1. Mechanism of Characteristics of Sports Trauma Chap. 9

2. Mechanical injury Trauma is defined as physical injury or wound sustained in sport, produced by internal or external force Mechanical injury results from force or mechanical energy that changes state of rest or uniform motion of matter

3. Tissue Properties P 239 in or forces acting on internal tissue Load- external force or forces acting on internal issue Stiffness- ability of a tissue to resist a load Stress- internal resistance to an external load Strain- extent of deformation of tissue under loading Deformation- change in shape of a tissue Elasticity- property that allows a tissue to return to normal following deformation Yield point- elastic limit of tissue Plastic- deformation of tissues that exists after the load is removed Creep- deformation of tissues that occurs with application of a constant load over time Mechanical failure- exceeding the ability to withstand stress and strain, causing tissue to break down.

5. Tissue Stresses P 240 Types of loading Compression Tension Shearing Bending Torsion

6. Soft tissue Trauma Soft tissue or non bony tissue is categorized as inert (nonconrtactile and contractile tissue Inert tissues- include ligaments, skin cartilage, capsules, fascia, dura mater and nerve roots. Don’t heal well Contractile issue involves muscles and tendons. Heal well

7. Skin Injuries Break in the continuity of skin as a result of trauma Anatomical considerations Skin or integument represent the largest organ of the bogy and consists of 2 layers Epidermis Dermis

8. Wound Classification Friction Blister-Continuous rubbing over skin surface that causes a collection of fluid below or within epidermal layer. Abrasion -Skin is scraped against rough surface resulting in capillary exposure due to skin removal Skin Bruise (contusion)- Compression or crush injury of skin surface that produces bleeding under the skin

9. Wound Class cont. Laceration- Wound in which skin has been irregularly torn Skin Avulsion- Skin that is torn by same mechanism as laceration to the extent that tissue is completely ripped from source Incision- Wound in which skin has been sharply cut Puncture- Penetration of the skin by a sharp object.

10. Skeletal Muscle Injuries High incidence in athletics Anatomical characteristics Composed of contractile cells that produce movement Possess following characteristics Irritability Contractility Conductivity Elasticity

11. Three types of muscles Cardiac Smooth skeletal

12. Acute Muscle Injuries Contusion Results from sudden blow to body Can be both deep and superficial Hematoma results from blood and lymph flow into surrounding tissue

13. Strains Stretch, tear or rip to MUSCLE or TENDON Causes Abnormal muscle contraction failure in reciprocal coordination of agonist and antagonist 2) electrolyte imbalance due to profuse sweating 3) strength imbalance.

14. Muscle strains cont Grades Grade 1- some fibers have been stretched or actually torn resulting in tenderness and pain on active ROM, movement painful but ROM= WNL Grade 2-number of fibers have been torn and active contraction is painful, usually a depression or divot is palpable, some swelling and discoloration Grade 3- complete rupture of muscles significant impairment with initially a great deal of pain that diminishes due to nerve damage

15. Tendon Injuries Tendon- connects muscle to bone. Tears generally occur in muscle and not tendon Repetitive stress on tendon will result in microtrauma and elongation, causing fibroblasts in flux and increased collagen production. This is called tendinitis.

16. Muscle cramps and spasms Painful involuntary contraction Attributed to dehydration/electrolyte imbalance Reflex reaction caused by trauma Two types Clonic- alternating involuntary muscular contractions and relaxation in quick succession Tonic- rigid contraction that lasts a period of time

17. Overexertion muscle problems Reflective in muscle soreness, decrease joint flexibility, general fatigue (24 hours post activity) Muscle soreness Overexertion in strenuous exercise resulting in pain Generally occurs following participation in activity that individual is unaccustomed

18. Two types of soreness Acute- onset muscle soreness- accompanies fatigue, and is transient muscle pain experience immediately after exercise delayed-onset muscle soreness (DOMS)- pain that occurs 24- 48 hours following activity that gradually subsides (3-4 days) Prevent soreness through gradual build up of intensity Treat with static or PNF stretching and ice application within 48-72 hours

19. Muscle Stiffness Does not produce pain Result of extended period of work Fluid accumulation in muscles, with slow reabsorbtion back into bloodstream, resulting in swollen, shorter, thicker muscles- resistant to stretching Light activity, motion, massage and passive mobilization assists in reducing stiffness

20. Muscle Guarding Following injury, muscles within an effected area contract to splint the area in a effort to minimize pain through limitation of motion Involuntary muscle contraction in response to pain following injury

21. Chronic Muscle Injuries Progress slowly over long period of time Repetitive acute injuries can lead to chronic condition Constant irritation due to poor mechanics and stress will cause injury to become chronic

