injury classification what’s wrong? what’s wrong?
TRANSCRIPT
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 Injury Classification
FractureFracture
– 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
SprainsSprains
– Injury to the following structuresInjury 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
• 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 overstretchMild tearing or overstretch
•YesYes
•MildMild
•Not effectedNot effected
•MildMild
•No LaxityNo Laxity
Signs & SymptomsSigns & 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 & SymptomsSigns & Symptoms
3rd Degree Sprain
• Ligament Damage
• Point Tenderness
• Loss of Function
• ROM
• Edema (swelling)
• Stress test results
•Complete tear Complete tear
•YesYes
•Severe w/instabilitySevere w/instability
•Decreased or increasedDecreased or increased
•Moderate to severeModerate to severe
•Laxity with no end pointLaxity with no end point
Signs & SymptomsSigns & Symptoms
• SubluxationSubluxation
– Bone comes partially out of joint(<50%)Bone comes partially out of joint(<50%)
– Usually goes back in place by itselfUsually 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 Requires outside force to put bone back in place (reduction of dislocation)(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
1+ 0-5mm
2+ 5-10 mm
3+ >10mm
AssessmentAssessment
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 ClassificationInjury Classification TendinopathyTendinopathy
•TendinitisTendinitis
–No longer considered inflammatory conditionNo longer considered inflammatory condition
•Mechanism of InjuryMechanism of Injury
–Tendon is overloaded due to extensive stressTendon is overloaded due to extensive stress
–Degenerative changes in the tendonDegenerative changes in the tendon
–Gradual onset Gradual onset
–Worsens with continued useWorsens with continued use
–Decreased flexibility exacerbates conditionDecreased flexibility exacerbates condition
Injury ClassificationInjury Classification Leg Cramps Leg Cramps
Muscle SpasmsMuscle Spasms•Involuntary muscle contractionsInvoluntary muscle contractions
–SuddenSudden
–ViolentViolent
–FatigueFatigue
–Loss of fluidsLoss of fluids
–Electrolyte imbalanceElectrolyte imbalance
–Nerve IrritationNerve Irritation