Chapter 9: Mechanisms and Characteristics of Sports Trauma

What is trauma? A physical injury or wound sustained in sport and produced by external or internal force.

Tissues have relative abilities to resist a particular load Tissues have relative abilities to resist a particular load. If the tissue is stronger, what will happen? The greater magnitude of load it can withstand.

List and define the five type of tissue stresses: Tension force that pulls or stretches tissue Stretching stretching beyond the yield point leads to rupturing of soft tissue or fracturing of a bone Compression a force that, with enough energy, crushes tissue Shearing a force that moves across the parallel organization of the tissue Bending force on a horizontal beam or bone that places stresses within the structure, causing it to bend or strain

What are the two categories of soft (non-bony) tissue and give examples non-contractile skin, joint capsules, ligaments, fascia, cartilage, dura mater, nerve roots nerve roots contractile muscle, tendons, bony insertions

What is the skin (integument)? External covering of the body

What does the skin represent? The body’s largest organ

The skin consist of what two layers? Epidermis and dermis

List the numerous mechanical forces that can adversely affect the skin’s integrity: friction or rubbing scraping compression or pressure tearing cutting Penetrating

How are skin wounds classified? According to the mechanical force that causes them

List and define the different types of wound classifications:

a. friction blister continuous rubbing over the surface of the skin causes a collection of fluid below or within the epidermal layer called a blister

b. abrasion common conditions in which the skin is scraped against a rough surface. The epidermis and dermis are worn away, exposing numerous blood capillaries

c. skin bruise when a blow compresses or crushes the skin surface and produces bleeding under the skin, the condition is defined as a bruise, or contusion

d. laceration a wound in which the flesh has been irregularly torn

e. skin avulsion skin that is torn by the same mechanism as a laceration to the extent that the tissue is completely ripped from its source is an avulsion injury

f. incision a wound in which the skin has been sharply cut

g. puncture penetrations of the skin by a sharp object

What are the three types of muscles within the body? Smooth Cardiac Striated (skeletal)

Which muscle is of major concern in sports medicine? Striated (skeletal) muscle

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

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

What is the range of intensity of a contusion? Deep to superficial

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

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

How are strains most often produced? Abnormal muscular contraction

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 uncoordination 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.

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.

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).

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.

What does a tendon attach? Muscle to bone

Because a tendon is usually double the strength of the muscle it serves, where do tears commonly occur? At the muscle belly, musculotendinous junction, or bony attachment

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

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

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

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.

Muscle cramps or spasms may lead to what? Muscle strain

What is one constant problem in physical conditioning and training? Overexertion

How is exercise over-dosage reflected? Muscle soreness Decreased joint flexibility General fatigue 24 hours after activity.

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

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).

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.

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.

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

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)

How do chronic injuries usually progress? Slowly, over a long period of time.

Often, what leads to a chronic condition? Repeated acute injuries

How does an acute injury cause a chronic injury? If the acute injury is managed improperly or that allows an athlete to return to activity before healing has completely occurred.

What is myositis/fasciitis? Inflammation of the muscle tissue

What is tendonitis? Inflammation of tendon-muscle attachments, tendons, or both

What is tenosynovitis? Inflammation of the synovial sheath surrounding a tendon

What is atrophy? The wasting away of muscle tissue

What may cause atrophy? Immobilization of a body part Inactivity Loss of nerve stimulation

What is a muscle contracture? An abnormal shortening of a muscle tissue in which there is a great deal of resistance to passive stretch

What do joints consists of? Cartilage and fibrous connective tissue

What is a joint capsule? Bones of a diarthrotic (freely movable) joint are held together by a cuff of fibrous tissue

What are ligaments? Sheets or bundles of collagen fibers that form a connection between two bones Attach bone to bone

Ligaments fall into what two categories? Intrinsic – occurring within the articular capsule Extrinsic – separate from the capsular thickening

What is articular cartilage and what does it do? Connective tissue that provides firm and flexible support

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

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

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.

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.

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.

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

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

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

What are the two major categories of chronic joint injuries? Osteochondrosis Traumatic arthritis

What is osteochondrosis? Degenerative changes in the ossification centers of the epiphysis of bones

What is traumatic arthritis? With repeated microtrauma to the articular joint surfaces, the bone and synovium thicken, and pain, muscle spasm, and articular crepitus, or grating on movement occur.

What is a bursa? A fluid-filled sac found at places at which friction might occur within body tissues.

What is bursitis? Inflammation of bursa at sites of bony prominences between muscle and tendon.

What is capsulitis and synovitis? Chronic inflammatory conditions of the joints.

What are the five basic functions of bone? Body support Organ protection Movement Calcium reservation Formation of blood cells

What are the three classifications of bone trauma? Periostitis Acute fractures Stress fractures

What is periostitis? Inflammation of the periosteum (bone covering)

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

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

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