Sport Injuries

&
Managements
Ahmad Fauzi
Divisi Orthopaedi & Traumatologi
Ilmu Bedah FK UNILA

What is Sports Medicine?

Sports medicine is a branch of medicine that deals with
physical fitness, treatment and prevention of injuries
related to sports and exercise.
Although Most sports teams have employed Team
physicians for many years, it is only since the late 20th
century that Sport and Exercise Medicine has emerged
as a distinct entity in health care
Wikipedia

Sports Medicine

Clinical works

Basic studies

Education

Clinical works in sports medicine

1. Prevention of sports injuries and disorders

(Medical check)
2. Treatment for sports injuries and disorders

Prevention of sports injuries and disorders

 Prevention of sports injuries and disorders

Medical check

Medical check :
Orthopaedics Joints,
Muscles

Medical check
Internal Med. Heart,
Lung

Specific gravity = Weight / Volume

Body fat ratio

Muscle stretch before the sports

Icing or cooling after the sports

Sport Injuries
Young athletes are subject to two basic types of
injuries :
Acute injury as the result of single impact
macrotrauma
Overuse injury due to repetitive microtrauma of
training

Pediat.
Orthopaedics

Internal
Medicine

Joint Surg.

Rehabilitation

Pediat.
Orthopaedics

Internal
Medicine

Sports Medicine

Joint Surg.

Rehabilitation

Important growth-related factors :

Susceptibility of growth cartilage to injury from
repetitive loading
Increased risk for injury associated with the growth
spurt

DiFiori JP. Curr Sports Med Reports. 2010;9:372-378

Acute Injuries
Fractures : epiphyseal plate fractures, stress
fractures
Joint injuries : ligamentous sprains, microtrauma
to articular cartilage
Musculotendinous injuries : avulsion fractures
upon apophysis, muscle strain

Overuse injuries
Divided into :
Stress fractures
Tendinitis and traction apophysitis of tendon
insertions
Bursitis
Joint disorders

Stress Fracture
Failure of cortical bone
subjected to repetitive
loading
Plain films are generally
negative for 6-8 weeks
99mTc bone scans can
detect 3-5 days after onset
of symptoms

Micheli and Klein. Br J Sport Med. 1991;25:6-9

Tendinitis and Bursitis

Tendinitis and bursitis can be found in young
athletes
Traction apophysitis is more characteristic for
this age group overuse syndromes

Joint Disorders
Extremely common and disabling problem in this
age population
Repetitive injury to subchondral bone and
overlying articular cartilage leads to
osteochondritis dissecans
reflects the particular sensitivity of the
pediatric joint surface to shear stress

Common Injuries in Children &

Adolescents
Main acute injuries in youth sports :
Sprains the most common : ankle and
knee
Strains
Fractures
Dislocations often recurrent and lead to
post-traumatic instability
Contusions

Frisch A, et al. Br Med Bull. 2009;92:95-121

Common Injuries in Children &

Adolescents
30 50% are overuse injuries (DiFiori JP, 1999)
Overuse injuries (Armstrong N et al, 2000)

19.5% medial tibial stress syndrome

18% apophyseal injuries
14.8% non-specific knee pain
7.3% lower back pain
Sprains and strains (Armstrong N et al, 2000)
3.4% ankle sprain/strain
2.4% foot sprain/strain

Periostitis/stress fracture (van Mechelen W, 1992)

Different Structures Involved

Knee injuries

(Ganley MD et al, 2001)

Below 10 : metaphyseal fractures, patellar dislocation

11-12 : synovial tears, patellar dislocations, osseous
bruises
13-16 : intra-articular fractures, patellar dislocations,
ligamentous and meniscal lesions

ACL disruptions (Armstrong N et al, 2000)

Under 12: 80% avulsions of tibial spine
12: 90% ACL tears

Specific Sports and Their Injuries

Soccer
Ankle sprains
Bruises
ACL Injuries
Mechanism of injury is plant and twist of knee
Usually non-contact
Knee effusion common

Soccer
ACL Injuries
Diagnosis can be made clinically on examination with
Lachmans test

Anterior Lachman

Pivot Shift Test

Soccer
ACL injuries
Radiography in the ED
AP/Lateral x-rays
Look for tibial plateau
fractures
ACL is soft tissue so may
not have radiologic findings

Football
Head and Neck
Acromioclavicular Sprains
Finger injuries
Jersey finger
Mallet finger

Mechanism of CSpine Injury

C-Spine straight
with axial loading
on top of head

Football
Acromioclavicular Sprains (AC Sprains)
Mechanism is direct hit to top of shoulder
Point tenderness at AC joint
Clavicle
Acromion

Overhead Sports Shoulder Pain

Rotator cuff syndrome is uncommon in young
athlete
Little leaguers shoulder is unique in young
overhead sports athletes (including baseball,
swimming, gymnastics, volleyball, and tennis)
Gradual onset of pain in the proximal humerus during
throwing
Overuse or stress injury of the proximal humeral
physis

Cassas KJ and Cassettari-Wayhs A. Am Fam Physician. 2006;73:1014-1022.

