injuries. signs and symptoms pain pain swelling swelling heat heat redness redness loss of function...

InjuriesInjuries

Signs and SymptomsSigns and Symptoms

PainPain SwellingSwelling HeatHeat RednessRedness Loss of functionLoss of function Depends on severity of injuryDepends on severity of injury

TreatmentTreatment

R.I.C.E. and possible NSAIDsR.I.C.E. and possible NSAIDs Range of Motion (Stretching!)Range of Motion (Stretching!) Strength and EnduranceStrength and Endurance Neuromuscular Control & BalanceNeuromuscular Control & Balance Functional and Sports Specific Functional and Sports Specific

ProgressionsProgressions Maintain Cardio FitnessMaintain Cardio Fitness

All depend on severity.All depend on severity. Begin rehab as soon as possible.Begin rehab as soon as possible.

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

ContusionsContusions Strains Strains

How does one receive a How does one receive a contusion?contusion?

Sudden traumatic blow to the Sudden traumatic blow to the bodybody

What is typical in cases of severe What is typical in cases of severe contusions?contusions?

a.a. the athlete reports being struck by a the athlete reports being struck by a hard blowhard blow

b.b. the blow causes pain and a transitory the blow causes pain and a transitory paralysis caused by pressure on and paralysis caused by pressure on and shock to the motor and sensory nervesshock to the motor and sensory nerves

c.c. palpation often reveals a hard area, palpation often reveals a hard area, indurated because of internal indurated because of internal hemorrhage hemorrhage

d.d. ecchymosis, or tissue discoloration, may ecchymosis, or tissue discoloration, may take place take place

What is a strain?What is a strain?

A stretch, tear, or rip in the A stretch, tear, or rip in the muscle or adjacent tissue such as muscle or adjacent tissue such as the fascia or muscle tendonthe fascia or muscle tendon

How are strains most often How are strains most often produced?produced?

Abnormal muscular contractionAbnormal muscular contraction

What is the cause of abnormal muscular What is the cause of abnormal muscular contraction?contraction?

It is fault in the reciprocal coordination of It is fault in the reciprocal coordination of the agonist and antagonist muscles take the agonist and antagonist muscles take place. The cause of this fault or un-place. The cause of this fault or un-coordination is a mystery. However, possible coordination is a mystery. However, possible explanations are that it may be related to:explanations are that it may be related to:

a mineral imbalance caused by profuse a mineral imbalance caused by profuse sweatingsweating

to fatigue metabolites collected in the to fatigue metabolites collected in the muscle itselfmuscle itself

to a strength imbalance between agonist to a strength imbalance between agonist and antagonist muscles. and antagonist muscles.

What is a grade 1 (or 1What is a grade 1 (or 1stst degree degree or 1°) strain?or 1°) strain?

Slight over-stretching to mild Slight over-stretching to mild tearing (20%) of the muscle tearing (20%) of the muscle fibers. It is accompanied by local fibers. It is accompanied by local pain, which is increased by pain, which is increased by tension in the muscle, and a tension in the muscle, and a minor loss of strength. There is minor loss of strength. There is mild swelling, ecchymosis, and mild swelling, ecchymosis, and local tenderness.local tenderness.

What is a grade 2 (or 2What is a grade 2 (or 2ndnd degree degree or 2°) strain?or 2°) strain?

Moderate tearing (20% - 70%) of Moderate tearing (20% - 70%) of the muscle fibers. It is similar to the muscle fibers. It is similar to a grade 1, but has moderate a grade 1, but has moderate signs and symptoms (moderate signs and symptoms (moderate loss of strength, moderate loss of strength, moderate swelling, ecchymosis, and local swelling, ecchymosis, and local tenderness).tenderness).

What is a grade 3 (or 3What is a grade 3 (or 3rdrd degree degree or 3°) strain?or 3°) strain?

Has signs and symptoms that are Has signs and symptoms that are severe (severe swelling, severe (severe swelling, ecchymosis, and local ecchymosis, and local tenderness) with a loss of muscle tenderness) with a loss of muscle function and, commonly, a function and, commonly, a palpable defect in the muscle.palpable defect in the muscle.

What does a tendon attach?What does a tendon attach?

Muscle to boneMuscle to bone

What does a ligament attach?What does a ligament attach?

Bone to boneBone to bone

What is a cramp?What is a cramp?

