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SPORTS RELATED INJURIES Harem P.

Deiparine Objectives Common injuries or region Diagnostic evaluations Ancillary methods Treatment Definition Sports injuries are injuries that occur in athletic activities. They are often due to overuse or acute trauma of a part of the body when participating in a certain activity. example: Stress fracture AFFECTIONS OF THE NECK Neck is very mobile Cervical Burners Cervical plexus - C4 to T1 Most common in football, Wrestling, UFC, Diagnostic evaluation Tenderness in neck, upper extremity. Sensory motor from roots. Pain radiating down the digits. Treatment Protecting the neck with a soft collar is the first step This is worn until xrays are taken to rule out fracture, dislocation, or other more serious neck injury Rest and gentle neck and shoulder range of motion Therapy (biofeedback, electrical nerve stimulation, and manual therapy) Range of motion and strengthening exercises AFFECTIONS OF THE SHOULDER Rupture of the Supraspinatus Tendon Is a common and important cause of shoulder disability Rupture occurs near its insertion Often associated with anterior shoulder dislocation

Shoulder Dislocation Most common dislocation of human Shoulder is unstable due to glenoid fossa which is shallow, flat articulate surface making it unstable. It affects part of brachial plexus, musculocutaneous nerve Numbness is felt Loss of normal roundess of shoulder causing it to appear flat- SULCUS SIGN XRAY AP and Lateral view

Etiology Tear or relaxation of the capsular ligaments Avulsion of the glenoid labrum from the anterior rim of the glenoid cavity Dislocation due to labrum & ligaments torn Treatment The recurrence is less if the shoulder was immobilized x 3 weeks post reduction Abduction and external rotation subluxation or dislocation Acromioclavicular Dislocation Fall on the lateral aspect of shoulder Continued upward displacement and instability of the lateral end of the clavicle may impair the function of the shoulder Grade 1 -- low; strain or microtear Grade 2 high Grade 3 severe; disruption of coraco-clavicular ligament & ligament connects acromion & clavicle

Rotator cuff tears SITS muscles


Treatment Conservative (grade I and II) Surgical reconstruction (grade III) Excision AFFECTIONS OF THE ARM Biceps Brachii Muscle Rupture The long heads may rupture at or near its origin from glenoid tubercle Muscle belly or on its insertion Ordinarily as result of sudden indirect violence Action: supination and flexion Sharp pain noted at the moment of rupture with an audible snap Sharply convex bulge near the middle of the arm (most characteristic feature) Popeyes sign doesnt occupy 2/3 of the arm AFFECTIONS OF THE ELBOW Joints: humeroulnar joint, proximal radioulnar joint type of joint: Hinge joint

Clinical

picture Sharp pain in the shoulder area Weakness in shoulder abduction Positive drop arm test

**Drop arm test Weak abduction Cant lift arm above head Cant maintain arm in abduction Most sensitive test Imaging MRI Abrupt disconnection of tendon

Tennis

Elbow "Lateral epicondylitis" Usually related to overuse of the elbow and hand Lateral epicondyle is affected Most common involved muscle: extensor carpi radialis brevis Common in activity that involves repeated forced grasping and pronation-supination Forceful supination and extension Micro tear in the elbow A partial tear of the extensortendons near its origin Tear is usually preceded with degenerative changes of the tendon.

Forearm pronation and supination strengthening Resisted elbow flexion and extension

AFFECTIONS OF THE HAND Function: grasping, pointing, Rupture of the Ulnar Collateral Ligament of the 1st MTP Joint "Gamekeepers thumb" ulnar collateral lig. - essential to strong pinch between thumb and index finger Ulnar collateral ligament injuries of the thumb Most commonly injured "Skier's thumb" Causes: forceful abduction of the thumb blow or fall on the extended thumb repeated abduction stress Clinical Presentation: Local swelling, tenderness on base of thumb and in between index finger Weakness of thumb-index pinch Slight thickening and tenderness over MTP joint Treatment Incomplete acute tears- immobilization x 6 weeks Acute complete - surgical repair de Quervains Tenosynovitis Commonly involves the abductor pollicis longus and extensor pollicis brevis

Clinical picture Gradual onset of increasing discomfort after continued overuse of the hand and wrist Common in 4th decade of life Pain start at the lateral aspect of the elbow and radiates to the forearm - persistent and annoying

Passive motion - intact Tenderness on active elbow extension, forearm supination and wrist extension Treatment Temporary immobilization of the elbow with a sling, adhesive dressing or plaster cast Heat application Persistent; surgical - released of tendon origin from the lateral epicondyle Excision of degenerated tendon fibers and granulation tissue Local injection of procaine and steroids Cortisone injection to the elbow Medial Epicondylitis Area of pain on medial epicondylitis Pain at the medial epicondyle is aggravated by resisted wrist flexion and pronation Treatment Non-steroidal anti-inflammatory drugs Heat or ice A counter-force brace or "elbow strap" to reduce strain at the elbow epicondyle, to limit pain provocation and to protect against further damage Medial Epicondylitis (Golfer's Elbow) Rehabilitation Exercises Wrist active range of motion: flexion and extension Wrist stretch Forearm pronation and supination Wrist flexion Wrist extension Grip strengthening

Read: Compartments of extensors Involved: Inflammed tendon sheath (covering) Thenar snuffbox

Trigger Finger Localized stenosis of the flexor tendon sheath located usually at the A1 pulley Nodule thickening of the tendon Partial obstruction of the movement of flexion or of extension Stenosis of canal Partial obstruction of gliding structure due to narrowing of canal

Treatment Splinting Hydrocortisone injection Surgical released - release of A1 pulley