Injury Classification What’s wrong? What’s wrong?

Trauma An injury or wound created by a force applied to any body part –Direct trauma: impact from a blow or fall –Indirect trauma: forcing a joint beyond its normal range of motion Results in a harmful disturbance in –Function –Structure

Injury Classification Fracture –Break or crack in bone –Simple, compound or stress fracture

Emergency Splinting –Splint all suspected fracture before moving the athlete or body part –Use proper immobilization to decrease risk of Secondary tissue damage Hemorrhage Potential for death (if handled improperly) –Splint the fracture where the athlete lies –Avoid moving the athlete before splinting –Splint one joint above and one joint below the fracture –Assess neurovascular status before and after splinting –Monitor vital signs

–Rapid form immobilizer –Air splints Clear plastic splint inflated with air around affected part Do not use with fracture deformity Provides moderate pressure and can be x-rayed through –Cardboard splints

–Lower Limb Splinting Foot and ankle require splinting of foot and knee Knee, thigh, or hip require splinting of whole leg and one side of trunk –Upper Limb Splinting Shoulder splinting is difficult –Use sling and swathe with upper limb bound to body Upper arm and elbow –Splint with arm straight to lessen bone override Lower arm and wrist –splint in position of forearm flexion and support with sling Hand and finger splint with tongue depressors, roller gauze and/or aluminum splints

Sprains –Injury to the following structures Joint CapsuleJoint Capsule LigamentsLigaments

Synovial Joint Fibrous (Joint) Capsule Ligaments Synovial Membrane Synovial Fluid Articular Cavity –Contains synovial fluid Articular Cartilage In some cases –meniscus/I –labrum

Synovial Joints Synovial fluid –Shock absorber –Cushions bone ends –Prevents irritation Meniscus/Labrum –In some synovial joints –Cartilagenous disc –Surrounded by synovial fluid –Reduces friction –Increases joint stability Function – –Allows movement in one or more directions – –Low friction articulation – –Allows movement with minimal effort

Synovial Joint Injury Pathology –Ligaments –Joint capsule –Synovial membrane Trauma - Sprains

Synovial Joint Mechanism of injury –Forcing of joint into abnormal position as in traumatic twist –Overstretch or tearing of structures –Degrees of sprains 1st over stretch 2nd partial tear 3rd complete tear Trauma - Sprains

1st Degree Sprain Ligament Damage Point Tenderness Loss of Function ROM Edema (swelling) Stress test results Mild tearing or overstretch Mild tearing or overstretch Yes Yes Mild Mild Not effected Not effected Mild Mild No Laxity No Laxity Signs & Symptoms

2nd Degree Sprain Ligament Damage Point Tenderness Loss of Function ROM Edema (swelling) Stress test results Moderate tearing Yes Moderate to severe Decreased Moderate Some laxity with end point Signs & Symptoms

3rd Degree Sprain Ligament Damage Point Tenderness Loss of Function ROM Edema (swelling) Stress test results Complete tear Complete tear Yes Yes Severe w/instability Severe w/instability Decreased or increased Decreased or increased Moderate to severe Moderate to severe Laxity with no end point Laxity with no end point Signs & Symptoms

SubluxationSubluxation –Bone comes partially out of joint(<50%) –Usually goes back in place by itself DislocationDislocation – –The separation of the bones of a joint more than 50% of articulation surfaces – –Mechanism of injury A force that causes a joint to go beyond its normal anatomical limits –Requires outside force to put bone back in place (reduction of dislocation)

Sprains Joint stability or ligamentous laxity tests Positive test indicated by –Abnormal translation of one bone in relation to another bone –Indicates laxity Grade mm mm 3+ >10mm Assessment

Normal End Points Soft tissue approximation –Soft and spongy –Gradual painless stop –ie. Knee flexion Capsular –Abrupt, hard, firm end point –Only a little give –ie. Hip rotation Bone to bone –Distinct and abrupt –Two hard surfaces contact –ie. Elbow extension Muscular –Springy –Some discomfort –ie. Shoulder abduction

Abnormal End Points Empty –Movement beyond anatomical limit –Pain before end range –ie. ligament rupture Spasm –Involuntary muscle contraction –Muscle guarding prevents motion Loose –Occurs w/extreme hypermobiltiy –ie. Previously sprained joint Springy block –Rebound at end point –Meniscus tear

Muscles, Tendons and Strains Muscles –Origin –Belly –Insertion Tendons –Connect muscle to bones Musculotendinous Junction –Area where muscle and tendon connect

1st Degree Strain Muscle damage: Mild tearing Pain w/contraction: Mild Pain w/stretching: Yes Muscle spasm: Possible Loss of function: Mild ROM: decreased Edema: Mild Palpable defect: None

2nd degree Strain Muscle damage: Moderate tearing Pain w/contraction: Moderate to severe Pain w/stretching: Yes Muscle spasm: Possible Loss of function: Moderate to severe ROM: Decreased Edema: Moderate Palpable defect: None Hamstring 2 º Strain

3rd Degree Strain Muscle damage: Complete tear Pain w/contraction: None to mild Pain w/stretching: No Muscle spasm: Possible Loss of function: Severe ROM: Decreased or increased Edema: Moderate to severe Palpable defect: Yes

Manual Muscle Testing Grading strength on 5/5 basis Classification ROM Gravity Added Resistance Strength 5/5 Full Yes Yes =/> than other side 4/5 Full Yes Yes < then other side 3/5 Full Yes No < then other side 2/5 Full No No < then other side 1/5 No No No Palpable contraction 0/5 No No No No Palpable contraction

Injury Classification Tendinopathy TendinitisTendinitis –No longer considered inflammatory condition Mechanism of InjuryMechanism of Injury –Tendon is overloaded due to extensive stress –Degenerative changes in the tendon –Gradual onset –Worsens with continued use –Decreased flexibility exacerbates condition

Injury Classification Leg Cramps Muscle Spasms Involuntary muscle contractionsInvoluntary muscle contractions –Sudden –Violent –Fatigue –Loss of fluids –Electrolyte imbalance –Nerve Irritation

Contusions - Bruises SkinSkin MusclesMuscles TendonsTendons LigamentsLigaments BoneBone NervesNerves “Charleyhorse”