A painful involuntary contraction A painful involuntary contraction of a skeletal muscle or muscle of a skeletal muscle or muscle group.group.

Cramps have been attributed to Cramps have been attributed to what?what?

A lack of water or other A lack of water or other electrolytes in relation to muscle electrolytes in relation to muscle fatigue.fatigue.

What is a spasm?What is a spasm?

A reflexive reaction caused by A reflexive reaction caused by trauma of the musculoskeletal trauma of the musculoskeletal system system

List and define the two types of List and define the two types of spasms or cramps:spasms or cramps:

a.a. clonic – alternating involuntary clonic – alternating involuntary muscular contraction and muscular contraction and relaxation in quick successionrelaxation in quick succession

b.b. tonic – rigid muscle contraction tonic – rigid muscle contraction that lasts a period of time.that lasts a period of time.

What are the four specific indicators What are the four specific indicators of possible overexertion?of possible overexertion?

a.a. acute muscle sorenessacute muscle soreness

b.b. delayed muscle sorenessdelayed muscle soreness

c.c. muscle stiffnessmuscle stiffness

d.d. muscle crampingmuscle cramping

List and define the two types of muscle List and define the two types of muscle soreness:soreness:

a.a. Acute-onset muscle soreness – which Acute-onset muscle soreness – which accompanies fatigue. This muscle pain accompanies fatigue. This muscle pain is transient and occurs during and is transient and occurs during and immediately after exercise.immediately after exercise.

b.b. Delayed-onset muscle soreness (DOMS) Delayed-onset muscle soreness (DOMS) – becomes most intense after 24 to 48 – becomes most intense after 24 to 48 hours and then gradually subsides so hours and then gradually subsides so that the muscle becomes symptom-free that the muscle becomes symptom-free after 3 or 4 days. (This second type of after 3 or 4 days. (This second type of pain is described as a syndrome of pain is described as a syndrome of delayed muscle pain leading to delayed muscle pain leading to increased muscle tension, swelling, increased muscle tension, swelling, stiffness, and resistance to stretch).stiffness, and resistance to stretch).

What are the possible causes for What are the possible causes for delayed-onset muscle soreness?delayed-onset muscle soreness?

It may occur from very small tears It may occur from very small tears in the muscle tissue, which seems in the muscle tissue, which seems to be more likely with eccentric or to be more likely with eccentric or isometric contractions.isometric contractions.

It may also occur because of It may also occur because of disruption of the connective tissue disruption of the connective tissue that hold muscle tendon fibers that hold muscle tendon fibers together.together.

What is muscle stiffness?What is muscle stiffness?

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

What can be done to assist in What can be done to assist in reducing muscle stiffness?reducing muscle stiffness?

Light exerciseLight exercise MassageMassage Passive mobilizationPassive mobilization

What is muscle guarding?What is muscle guarding?

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

The suffix “itis” means inflammation:The suffix “itis” means inflammation: Myositis/Fasciitis - inflammation of Myositis/Fasciitis - inflammation of

the muscle tissuethe muscle tissue Tendinitis – inflammation of a tendonTendinitis – inflammation of a tendon Tenosynovitis - Inflammation of the Tenosynovitis - Inflammation of the

synovial sheath surrounding a synovial sheath surrounding a tendontendon

Bursitis – inflammation of the bursaBursitis – inflammation of the bursa Periostitis – inflammation of the bone Periostitis – inflammation of the bone

coveringcovering

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

SprainsSprains Subluxations Subluxations Dislocations Dislocations

What is a sprain?What is a sprain?

Stretching or total tearing of the Stretching or total tearing of the stabilizing connective tissues stabilizing connective tissues (ligaments)(ligaments)

What is a grade 1 (or 1What is a grade 1 (or 1stst degree or degree or 1°) sprain?1°) sprain?

Slight over-stretching to mild Slight over-stretching to mild tearing (20%) of the ligament. It is tearing (20%) of the ligament. It is characterized by some pain, characterized by some pain, minimum loss of function, mild minimum loss of function, mild point tenderness, little or no point tenderness, little or no swelling, and no abnormal motion swelling, and no abnormal motion when tested. when tested.

What is a grade 2 (or 2What is a grade 2 (or 2ndnd degree or degree or 2°) sprain?2°) sprain?