22. Examples of chronic muscle injuries Myositis/fascitis- inflammation of muscle tissue. Fibrositis or inflammation of connective tissue. Ex. Plantar fasciitis Tendinitis- gradual onset, with diffuse tenderness due to repeated micro trauma and degenerative changes Tenosynovitis- inflammation of synovial sheath Ectopic Calcification (myositis ossificans)- striated muscle becomes chronically inflamed resulting in compression trauma

23. After injury Atrophy- wasting away of muscle due to immobilization inactivity or loss of nerve functioning Contracture is and abnormal shortening of muscle where there is a great deal of resistance to passive stretch

24. Synovial joints Anatomical characteristics Consist of cartilage and fibrous connective tissue Capsule or ligaments, synovial membrane, cartilage, synovial fluid and blood and nerve supply with muscles crossing joint.

25. Joint capsule Bones are held together by fibrous cuff Consists of bundles of collagen and function to maintain relative joint position Extremely strong and can withstand cross sectional forces Will be slack or taut depending on joint movement

26. ligaments Connects Bone to Bone Sheets or bundles of collagen that form connection between two bones Strong in the middle, weak at the ends Poor viscoelastic properties are primary factor in ligamentous injuries

27. Synovial Membrane Single layer of flattened cells Secretes and absorbs fluid- serves as lubricant

28. Articular cartilage Provides firm flexible support No direct blood or nerve supply Fibrocartilage- vertebral disks, sumphysis pubis and menisci Elastic: external ear Hyaline, nasal septum, larynx, trachea, bronchi and articular ends of bones.

29. Nerve Supply Capsule, ligaments outer aspects of synovial membrane and fat pads are well supplied

30. Types of Synovial joints Ball and Socket- allows movement in all planes Hinge- allows for flexion and extension Pivot- rotation about and axis Ellipsoidal- elliptical convex and concave articulation Saddle- reciprocally convex-concave Gliding- all sliding back and forth

31. Types of Synovial joints Ball and Socket- allows movement in all planes (Hip) Hinge- allows for flexion and extension (elbow) Pivot- rotation about and axis (Cervical spine) Ellipsoidal- elliptical convex and concave articulation (Wrist) Saddle- reciprocally convex-concave (1 st MP Joint) Gliding- all sliding back and forth (carpal Joint)

32. Synovial Joint Injury Classifications Acute Injury Sprains- Result of traumatic joint twist that causes stretching or tearing Sprains is an injury to a ligament Graded on severity Grade I- some pain, minimal loss of function, no abnormal motion, mild point tenderness. < 10% Grade II- Pain, moderate loss of function, swelling and instability 10-90% Grade III- Extremely painful, inevitable loss of function, severe in stability and swelling and instability 100% S/Sx- Joint effusion and swelling, local temperatur increase, pain and poinst tenerness, ecchymosis (skin color change)

33. Joint injuries classification continued Subluxations- partial dislocations causing incomplete separation of two bones Luxation- presents with total disunion of bone apposition between articular surfaces S/Sx- loss of limb function, gross deformity, swelling and point tenderness Once a dislocation, always a dislocation.

34. Chronic Joint Injuries Stem from microtrauma and overuse Include, osteochondrosis, osteoarthritis and epiphyseal injuries To prevent avoid over training and protective gear should be used.

35. Osteochondrosis Degenerative changes to epiphyses of bone during rapid child growth

37. Osteoarthritis Wearing away of hyaline cartilage as a result of normal use S/Sx- pain, stiffness, prominent uprsising in the morning, localized tenderness, creaking, grating, often is localized to one.

38. Bursitis Fluid filled sac that develops in area of friction S/sx- swelling pain and some loss of function

39. Skeletal Trauma Bone Functions Body Support Organ protection Movement Calcium storage Formation of blood cells

40. Bones cont. Types of bones Flat bones- Irregular bones Short bones Long bones

41. Bone Injuries Periostitis- inflammation of the periosteum, result primarily of contusion and produces rigid skin overlying muscles Acute bone fractures- partial or complete disruption that can be either closed or open serious condition Type of Fx include- depressed, greenstick, impacted longitudinal, oblique, serrated, spiral, transverse, comminuted, blowout, avulsion Stress Fx- no specific cause but with a number of possible poor mechanics, training surface S/Sx- pain with activity, pain becomes constant particularly at night, positive percussion tap test.

42. TREATMENT OF ALL INJURIES RICE R- REST I- ICE 20 mins. every hour C- COMPRESSION- Ace wrap E- ELEVATION- Above the heart.