of the foot and ankle, non-weight bearing cardiovascular exercises, may resume activities within pain limits when pain subsides, must wear a cushioned shoe.
Jone’s Fracture
Inversion and plantar flexion of the foot, direct forces, or repetitive stress.
Typical, Immediate swelling and pain over the 5th metatarsal, high non-union rate, coarse of healing is unpredictable.
Typical, Crutches with no immobilization, gradually progress to full weight bearing as pain subsides, return to activity is possible in 6 weeks, non-union may cause re-fracture to occur.

46. Fractures (cont.) Injury Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Metatarsal Stress Fracture (March Fracture)
Most commonly involves the shaft of the 2nd metatarsal (March fracture). Occurs in the runner suddenly changing training patterns, such as increasing mileage, running hills, or running on a harder surface. An atypical condition such as a structural forefoot varus, hallux valgus, or a short 1st metatarsal will predispose to a 2nd metatarsal stress fracture. A stress fracture of the 5th metatarsal at the insertion of the peroneous brevis tendon can occur, but should not be confused with a Jones fracture.
Typical
Typical, Bone scan is the best way to detect this injury, 3 or 4 days of partial weight bearing after two weeks of rest, return to running should be gradual, orthotics can help to reduce stress
Phalanges
Occurs by either kicking an object, stubbing a toe, or being stepped on. Dislocations are less common than fractures.
Typical, deformity. Stiffness and residual pain may last for several days
Typical, buddy tape, possible physician referral
Clavicular Fracture
Fall on the outstretched, a fall on the tip of the shoulder, or direct impact.
Typical, Clavicle appears slightly lower than the opposite side. possible deformity
Typical, Sling and swathe, treat for shock, X-ray, immobilization for 6 to 8 weeks. After immobilization, begin gentle isometrics and mobilization exercises. May require surgery.
Scapular Fracture
Direct impact or force transmitted through the humerus to the scapula.
Typical, Pain during shoulder movement
Typical, Sling, x-ray, begin overhead strengthen in 1 week.
Fracture of the Humerus
Direct blow or fall on the outstretched arm
Typical, inability to move arm
Typical, Sling and swathe, treat for shock, physician referral, immobilization for 6 to 8 weeks

47. Fractures (cont.) Injury Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Forearm fracture
Direct trauma or fall on the outstretched arm
Typical, Audible pop or crack
Typical, sling, physician referral
Colle’s Fracture
Fall on an outstretched armforcing the radius and ulna into hyperextension, or falling on the backward hand
Typical, Possible silver fork deformity, and possible median nerve damage
Scaphoid (Navicular) Fracture
Force on the outstretched arm
Typical
Typical, splint, physician referral
Hamate fracture
Fall or from contact from a sports implement
Lumbar Vertebrae Fracture
Compression fracture may occur as a result of hyperflexion of the trunk; falling from a height and landing on the feet or buttocks; direct impact from a sudden blow
Typical, X-ray, physician referral, put athlete on a spine board
Cervical fracture
Axial loading; sudden forced hyperextension
Point tenderness, restricted movement, cervical spasm, cervical pain and pain in the chest and extremities, numbness in the trunk and/or limbs, weakness or paralysis in the trunk and/or limbs, loss of bladder and/or bowel control
C-spine, Physician referral
Rib Fracture
Direct or indirect trauma, violent muscular contractions
Typical, Sharp pain during inspiration, possible crepitus during palpation
Typical, physician referral, rest and immobilization

48. Tendinitis Injury Mechanism of Injury (Etiology) Signs & Symptoms
Treatment
Osgood-Schlatter
repetitive stress at the tibial tuberosity
Typical, hemorrhage, gradual degeneration, severe pain when kneeling, running, or jumping, point tenderness
Typical, reduce irritating activities, cast may be required, isometric strengthening for quads and hamstrings
Larsen Johansson
repetitive stress at the inferior patellar pole
Patellar Tendinitis (Jumper’s or Kicker’s Knee)
Repetitive running, jumping, and kicking
Typical, Pain and tenderness at the posterior, inferior patellar pole
Typical, thermal agents, ultrasound, brace (counter-force) massage
Runner’s (Cyclist’s) Knee
Repetitive, overuse
Typical, Malalignment and structural asymmetries of the foot and lower leg. Contributes to iliotibial band friction syndrome and pes anserinus tendonitis or bursitis
Typical, Correction of foot and leg alignment problems, RICE, proper warm-up and stretching, avoidance of aggravating activities, NSAIDs.
Achilles Tendinitis
Excessive tensile stresses placed on it during repetitive movements and presents with a gradual onset.
Typical, uphill running and hill workouts aggravate the condition, weak gastrocnemius-soleus complex, morning stiffness, discomfort walking after prolonged sitting, tendon is warm and painful upon palpation, palpable crepitus with active plantar and dorsiflexion, pain on passive stretching, chronic inflammation.
Typical, may be resistant to quick resolution, address structural faults (i.e. footwear, orthotics, etc.) ultrasound to increase blood flow, friction massage may be helpful, strengthening of the gastrocnemius-soleus unit. May be resistant to quick resolution, address structural faults (i.e. footwear, orthotics, etc.) RICE, ultrasound to increase blood flow, friction massage may be helpful, strengthening of the gastrocnemius-soleus unit.