Moderate tearing (20% - 70%) of Moderate tearing (20% - 70%) of the ligament. There is pain, the ligament. There is pain, moderate loss of function, moderate loss of function, swelling, and in some cases slight swelling, and in some cases slight to moderate instability.to moderate instability.

What is a grade 3 (or 3What is a grade 3 (or 3rdrd degree or degree or 3°) sprain?3°) sprain?

It is extremely painful, with major It is extremely painful, with major loss of function, severe instability, loss of function, severe instability, tenderness, and swelling.tenderness, and swelling.

What is a subluxation?What is a subluxation?

Partial dislocations in which an Partial dislocations in which an incomplete separation between incomplete separation between two articulating bones occurs.two articulating bones occurs.

What is a dislocation (luxation)?What is a dislocation (luxation)?

Total disunion of bone apposition Total disunion of bone apposition between articulating surfacesbetween articulating surfaces

What are several factors that are What are several factors that are important in recognizing and important in recognizing and evaluating dislocations?evaluating dislocations?

Loss of limb functionLoss of limb function DeformityDeformity SwellingSwelling Point tendernessPoint tenderness

What is an acute bone fracture?What is an acute bone fracture?

A partial or complete interruption A partial or complete interruption in a bone’s continuityin a bone’s continuity

What is a stress fracture?What is a stress fracture?

Rhythmic muscle action performed Rhythmic muscle action performed over a period of time at a sub-over a period of time at a sub-threshold level causes the stress-threshold level causes the stress-bearing capacity of a bone to be bearing capacity of a bone to be exceededexceeded

What are the typical causes of What are the typical causes of stress fractures in sports?stress fractures in sports?

Coming back into competition too Coming back into competition too soon after an injury or illnesssoon after an injury or illness

Going from one event to another Going from one event to another without proper training in the without proper training in the second eventsecond event

Starting initial training too quicklyStarting initial training too quickly Changing habits or the Changing habits or the

environment environment

InjuryInjury Mechanism of Injury (Etiology)Mechanism of Injury (Etiology) Signs & SymptomsSigns & Symptoms TreatmentTreatment

Groin Strain (Hip)Groin Strain (Hip) Running, Jumping, Twisting (ER)Running, Jumping, Twisting (ER) TypicalTypical Typical, May need crutches, Typical, May need crutches, compression wrap during compression wrap during activityactivity

Quadriceps Strain (Thigh)Quadriceps Strain (Thigh) Sudden stretch from knee Sudden stretch from knee flexionflexion

TypicalTypical Typical, May need crutches, Typical, May need crutches, compression wrap during compression wrap during activityactivity

Hamstring Strain (Thigh)Hamstring Strain (Thigh) Sudden stretch from knee Sudden stretch from knee extensionextension

TypicalTypical Typical, May need crutches, Typical, May need crutches, compression wrap during compression wrap during activityactivity

Gastrocnemius Strain (Leg)Gastrocnemius Strain (Leg) Quick starts & stops, jumping, Quick starts & stops, jumping, sudden knee extension.sudden knee extension.

TypicalTypical Typical, heel wedge, Typical, heel wedge, compression wrap during compression wrap during activityactivity

Achilles Tendon Strain (Ankle)Achilles Tendon Strain (Ankle) Usually after ankle sprains or Usually after ankle sprains or sudden excessive ankle sudden excessive ankle dorsiflexion.dorsiflexion.

TypicalTypical Typical, heel lift, compression Typical, heel lift, compression wrap during activitywrap during activity

Achilles Tendon Rupture (Ankle)Achilles Tendon Rupture (Ankle) Sudden pushing-off action of the Sudden pushing-off action of the forefoot with the knee being forefoot with the knee being forced into complete extension.forced into complete extension.

Typical, hears a pop, indentation Typical, hears a pop, indentation at site, positive Thompson’s Testat site, positive Thompson’s Test

RICE, X-ray to rule out fracture, RICE, X-ray to rule out fracture, possible surgical repair, possible surgical repair, immobilization for 4 to 6 weeks, immobilization for 4 to 6 weeks, begin rehab. Heel lifts in both begin rehab. Heel lifts in both shoesshoes

Longitudinal Arch StrainLongitudinal Arch Strain Repetitive contact with a hard Repetitive contact with a hard playing surface. It may appear playing surface. It may appear suddenly or slowly over time.suddenly or slowly over time.