Overhead Sports Shoulder Pain

Little leaguers shoulder :
Radiography: AP in internal and external rotation, lateral Yview or axillary view, comparison views of the uninvolved
side classic findings: widening proximal humeral physis
with or without physeal fragmentation, sclerosis and
demineralization

Cassas and Cassettari-Wayhs.

Am Fam Physician.
2006;73:1014-22.

Overhead Sports Elbow Pain

Little leaguers elbow
Due to throwing significant tension forces
on the medial and compression forces on the
lateral radiocapitellar joint
Examination :
Swelling
Loss of motion
Tenderness along medial aspect of the elbow,
distal arm or proximal forearm

Cassas KJ and Cassettari-Wayhs A. Am Fam Physician. 2006;73:1014-1022.

Baseball/Softball
Osteochondritis Dissecans (OCD)
Dx : initial
radiographs, MRI
for staging, loose
body

Basketball
ACL injuries
Patellar tendonitis (Jumpers knee)
Ankle sprains
very commonly injured joint
Most common is lateral ankle sprains
In child with open physis, if tender over lateral
malleolus, then splint and refer for follow-up

Basketball
Lateral ankle sprains
Mechanism is inversion, plantar flexed

Gymnastics
Back Injuries
Spondylolysis
Spondylolisthesis

Spondylolysis
Mechanical injury to the Pars Interarticularis
Most commonly involves L5

Gymnastics
Spondylolysis

Spondylolisthesis

Gymnastics
Diagnosis
X-rays: AP, Lateral and oblique
If neg., CT, spect scan or MRI

Treatment

Rest, analgesics
Lumbo-sacral stabilization program
Ant-lordotic bracing
Surgical options

Gymnastics
Pearl
Back pain in children less than 18 is always
pathologic until proven otherwise

Knee Anatomy
Femur and Tibia
Articular Cartilage
Meniscus
Ligaments

Meniscal Tear
Mechanism
Young : twisting or pivoting
Older : minor trauma

Signs and Sx
Swelling
Catching
Giving way
Locking

Meniscal Tear

Treatment
Acute : Rest, Ice, Activity Modification, Surgery
Meniscal tears will not normally heal without help
unless very young

Chronic : Surgical excision

Articular Cartilage Tear

Mechanism
Acute trauma
Wear and tear

Signs and Sx
Pain
Swelling

Treatment
Non Surgical :
Activity Modification, Pain Medications, Injections
Surgical :
Arthroscopic debridement and removal of lose fragments
Procedures to restore weight bearing surface
Resurfacing, Cartilage Transplant, Joint Replacement

ACL Tear
Mechanism
Twisting
Pivoting
Sudden stop

Signs and Sx
Acute : swelling, pain, instability
Chronic : frequent giving way, pain

ACL Tear

Treatment
Non Surgical :
Activity Modification, Rehabilitation, Bracing

Surgical : Reconstruction of Ligament

Goals of Surgery :
Restore normal knee stability and function
Delay onset of degenerative arthritis

Shoulder Anatomy
Humerus and Scapula
Labrum
Biceps Tendon
Rotator Cuff

Shoulder Dislocation

Treatment
Non Surgical :
Acute : Immobilization, Rest, Ice, Rehab
Chronic : Rehab, Meds

Surgical :
Arthroscopic stabilization as effective as open
procedures
Repair bankart lesion, tighten capsule

Rotator Cuff Tear

Continuum from Impingement to Complete Tear
Mechanism :
Acute
Chronic

: trauma
: degeneration with age due to poor blood
supply to tendon

Signs and Sx
Pain reaching overhead
Pain sleeping
Weakness and dysfunction

Rotator Cuff Tear

Treatment
Non Surgical :
Activity modification
Physical Therapy
Injections
Surgical :
Arthroscopic or Open repair of tendon and
removal of bone spurs
Shoulder replacement