1 Classification of Injuries

Sign: a finding that is observed or that can be objectively measured (swelling, discoloration, deformity, crepitus) Sign Versus Symptom Symptom: subjective complaint or an abnormal sensation that the patient describes but cannot be directly observed (pain, nausea, fatigue, altered sensation)

Acute: sudden onset and of short duration (one-time traumatic event or mechanism) Acute Versus Chronic Chronic: gradual onset and of prolonged duration (accumulation of minor insults or repetitive stress)

Soft tissue injuries: contusion, sprain, strain Closed Wounds Bone and joint articulations: closed fractures, epiphyseal injury, dislocation, subluxation Nerve injuries

Characteristic signs and symptoms include First Degree Contusions superficial damage, minimal swelling, and localized tenderness.

Characteristic signs and symptoms include Second Degree Contusions increased area and depth of tissue damage, and mild to moderate limitations in ROM, muscle function.

Characteristic signs and symptoms include Third Degree Contusions severe pain, significant hemorrhage, severe limitations in ROM and muscle damage, and possible damage to deeper structures.

Characterized by First Degree Sprains mild overstretching and no tissue disruption. mild pain, tenderness over ligament; little or no disability; Signs and symptoms include minor inflammation, discloration. pain at end ROM; and

Characterized by Second Degree Sprains further stretching and partial disruption of ligament. moderate to severe pain, rapid swelling, Signs and symptoms include ecchymosis, and limited ROM, function.

Characterized by complete disruption. Third Degree Sprains “pop,” immediate pain, Signs and symptoms include rapid swelling, loss of function, and less painful ROM, stress test.

Characterized by First Degree Strains overstretching and microtearing. mild pain and tenderness, full AROM and PROM, and Signs and symptoms include pain with resisted contraction.

Characterized by Second Degree Strains further stretching and partial tearing. pain and localized tenderness, disability, Signs and symptoms include ecchymosis, and decreased ROM and strength.

Characterized by complete rupture. Third Degree Strains “pop,” pain, Signs and symptoms include loss of function, palpable defect, hemorrhage, and diffuse swelling.

Severe stretching or complete disruption of one or more supporting ligaments resulting in Joint Dislocation immediate pain, swelling, loss of function. deformity, and The joint may spontaneously reduce. Chronic instability often follows acute dislocation.

An incomplete disassociation of two joint surfaces. Athlete may complain of a feeling of “giving out.” History is important because these injuries Subluxation often reduce spontaneously, have minimal deformity, and vary in signs and symptoms (pain, swelling, joint instability), depending on degree of injury.

Common mechanisms include Nerve Injuries compression or tensioning of neural structure, direct blow, and acute swelling in space occupied by lesion/pathology. anesthesia (no sensation), paresthesia (tingling, burning, numbness), and Ranges of sensory impairment include hyperesthesia (hypersensitivity).

Transient and reversible loss in nerve function secondary to trauma or irritation. It is characterized by Neuropraxia mechanical deformation of a nerve, no disruption of nerve fibers, and short-lived sensory and motor deficits (ranging from seconds to two weeks).

Partial disruption of a nerve with eventual regeneration Axonotmesis Prolonged sensory and motor deficits (two weeks to one year) Considerable atrophy and weakness

Complete severance of a nerve Neurotmesis Permanent loss of function of innervated structures distal to the point of injury No regeneration evident after one year