TypicalTypical Typical, Reduce weight bearing Typical, Reduce weight bearing activity, possible arch support activity, possible arch support tapingtaping

Metatarsal Arch StrainMetatarsal Arch Strain Excessive pronation and weak Excessive pronation and weak intertarsal ligaments will allow intertarsal ligaments will allow the foot to abnormally spread the foot to abnormally spread resulting in a fallen archresulting in a fallen arch

TypicalTypical Typical, orthotic or pad to Typical, orthotic or pad to elevate the fallen arch.elevate the fallen arch.

Patellar Tendon Rupture Sudden powerful contraction of the quadriceps

Typical, 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, surgeryTypical, surgery

StrainsStrains


Elbow strainElbow strain Excessive resistive motion, repeated microtears

TypicalTypical TypicalTypical

Lumbar strainLumbar 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 strainNeck and Upper Back strain Turn the head suddenly or forced flexion, extension, or rotation

Typical, Typical, muscle guarding and reluctance to move the neck in any direction

Typical, Typical, possible soft cervical collar

Cervical sprain (Whiplash)Cervical sprain (Whiplash) Turn the head suddenly or forced flexion, extension, or rotation, but much more violently than the cervical strain

Typical, 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, Typical, X-rays to rule out fracture. and possible soft cervical

StrainsStrains


Hip SprainHip Sprain Sudden stretch from knee Sudden stretch from knee flexionflexion

TypicalTypical Typical, May need crutchesTypical, May need crutches

MCL Sprain (Knee)MCL Sprain (Knee) Direct blow (valgus force), Direct blow (valgus force), severe outward twistsevere outward twist

Typical, positive valgus stress Typical, positive valgus stress testtest

Typical, May need crutchesTypical, May need crutches

LCL Sprain (Knee)LCL Sprain (Knee) Direct blow (varus force)Direct blow (varus force) Typical, positive varus stress Typical, positive varus stress testtest

Typical, May need crutchesTypical, May need crutches

ACL Sprain (Knee)ACL Sprain (Knee) Direct blow, rotation, Direct blow, rotation, hyperextensionhyperextension

Typical, positive anterior drawer Typical, positive anterior drawer test, positive Lachman’s testtest, positive Lachman’s test

Typical, crutches, Typical, crutches, immobilization, physician immobilization, physician referral, possible surgeryreferral, possible surgery

PCL Sprain (Knee)PCL Sprain (Knee) Direct blow, knee flexion, Direct blow, knee flexion, landing on a flexed kneelanding on a flexed knee

Typical, positive posterior Typical, positive posterior drawer testdrawer test

Typical, crutches, Typical, crutches, immobilization, physician immobilization, physician referral, possible surgeryreferral, possible surgery

Inversion (Lateral) Ankle SprainInversion (Lateral) Ankle Sprain Foot inversion, plantar flexion, Foot inversion, plantar flexion, adductionadduction

Typical, positive anterior drawer Typical, positive anterior drawer test, positive Talar tilt testtest, positive Talar tilt test

Typical, possible crutches, Typical, possible crutches, possible immobilization, possible possible immobilization, possible physician referral, possible physician referral, possible surgerysurgery

Eversion (Medial) Ankle SprainEversion (Medial) Ankle Sprain Foot pronation, hypermobility, Foot pronation, hypermobility, depressed medial longitudinal depressed medial longitudinal archarch

Typical, positive anterior drawer Typical, positive anterior drawer test, positive Talar tilt testtest, positive Talar tilt test

Typical, possible crutches, Typical, possible crutches, possible immobilization, possible possible immobilization, possible physician referral, possible physician referral, possible surgerysurgery

Syndesmotic (High) Ankle SprainSyndesmotic (High) Ankle Sprain External rotation, forced External rotation, forced dorsiflexiondorsiflexion

TypicalTypical Typical, may take months to Typical, may take months to healheal

Sprained Toes or Turf ToeSprained Toes or Turf Toe Force against an unyielding Force against an unyielding objectobject

Typical, Valgus & Varus Stress Typical, Valgus & Varus Stress Tests, Anterior & Posterior Tests, Anterior & Posterior Drawer TestsDrawer Tests

Typical, tapeTypical, tape

Acromioclavicular (AC) SprainAcromioclavicular (AC) Sprain Direct Impact Typical Typical, Typical, immobilization, possible physician referral

SprainsSprains


Elbow sprainElbow sprain Hyperextension or valgus forces TypicalTypical TypicalTypical

