Caused from direct trauma

-Partial or complete disruption

-Closed or open= through the skin

Caused by repetitive trauma

Presents with deformity, point tenderness, swelling and pain

No specific cause

-Overload due to muscle contraction, altered stress distribution due to playing surface/ shoes

-Common in LE

Signs and Symptoms

-No trauma

-Dull ache worsens with time

-Initially= pain during activity

-Eventually= pain following activity

Usually immobilized 4-6 weeks

-Stress fractures

        -May not show up on x-ray right away

        - generally 2 weeks with NO activity

-Displaces out of normal joint alignment

-More common in UE

-Tendon and ligament injuries might be invovled

-Never Reduce

-A bone comes out of normal alignment and goes right back into place

            -Higher incidence in fingers and shoulder

Soft Tissue Trauma

Noncontactile

tissues include ligaments, skin, cartilage

Soft Tissue Trauma

Contractile

 Abrasion

    -Skin is scraped against floor

Lacceration

     -Sharp, pointed object tears the skin

Puncture wound

     -Direct penetration of skin with object

Incision

     -Clean wound, usually where a blow was taken over a bony area

Avulsion

      -Skin is torn from the body a lot of blood loss is associated with this EX: Shark bite

Injury to a ligament- Sprain

-Result of traumatic joint twisting

-Causes stretching or tearing of connective tissue

Grades of Acute Joint Injuries

Depends on Severity

Ligaments will never regain their original tension thus muscle strengthening must be performed)

Three grades of sprains

           Grade 1: Minimal tearing of ligament, mild pain & swelling

            Grade 2: A tear of ligament, moderate to severe painm immediate swelling, instability

-Restoration of joint stability is difficult with grade I/ II injuries, The ligament has been stretched causing development of inelstic scar

             Grade 3: Complete tear, initially severe pain then little to no pain, lots of swelling, total instability

Grade 1: Minimal tearing, tenderness & pain with motion full ROM- But painful

Grade 2: Number of muscle fibers are torn, active motion painful and limited, swelling and discoloration

Grade 3: Complete rupture usually at muscle-tendon junction, loss of movement, initially painful then little to no pain.

Muscle Soreness

          -Over exertion occurs two types of soreness

1) Acute Muscle Soreness- accompanies fatigue, experienced immediately

2) Delayed onset- Pain that occurs 24-48 hours following activity, (pain subsides 3-4 days later)

-Following injury muscles within an effected area contract to splint the area minimize pain through limitation of motion

Can be both deep and superficial

-Blow from an external object causing the soft tissue to crash into bone

-Speed of healing dependent on the extent

-Repeated blows to the same area can cause calcium deposits. Quads/ Biceps

-Invovled with compression or tension

-Abnormal nerve responses may be associate with a injury

-Lacerate a nerve when a fracture or dislocation occurs

-Can produce variety of sensory responses:

-Pinch, burn, tingle, weakness, radiating pain.

Hypo-esthesia- Diminished feeling

Hyper-esthesia- Increased feeling

Parestesia- Numbness

Tendinitis- moving tendon slides repeatedly

Tenosynovitis- Inflammation of tendon sheath

Bursitis: Inflammation of bursac

Trigger points: Area of tenderness in a tight muscle

Healing Process of injured nerve/tendon

Stage 1: Inflammatory Response

               -Redness, swelling, tenderness,increased temp

Stage 2: Fibroblastic Repair

•   Scar formation and repair of injured tissue occurs, starts a few hours after injury.     
• Lasts 4-6 weeks
• with increase of scar

Stage 3:   Maturation-Remodeling

• Remodeling scar tissue to original structure
• not as strong
• Gradually resumes normal appearance                

ch 15

Preventing Injury in the lower leg/ankle

• Achillies tendon stretching
• Tight heel cord may limit dorsiflexion
• Stretch with knee extended and flexed
• Strengthening and neuromuscular control training
• Training on uneven surfaces or a balance board
• Footwear
• Appropriate shoe for activity
• Preventive taping n braces
• Tape= some protection

ch 15

Assessment using HOPS

History, Observation, Palpation, Special Tests

History-

• How did it happen? Was it a sudden strain, twist, or blow?
• Dd happen suddenly or over time?
• Were you able to continue or did you have to stop?
• Where is the pain? What type of pain is it?
• Surface you were on?
• Did you hear a noise? Snap Crack Pop?

ch15

                                 HOPS

             Observation:

Observation: Watch for a limp, how they take off shoes and socks

• Look for swelling, bruising, redness
• Color and texture of skin
• Wear patterns of shoes
•  

Ch.15

HOPS

PALPATION

Palpation

• Bones
• Muscles/tendons
• Ligaments

Feeling For:

• Deformity
• Swelling
• Point of tenderness
• Increase body temp
• muscle spasm
• Crepitus
• Pulse

HOPS

Special Test- Fracture of lower leg

Ankle Stability Tests

Anterior Drawer Test:

• Test anterior talofibular ligament
• Positive test occurs when foot slides forward and makes a clunking sound as it reaches end point

Talar Tilt Test

• Tests medial and lateral ligament
• With foot at 90 degrees calcaneus is inverted and excessive motion indicates injury to ligament

Ankle/ Lower Leg injury

Functional Tests

• While weight bearing the following should be performed
• Walk on toes
• walk on heels
• hop on injured ankle
• start and stop running
• change direction rapidly
• run figure 8's

