Chapter 9: Mechanisms and Characteristics of Sports Trauma

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Chapter 9Mechanisms and Characteristicsof
Sports Trauma
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• What is trauma?
• A physical injury or wound sustained in sport
  and produced by external or internal force.

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• Tissues have relative abilities to resist a
  particular load. If the tissue is stronger, what
  will happen?
• The greater magnitude of load it can withstand.

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• List and define the five type of tissue
  stresses
• Tension
• force that pulls or stretches tissue
• Stretching
• stretching beyond the yield point leads to
  rupturing of soft tissue or fracturing of a bone
• Compression
• a force that, with enough energy, crushes tissue
• Shearing
• a force that moves across the parallel
  organization of the tissue
• Bending
• force on a horizontal beam or bone that places
  stresses within the structure, causing it to bend
  or strain

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• What are the two categories of soft (non-bony)
  tissue and give examples
• non-contractile
• skin, joint capsules, ligaments, fascia,
  cartilage, dura mater, nerve roots nerve roots
• contractile
• muscle, tendons, bony insertions

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• What is the skin (integument)?
• External covering of the body

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• What does the skin represent?
• The bodys largest organ

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• The skin consist of what two layers?
• Epidermis and dermis

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• List the numerous mechanical forces that can
  adversely affect the skins integrity
• friction or rubbing
• scraping
• compression or pressure
• tearing
• cutting
• Penetrating

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• How are skin wounds classified?
• According to the mechanical force that causes
  them

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• List and define the different types of wound
  classifications

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• a. friction blister
• continuous rubbing over the surface of the skin
  causes a collection of fluid below or within the
  epidermal layer called a blister

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• b. abrasion
• common conditions in which the skin is scraped
  against a rough surface. The epidermis and dermis
  are worn away, exposing numerous blood capillaries

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• c. skin bruise
• when a blow compresses or crushes the skin
  surface and produces bleeding under the skin, the
  condition is defined as a bruise, or contusion

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• d. laceration
• a wound in which the flesh has been irregularly
  torn

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• e. skin avulsion
• skin that is torn by the same mechanism as a
  laceration to the extent that the tissue is
  completely ripped from its source is an avulsion
  injury

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• f. incision
• a wound in which the skin has been sharply cut

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• g. puncture
• penetrations of the skin by a sharp object

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• What are the three types of muscles within the
  body?
• Smooth
• Cardiac
• Striated (skeletal)

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• Which muscle is of major concern in sports
  medicine?
• Striated (skeletal) muscle

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• What are the two categories of acute muscle
  injuries?
• Contusions
• Strains

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• How does one receive a contusion?
• Sudden traumatic blow to the body

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• What is the range of intensity of a contusion?
• Deep to superficial

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• What is typical in cases of severe contusions?
• the athlete reports being struck by a hard blow
• the blow causes pain and a transitory paralysis
  caused by pressure on and shock to the motor and
  sensory nerves
• palpation often reveals a hard area, indurated
  because of internal hemorrhage
• ecchymosis, or tissue discoloration, may take
  place

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• What is a strain?
• A stretch, tear, or rip in the muscle or
  adjacent tissue such as the fascia or muscle
  tendon

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• How are strains most often produced?
• Abnormal muscular contraction

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• What is the cause of abnormal muscular
  contraction?
• It is fault in the reciprocal coordination of
  the agonist and antagonist muscles take place.
  The cause of this fault or uncoordination is a
  mystery. However, possible explanations are that
  it may be related to
• a mineral imbalance caused by profuse sweating
• to fatigue metabolites collected in the muscle
  itself
• to a strength imbalance between agonist and
  antagonist muscles.

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• What is a grade 1 (or 1st degree or 1) strain?
• Slight over-stretching to mild tearing (20) of
  the muscle fibers. It is accompanied by local
  pain, which is increased by tension in the
  muscle, and a minor loss of strength. There is
  mild swelling, ecchymosis, and local tenderness.

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• What is a grade 2 (or 2nd degree or 2) strain?
• Moderate tearing (20 - 70) of the muscle
  fibers. It is similar to a grade 1, but has
  moderate signs and symptoms (moderate loss of
  strength, moderate swelling, ecchymosis, and
  local tenderness).

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• What is a grade 3 (or 3rd degree or 3) strain?
• Has signs and symptoms that are severe (severe
  swelling, ecchymosis, and local tenderness) with
  a loss of muscle function and, commonly, a
  palpable defect in the muscle.

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• What does a tendon attach?
• Muscle to bone

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• Because a tendon is usually double the strength
  of the muscle it serves, where do tears commonly
  occur?
• At the muscle belly, musculotendinous junction,
  or bony attachment

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• What is a cramp?
• A painful involuntary contraction of a skeletal
  muscle or muscle group.

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• Cramps have been attributed to what?
• A lack of water or other electrolytes in
  relation to muscle fatigue.

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• What is a spasm?
• A reflexive reaction caused by trauma of the
  musculoskeletal system

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• List and define the two types of spasms or
  cramps
• clonic alternating involuntary muscular
  contraction and relaxation in quick succession
• tonic rigid muscle contraction that lasts a
  period of time.