Wrist sprainWrist sprain Fall on hyperextended wrist; any abnormal, forced movement of the wrist


Finger sprainFinger sprain Fall on hyperextended wrist; any abnormal, forced movement of the wrist


Finger fracturesFinger fractures Direct trauma or violent twisting TypicalTypical TypicalTypical

Lumbar sprainLumbar sprain Forward bending and twists while lifting or moving some object


Sacroiliac sprainSacroiliac 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, 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, Typical, Bracing may be helpful. Joint should be mobilized to correct existing asymmetry

SprainsSprains


Trochanteric BursitisTrochanteric Bursitis RepetitiveRepetitive Typical, pain may radiate to the Typical, pain may radiate to the knee causing a limpknee causing a limp

Typical, May need crutches, Typical, May need crutches, NSAIDs and analgesics.NSAIDs and analgesics.

Patellar BursitisPatellar Bursitis Continual kneeling, overuse Typical, ballotableTypical, ballotable Typical, eliminate the cause, NSAIDs

Shoulder bursitisShoulder bursitis OveruseOveruse Typical, Typical, positive impingement test

TypicalTypical

Olecranon Bursitis Direct force, overuseDirect force, overuse TypicalTypical TypicalTypical

BursitisBursitis


Shoulder dislocation/subluxationShoulder dislocation/subluxation Forced abduction, external rotation, direct blow

Typical, Typical, possible deformity, unable to touch opposing shoulder (Apley’s scratch test

Typical, Typical, Immediate immobilization, RICE, pillow under the arm for comfort, physician referral, x-rays to rule out a fracture

Elbow dislocationElbow 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, Typical, Rupturing or tearing most of the stabilizing ligaments, profuse hemorrhage and swelling. Severe pain and disability, possible radial head fracture.

Typical, Typical, sling, physician referral

Lunate DislocationLunate 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, Typical, possible physician referral

Finger dislocations/subluxationsFinger dislocations/subluxations Direct trauma or violent twisting TypicalTypical 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

TypicalTypical Typical, Typical, X-ray, physician referral, put athlete on a spine board

Cervical dislocationCervical 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, C-spine, Physician referral

Dislocations and Dislocations and SubluxationsSubluxations


Hip Contusion (Hip Pointer)Hip Contusion (Hip Pointer) Direct blowDirect blow Typical, spasms, Typical, spasms, transistory paralysis, unable to rotate the trunk or to flex the thigh without pain

Typical, physician referral to r/o Typical, physician referral to r/o fracture, 1 to 2 days bed rest, fracture, 1 to 2 days bed rest, ice massage, ultrasound, NSAIDsice massage, ultrasound, NSAIDs

Quadriceps ContusionQuadriceps Contusion Direct blowDirect blow Typical, Typical, transitory loss of function

Typical, Typical, RICE with the knee in flexion, NSAIDs

Joint ContusionJoint Contusion Direct blowDirect blow TypicalTypical Typical, possible physician Typical, possible physician referral, referral, return to activity with protective padding when initial pain and irritation subsides.

Shin contusionShin contusion Blow to the anterior aspect of the lower leg.

Typical, Typical, rapid hematoma formation, can be associated with compartment syndrome or fracture.

Typical, 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 ContusionCalcaneal Contusion Occurs by impact from running or jumping

TypicalTypical Typical, 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 contusionsFinger contusions Direct traumaDirect trauma TypicalTypical Typical Typical

Rib contusionRib contusion Direct blowDirect blow Typical, Typical, Sharp pain during breathing, point tenderness, pain when the rib cage is compressed

Typical, Typical, possible bed rest and cessation of sports activities

ContusionsContusions


Femoral Stress FracturesFemoral Stress Fractures RepetitiveRepetitive 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, Typical, Rest, for 2 to 5 months, x-rays and possible bone scan, swimming

Acute Femoral FractureAcute Femoral Fracture Direct TraumaDirect Trauma Typical, pain over the fracture Typical, pain over the fracture site, deformitysite, deformity

Ice, Ice, Treat for shock, verify neurovascular status, splint, physician referral

Patellar FracturePatellar Fracture Direct or indirect traumaDirect or indirect trauma Typical, Typical, Hemorrhage and joint effusion

Typical, physician referralTypical, physician referral

Acute Leg FractureAcute Leg Fracture Direct traumatic blowDirect 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 FractureTibia or Fibular Stress Fracture Repetitive or OveruseRepetitive or Overuse Typical, positive percussion or compression test, positive x-ray or bone scan

Typical, 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)Ankle Fracture (misnomer) Forced abduction or planting in combination with forced internal rotation, trauma.