49. Tendinitis (cont.) Injury Mechanism of Injury (Etiology)
Signs & Symptoms
Treatment
Anterior Tibialis Tendinitis
Common when running downhill for extended periods of time.
Typical
Typical, avoid hills
Posterior Tibialis Tendinitis
Overuse injury among runners with hypermobility or pronated feet
Typical, Swelling of the medial malleolus area, edema and point tenderness behind the medial malleolus area, pain can become more intense during resistive inversion and plantar flexion
Typical, non-weight bearing short-leg cast with the foot in inversion may be used, Low Dye taping or orthotic can be used to correct pronation.
Peroneal Tendinitis
Problem in athletes with pes cavus where the foot tends to excessive supinate.
Typical, Pain of the lateral malleolus area when rising on the ball of the foot, tenderness behind the lateral aspect of the calcaneous distally beneath the cuboid.
Typical, tape with elastic tape, appropriate warm-up and flexibility exercises, Low Dye taping or orthotic can be used to prevent excessive supination.
Wrist tendinitis
Repetitive pulling movements

50. Chondramalacia (Patellofemoral Arthralgia)
Etiology:
Abnormal patellar tracking
Signs & Symptoms:
Pain in the anterior aspect while running, walking, ascending stairs, and squatting. Recurrent swelling, grating sensation during flexion and extension, patellar grind test produces crepitus.
Treatment:
Avoid irritating activities, pain-free isometric exercise to strengthen the quads, anti-inflammatories, orthotics to correct pronation and reduce tibial torsion, possible surgery.

51. Patellofemoral Stress Syndrome (PFSS) (Patellofemoral Arthralgia)
Etiology:
Hamstrings, gastrocnemius, IT band, or lateral retinaculum tightness; increased Q angle, foot pronation, patella alta, VMO insufficiencies
Signs & Symptoms:
Tenderness over the patellar lateral facet, swelling, dull ache in the center of the knee, patellar compression will elicit pain and crepitis, positive apprehension test
Treatment:
Strengthen VMO; stretching for hamstrings, gastrocnemius, and IT band; orthotics and/or taping to correct alignment

52. Cramps and Spasms Etiology:
Excessive loss of fluids through sweating, inadequate muscle coordination.
Signs & Symptoms:
Pain, tonic contraction.
Treatment:
Athlete should relax, gradual stretching, ice or gentle ice massage.

53. Medial Tibial Stress Syndrome
Etiology:
Repetitive microtrauma, weak leg muscles, inadequate footwear, inappropriate training, malalignment problems.
Signs & Symptoms:
Grade 1: pain after activity
Grade 2: pain before and after activity, but does not affect performance
Grade 3: pain before, during, and after activity, affects performance
Grade 4: constant pain that makes performance impossible
Pain is along the lower medial anterior tibialis.
Treatment:
Physicians referral to rule out other problems, RICE, NSAIDs and analgesics, ice massage, modify activity, correct biomechanics, orthotics and/or arch taping.

54. Lateral Epicondylitis (Tennis Elbow)
Etiology:
Repetitive microtrauma, hyperextension activities
Signs & Symptoms:
Aching pain over the region during and after exercise, pain worsens with continued activity, weakness in the hand and wrist
Treatment:
RICE, NSAIDs and analgesics, immobilization, strengthening and stretching exercises, correct biomechanics, counterforce brace

55. Medial Epicondylitis (Pitcher’s Elbow, Racquetball Elbow, Golfer’s Elbow, Javelin-Thrower’s Elbow)
Etiology:
Repeated forceful extension of the wrist and valgus torques of the elbow.
Signs & Symptoms:
Pain, possible radiating pain, point tenderness, mild swelling, AROM produces pain.
Treatment:
RICE, NSAIDs and analgesics, immobilization (sling), strengthening and stretching exercises, correct biomechanics, counterforce brace. For severe cases, splint and complete rest for seven to 10 days.

56. Carpal Tunnel Syndrome
Etiology:
Repetitive wrist flexion, direct trauma
Signs & Symptoms:
Sensory or motor deficits; tingling, numbness, and paresthesia over the thumb, index and middle fingers, and palm of the hand; muscular weakness
Treatment:
RICE, immobilization, and NSAIDs. Surgical decompression may be necessary

57. de Quervain’s Disease (Hoffman’s Disease)
Etiology:
Constant wrist movement
Signs & Symptoms:
Aching pain which may radiate into the hand or forearm, positive Finklestein’s test; point tenderness and weakness during thumb extension and abduction; there may be a painful snapping and catching of the tendons
Treatment:
Immobilization, rest cryotherapy, NSAIDs, ultrasound, ice massage

58. Wrist Ganglion Etiology: Appears slowly after a wrist sprain
Signs & Symptoms:
Occasional pain with a lump at the site. Pain increases with use
Treatment:
RICE, pressure with a felt pad, ultrasound, possible surgical removal

59. Sciatica
Etiology:
Torsion or direct blow to the back causing inflammation or compression of the sciatic nerve
Signs & Symptoms:
Pain may be abrupt or gradual, produces a sharp shooting pain that follows the nerve pathway along the posterior and medial thigh; there may be tingling and numbness along its path; nerve may be extremely sensitive to palpation; straight leg raises intensifies pain.
Treatment:
Rest is essential. Stretching of a tight piriformis muscle may decrease symptoms; NSAIDs and RICE, surgery may be necessary.

60. Brachial Plexus Neurapraxia (Burner or Stinger)
Etiology:
Stretching or compression of the brachial plexus
Signs & Symptoms:
Burning sensation, numbness, tingling, and pain extending from the shoulder down to the hand with some loss of function of the arm and hand that lasts for several minutes.
Treatment:
RICE; strengthening exercises; Athlete may return to full activity once symptoms have completed resolve and there are no associated neurological symptoms.