Once able to do those listed can return to play

The most common injury in sports is the sprained ankle

• Inversion Sprains are the most common
• Injury to the lateral ligaments

Cause: The foot comes down on uneven surfaces

Management of Ankle injury

Eversion:5-10% of all ankle sprains

Eversion ankle sprain

• Less common rolling of the ankle inside (Medial)
• Damage of deltoid ligament

• Swelling varing in degree of sprain
• Point tender over involved ligaments
• discoloration
• variable weight bearing ability
• test with anterior drawer/ talar tilt

Grade 1:

• Signs and Symptoms
• Mild pain and disability
• point tender over ligaments

Grade 2:

• Feel or hear pop
• moderate pain with difficulty of range
• Positive talar tilt/ anterior drawer tests
• possible tearing of ligaments

Grade 3:

• Severe pain
• unable to WB flex
• Postive talar tilt/ anterior drawer test
• inability due to complete ligament rupture
•  

• First rule out avulsion fracture
• PRICE
• Weight bearing devices, tape/brace
• Immediate compression with horseshoe
• ROM strengthening

• Cause of injury
• Acute: Direct Blow
• Chronic: Overuse of improper shoes
• Signs of Injury
• Swelling and pain with possible deformity
• May be open or closed (out of skin)
• Leg may appear hard or swollen
• Care
• Splint and refer to physician for X-Rays
• Walking cast
• Surgery
• Immobilization lasting 4-8 weeks

• Cause of Injury
• Overuse condition
• Signs of Injury
• Pain w activity
• Pain more intense after exercise than before
• Point tenderness
• May not show up on Xray right away
• Care
• Eliminate stressful activity
• About 14 days
• Use crutches for walking (until pain subsides)
• Gradually return to activity
• Find Cause

Medial Tibial Stress Syndrome

(Shin Splints)

Cause:

• Overuse, improper footwear
• Calf tightness, poor running technique, weak muscles
• Training on different surfaces

Signs:

• Pain along 1/3 medial aspect of shin below knee
• Pain after workouts, pain all the time
• pt tenderness

Care:

• PRICE
• Refer to rule out stress fracture
• activity modification
• correction
• stretch!
• Find Cause

• Increase pressure in one of the four compartments
• Comprimises neurovascular network

Causes:

• Blunt Trauma
• Swelling
• Deep aching pain
• reduced pulse to foot

Care:

• Medical emergency
• rest
• ice
• elevate
• DO NOT use compression wrap (clotting)

• Cause:
• Overuse
• Decreased flexibility

Signs of Injury:

• Pain & stiffness
• Warmth, crepitus

Care:

• Resistance due to slow healing nature of tendon
• reduce stress on tendon
• Heel lift or taping
• Agressive stretching and strengthening

Cause:

• Occurs w sudden stop and go; forceful plantar flexion with knee moving into full extension
• Commonly seen in athletes above 30
• Generally has chronic inflammation

Signs:

• Sudden snap w immediate pain
• Point tenderness, swelling, discoloration
• Postive Thompson test

Care:

• Surgical repair/ PRICE, NSAIDS
• Must work to regain normal range of motion followed by gradual strengthening program

Ch 16              Knee and Related Structures

Knee Anatomy

Knee Anatomy:

• Femur
• Tibia
• Fibula
• Patella

Muscles and other structures

• Knee Extension- Quadriceps
• Knee Flexion- Hamstring
• Meniscus- Poor blood supply to deep areas
• Medial: Connected to deeper portion of MCL
• "c" shape
• Lateral: "o" shape, harder to injure

ch 16

Prevention of Knee Injuries

Strength and Conditioning:

• Muscle strength to maximize stability
• Flexibility
• Hamstrings, hip adductors, quads

ACL Prevention Programs

• Focus on strength neuromuscular control, balance
• Balance board training
• Landing strategies
• Plyometric training

PROPER FOOTWEAR for sport or activity

• Does it feel like grinding/ grating
• Does it ever feel like knee is giving away
• locks and catches?
• Pain when going up/down stairs?

ACL and PCL are not palpatable

Girth measurements n ROM

• Check ROM
• AROM
• PROM
• RPOM
• Record all through rehab process

Special Tests:

• Lachman Test: Knee is placed in 30 degree of flexion, attempt is made to translate tibia anteriorly on the femur
• Apley's compression test: Downward pressure applied with rotation

Ch 16

MCL Sprain

Cause:

• Hit to outside of knee (Valgus force)
• Foot planted w exterior rotation

Care:

• PRICE
• Crutches
• Knee immobilizer @ 30 degrees
• non operative

Tests: Valgus stress test

ch 16

ACL Sprain

Cause:

• Hit to front of knee
• Hyperextension
• Foot was planted with external rotation of knee

More common injury among females

• Study shoe intrinsic factors
• Femoral notch
• ACL size and laxity

Extrinsic factors may be

• Conditioning, skill acquisition, playing style, equipment

Signs

• Athlete will feel like the knee is coming apart after a few mins they will feel like it is OK
• May have heard a pop

Tests: Lachman's Test/ Anterior Drawer test

Cause: Medial meniscus more commonly injured

Signs:

• Effusion developing over 48-72hr period
• Joint line pain and loss of motion
• Intermittent locking
• Pain w/ squatting

Cause:

• Acute, chronic or recurrent swelling
• Prepatellar= continuous kneeling (catcher)
• Infrapatellar= overuse of patellar tendon
•  

Cause:

• Repetitive overuse, running on crowned roads
• Mal- alignment and structural asymmetries

Signs: Pain with activity

Care: Ice before and after, proper warm up