Typical, possible deformityTypical, possible deformity Typical, 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.

FracturesFractures


Talus FractureTalus 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 FractureCalcaneal 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 weightTypical, 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 FractureCalcaneal Stress Fracture Occurs from repetitive impact during heel strike and characterized by a sudden onset of constant pain in the plantar-calcaneal area.

Typical, Typical, Feels pain on weight bearing, pain tends to continue after exercise stops, bone scan may be required.

Typical, 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 FractureJone’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, 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.

Fractures (cont.)Fractures (cont.)


Metatarsal Stress Fracture Metatarsal Stress Fracture (March 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

PhalangesPhalanges 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 FractureScapular 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 HumerusFracture 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



Forearm fractureForearm fracture Direct trauma or fall on the outstretched arm

Typical, Audible pop or crack Typical, Typical, sling, physician referral

Colle’s FractureColle’s Fracture Fall on an outstretched armforcing the radius and ulna into hyperextension, or falling on the backward hand

Typical, Typical, Possible silver fork deformity, and possible median nerve damage

Typical, Typical, sling, physician referral

Scaphoid (Navicular) FractureScaphoid (Navicular) Fracture Force on the outstretched arm Typical Typical, Typical, splint, physician referral

Hamate fractureHamate fracture Fall or from contact from a sports implement

Typical Typical, Typical, splint, physician referral

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 Typical, X-ray, physician referral, put athlete on a spine board

Cervical fractureCervical 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 FractureRib Fracture Direct or indirect trauma, violent muscular contractions

Typical, Sharp pain during inspiration, possible crepitus during palpation

Typical, physician referral, rest and immobilization



Osgood-Schlatter repetitive stress at the tibial tuberosity

Typical, hemorrhage, gradual degeneration, severe pain when kneeling, running, or jumping, point tenderness

Typical, Typical, reduce irritating activities, cast may be required, isometric strengthening for quads and hamstrings

Larsen Johansson repetitive stress at the inferior patellar pole

Typical, hemorrhage, gradual degeneration, severe pain when kneeling, running, or jumping, point tenderness

Typical, Typical, reduce irritating activities, cast may be required, isometric strengthening for quads and hamstrings

Patellar Tendinitis(Jumper’s or Kicker’s Knee)

Repetitive running, jumping, and kicking

Typical, Typical, Pain and tenderness at the posterior, inferior patellar pole

Typical, Typical, thermal agents, ultrasound, brace (counter-force) massage

Runner’s (Cyclist’s) Knee Repetitive, overuseRepetitive, overuse Typical, Typical, Malalignment and structural asymmetries of the foot and lower leg. Contributes to iliotibial band friction syndrome and pes anserinus tendonitis or bursitis

Typical, Typical, Correction of foot and leg alignment problems, RICE, proper warm-up and stretching, avoidance of aggravating activities, NSAIDs.

Achilles TendinitisAchilles Tendinitis Excessive tensile stresses placed on it during repetitive movements and presents with a gradual onset.

Typical, 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.

TendinitisTendinitis


Anterior Tibialis TendinitisAnterior Tibialis Tendinitis Common when running downhill for extended periods of time.

Typical Typical, avoid hills

Posterior Tibialis TendinitisPosterior 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 TendinitisPeroneal 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 tendinitisWrist tendinitis Repetitive pulling movements Typical TypicalTypical

Tendinitis (cont.)Tendinitis (cont.)

Chondramalacia Chondramalacia (Patellofemoral (Patellofemoral

Arthralgia)Arthralgia) Etiology: Etiology: Abnormal patellar trackingAbnormal patellar tracking Signs & Symptoms:Signs & Symptoms: Pain in the anterior aspect while running, Pain in the anterior aspect while running,

walking, ascending stairs, and squatting. walking, ascending stairs, and squatting. Recurrent swelling, grating sensation during Recurrent swelling, grating sensation during flexion and extension, patellar grind test flexion and extension, patellar grind test produces crepitus.produces crepitus.