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• Muscle cramps or spasms may lead to what?
• Muscle strain

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• What is one constant problem in physical
  conditioning and training?
• Overexertion

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• How is exercise over-dosage reflected?
• Muscle soreness
• Decreased joint flexibility
• General fatigue 24 hours after activity.

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• What are the four specific indicators of
  possible overexertion?
• acute muscle soreness
• delayed muscle soreness
• muscle stiffness
• muscle cramping

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• List and define the two types of muscle
  soreness
• Acute-onset muscle soreness which accompanies
  fatigue. This muscle pain is transient and occurs
  during and immediately after exercise.
• Delayed-onset muscle soreness (DOMS) becomes
  most intense after 24 to 48 hours and then
  gradually subsides so that the muscle becomes
  symptom-free after 3 or 4 days. (This second type
  of pain is described as a syndrome of delayed
  muscle pain leading to increased muscle tension,
  swelling, stiffness, and resistance to stretch).

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• What are the possible causes for delayed-onset
  muscle soreness?
• It may occur from very small tears in the muscle
  tissue, which seems to be more likely with
  eccentric or isometric contractions.
• It may also occur because of disruption of the
  connective tissue that hold muscle tendon fibers
  together.

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

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• What can be done to assist in reducing muscle
  stiffness?
• Light exercise
• Massage
• Passive mobilization

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

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• How do chronic injuries usually progress?
• Slowly, over a long period of time.

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• Often, what leads to a chronic condition?
• Repeated acute injuries

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• How does an acute injury cause a chronic injury?
• If the acute injury is managed improperly or
  that allows an athlete to return to activity
  before healing has completely occurred.

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• What is myositis/fasciitis?
• Inflammation of the muscle tissue

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• What is tendonitis?
• Inflammation of tendon-muscle attachments,
  tendons, or both

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• What is tenosynovitis?
• Inflammation of the synovial sheath surrounding
  a tendon

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• What is atrophy?
• The wasting away of muscle tissue

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• What may cause atrophy?
• Immobilization of a body part
• Inactivity
• Loss of nerve stimulation

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• What is a muscle contracture?
• An abnormal shortening of a muscle tissue in
  which there is a great deal of resistance to
  passive stretch

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• What do joints consists of?
• Cartilage and fibrous connective tissue

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• What is a joint capsule?
• Bones of a diarthrotic (freely movable) joint
  are held together by a cuff of fibrous tissue

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• What are ligaments?
• Sheets or bundles of collagen fibers that form a
  connection between two bones
• Attach bone to bone

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• Ligaments fall into what two categories?
• Intrinsic occurring within the articular
  capsule
• Extrinsic separate from the capsular thickening

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• What is articular cartilage and what does it do?
• Connective tissue that provides firm and
  flexible support

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• What are the major acute injuries that happen to
  synovial joints?
• Sprains
• Subluxations
• Dislocations

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• What is a sprain?
• Stretching or total tearing of the stabilizing
  connective tissues (ligaments)

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• What is a grade 1 (or 1st degree or 1) sprain?
• Slight over-stretching to mild tearing (20) of
  the ligament. It is characterized by some pain,
  minimum loss of function, mild point tenderness,
  little or no swelling, and no abnormal motion
  when tested.

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• What is a grade 2 (or 2nd degree or 2) sprain?
• Moderate tearing (20 - 70) of the ligament.
  There is pain, moderate loss of function,
  swelling, and in some cases slight to moderate
  instability.

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• What is a grade 3 (or 3rd degree or 3) sprain?
• It is extremely painful, with major loss of
  function, severe instability, tenderness, and
  swelling.

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• What is a subluxation?
• Partial dislocations in which an incomplete
  separation between two articulating bones occurs.

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• What is a dislocation (luxation)?
• Total disunion of bone apposition between
  articulating surfaces

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• What are several factors that are important in
  recognizing and evaluating dislocations?
• Loss of limb function
• Deformity
• Swelling
• Point tenderness

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• What are the two major categories of chronic
  joint injuries?
• Osteochondrosis
• Traumatic arthritis

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• What is osteochondrosis?
• Degenerative changes in the ossification centers
  of the epiphysis of bones

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• What is traumatic arthritis?
• With repeated microtrauma to the articular joint
  surfaces, the bone and synovium thicken, and
  pain, muscle spasm, and articular crepitus, or
  grating on movement occur.

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• What is a bursa?
• A fluid-filled sac found at places at which
  friction might occur within body tissues.

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• What is bursitis?
• Inflammation of bursa at sites of bony
  prominences between muscle and tendon.

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• What is capsulitis and synovitis?
• Chronic inflammatory conditions of the joints.

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• What are the five basic functions of bone?
• Body support
• Organ protection
• Movement
• Calcium reservation
• Formation of blood cells

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• What are the three classifications of bone
  trauma?
• Periostitis
• Acute fractures
• Stress fractures

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• What is periostitis?
• Inflammation of the periosteum (bone covering)

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• What is an acute bone fracture?
• A partial or complete interruption in a bones
  continuity

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• What is a stress fracture?
• Rhythmic muscle action performed over a period
  of time at a sub-threshold level causes the
  stress-bearing capacity of a bone to be exceeded

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• What are the typical causes of stress fractures
  in sports?
• Coming back into competition too soon after an
  injury or illness
• Going from one event to another without proper
  training in the second event
• Starting initial training too quickly
• Changing habits or the environment