Treatment:Treatment: Avoid irritating activities, pain-free isometric Avoid irritating activities, pain-free isometric

exercise to strengthen the quads, anti-exercise to strengthen the quads, anti-inflammatories, orthotics to correct pronation inflammatories, orthotics to correct pronation and reduce tibial torsion, possible surgery.and reduce tibial torsion, possible surgery.

Patellofemoral Stress Syndrome Patellofemoral Stress Syndrome (PFSS) (Patellofemoral (PFSS) (Patellofemoral

Arthralgia)Arthralgia) Etiology: Etiology: Hamstrings, gastrocnemius, IT band, or lateral Hamstrings, gastrocnemius, IT band, or lateral

retinaculum tightness; increased Q angle, foot retinaculum tightness; increased Q angle, foot pronation, patella alta, VMO insufficienciespronation, patella alta, VMO insufficiencies

Signs & Symptoms:Signs & Symptoms: Tenderness over the patellar lateral facet, Tenderness over the patellar lateral facet,

swelling, dull ache in the center of the knee, swelling, dull ache in the center of the knee, patellar compression will elicit pain and crepitis, patellar compression will elicit pain and crepitis, positive apprehension testpositive apprehension test

Treatment:Treatment: Strengthen VMO; stretching for hamstrings, Strengthen VMO; stretching for hamstrings,

gastrocnemius, and IT band; orthotics and/or gastrocnemius, and IT band; orthotics and/or taping to correct alignmenttaping to correct alignment

Cramps and SpasmsCramps and Spasms Etiology: Etiology: Excessive loss of fluids through Excessive loss of fluids through

sweating, inadequate muscle sweating, inadequate muscle coordination.coordination.

Signs & Symptoms:Signs & Symptoms: Pain, tonic contraction.Pain, tonic contraction. Treatment:Treatment: Athlete should relax, gradual Athlete should relax, gradual

stretching, ice or gentle ice stretching, ice or gentle ice massage.massage.

Medial Tibial Stress Medial Tibial Stress SyndromeSyndrome Etiology: Etiology:

Repetitive microtrauma, weak leg muscles, inadequate Repetitive microtrauma, weak leg muscles, inadequate footwear, inappropriate training, malalignment problems.footwear, inappropriate training, malalignment problems.

Signs & Symptoms:Signs & Symptoms: Grade 1: pain after activityGrade 1: pain after activity Grade 2: pain before and after activity, but does not affect Grade 2: pain before and after activity, but does not affect

performanceperformance Grade 3: pain before, during, and after activity, affects Grade 3: pain before, during, and after activity, affects

performanceperformance Grade 4: constant pain that makes performance impossibleGrade 4: constant pain that makes performance impossible Pain is along the lower medial anterior tibialis.Pain is along the lower medial anterior tibialis. Treatment:Treatment: Physicians referral to rule out other problems, RICE, Physicians referral to rule out other problems, RICE,

NSAIDs and analgesics, ice massage, modify activity, NSAIDs and analgesics, ice massage, modify activity, correct biomechanics, orthotics and/or arch taping.correct biomechanics, orthotics and/or arch taping.

Lateral EpicondylitisLateral Epicondylitis(Tennis Elbow)(Tennis Elbow)

Etiology: Etiology: Repetitive microtrauma, hyperextension Repetitive microtrauma, hyperextension

activitiesactivities Signs & Symptoms:Signs & Symptoms: Aching pain over the region during and after Aching pain over the region during and after

exercise, pain worsens with continued activity, exercise, pain worsens with continued activity, weakness in the hand and wristweakness in the hand and wrist

Treatment:Treatment: RICE, NSAIDs and analgesics, immobilization, RICE, NSAIDs and analgesics, immobilization,

strengthening and stretching exercises, strengthening and stretching exercises, correct biomechanics, counterforce brace correct biomechanics, counterforce brace

Medial EpicondylitisMedial Epicondylitis(Pitcher’s Elbow, Racquetball Elbow, (Pitcher’s Elbow, Racquetball Elbow,

Golfer’s Elbow, Javelin-Thrower’s Golfer’s Elbow, Javelin-Thrower’s Elbow)Elbow)

Etiology: Etiology: Repeated forceful extension of the wrist and valgus Repeated forceful extension of the wrist and valgus

torques of the elbow.torques of the elbow. Signs & Symptoms:Signs & Symptoms: Pain, possible radiating pain, point tenderness, mild Pain, possible radiating pain, point tenderness, mild

swelling, AROM produces pain.swelling, AROM produces pain. Treatment:Treatment: RICE, NSAIDs and analgesics, immobilization (sling), RICE, NSAIDs and analgesics, immobilization (sling),

strengthening and stretching exercises, correct strengthening and stretching exercises, correct biomechanics, counterforce brace. For severe cases, biomechanics, counterforce brace. For severe cases, splint and complete rest for seven to 10 days. splint and complete rest for seven to 10 days.

Carpal Tunnel SyndromeCarpal Tunnel Syndrome

Etiology: Etiology: Repetitive wrist flexion, direct traumaRepetitive wrist flexion, direct trauma Signs & Symptoms:Signs & Symptoms: Sensory or motor deficits; tingling, numbness, Sensory or motor deficits; tingling, numbness,

and paresthesia over the thumb, index and and paresthesia over the thumb, index and middle fingers, and palm of the hand; middle fingers, and palm of the hand; muscular weaknessmuscular weakness

Treatment:Treatment: RICE, immobilization, and NSAIDs. Surgical RICE, immobilization, and NSAIDs. Surgical

decompression may be necessarydecompression may be necessary

de Quervain’s Diseasede Quervain’s Disease(Hoffman’s Disease)(Hoffman’s Disease)

Etiology: Etiology: Constant wrist movementConstant wrist movement Signs & Symptoms:Signs & Symptoms: Aching pain which may radiate into the Aching pain which may radiate into the

hand or forearm, positive Finklestein’s hand or forearm, positive Finklestein’s test; point tenderness and weakness test; point tenderness and weakness during thumb extension and abduction; during thumb extension and abduction; there may be a painful snapping and there may be a painful snapping and catching of the tendonscatching of the tendons

Treatment:Treatment: Immobilization, rest cryotherapy, NSAIDs, Immobilization, rest cryotherapy, NSAIDs,

ultrasound, ice massageultrasound, ice massage

Wrist GanglionWrist Ganglion

Etiology: Etiology: Appears slowly after a wrist sprainAppears slowly after a wrist sprain Signs & Symptoms:Signs & Symptoms: Occasional pain with a lump at the site. Pain Occasional pain with a lump at the site. Pain

increases with useincreases with use Treatment:Treatment: RICE, pressure with a felt pad, ultrasound, RICE, pressure with a felt pad, ultrasound,

possible surgical removalpossible surgical removal

SciaticaSciatica Etiology: Etiology: Torsion or direct blow to the back causing Torsion or direct blow to the back causing

inflammation or compression of the sciatic nerveinflammation or compression of the sciatic nerve Signs & Symptoms:Signs & Symptoms: Pain may be abrupt or gradual, produces a sharp Pain may be abrupt or gradual, produces a sharp

shooting pain that follows the nerve pathway along shooting pain that follows the nerve pathway along the posterior and medial thigh; there may be the posterior and medial thigh; there may be tingling and numbness along its path; nerve may be tingling and numbness along its path; nerve may be extremely sensitive to palpation; straight leg raises extremely sensitive to palpation; straight leg raises intensifies pain.intensifies pain.

Treatment:Treatment: Rest is essential. Stretching of a tight piriformis Rest is essential. Stretching of a tight piriformis

muscle may decrease symptoms; NSAIDs and RICE, muscle may decrease symptoms; NSAIDs and RICE, surgery may be necessary. surgery may be necessary.

Brachial Plexus Neurapraxia Brachial Plexus Neurapraxia (Burner or Stinger)(Burner or Stinger)

Etiology: Etiology: Stretching or compression of the brachial plexusStretching or compression of the brachial plexus Signs & Symptoms:Signs & Symptoms: Burning sensation, numbness, tingling, and pain Burning sensation, numbness, tingling, and pain

extending from the shoulder down to the hand with extending from the shoulder down to the hand with some loss of function of the arm and hand that lasts some loss of function of the arm and hand that lasts for several minutes.for several minutes.

Treatment:Treatment: RICE; strengthening exercises; Athlete may return to RICE; strengthening exercises; Athlete may return to

full activity once symptoms have completed resolve full activity once symptoms have completed resolve and there are no associated neurological symptoms.and there are no associated neurological symptoms.

injuries. signs and symptoms pain pain swelling swelling heat heat redness redness loss of function...

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