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Sports Injuries An Overview

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  • 1. SPORTS INJURIES AN OVERVIEW DR. JAYANT SHARMA M.S.,D.N.B., M.N.A.M.S. CONSULTANT ORTHOPAEDICS AND SPORTS MECINE.
  • 2.
    • The aim of Sports Medicine is to prepare and educate an athelete to achieve the optimum physical efficiency and safety.
    • Increase in the speed and competitiveness has resulted in an increase in the incidence of sports injuries.
    • Williams had reported way back in1979 the incidence of injuries to 5-10% in the population attending the O.P.D.
  • 3. CLASSIFICATION
    • 1. TRAUMATIC, EXTENAL/ EXTRINSIC INJURIES– COMMON IN CONTACT SPORTS.
    • 2.NON TRAUMATIC, INTRINSIC OR INTERNAL INJURIES.– INDIRECT TRAUMA, DUE TO OVERUSE OF A PARTICULAR ORGAN DUE TO REPETITIVE MOVEMENTS.THESE ARE RESULT OF INDIRECT MICROTRAUMA SUM UP TO RESULT IN INTERNAL TISSUE INJURY.
  • 4. CAUSES OF SPORTS INJURIES PREDISPOSING FACTORS
    • BOUNDARY CONDITIONS
    • EXTERNAL – LIKE GROUND, SHOES, SURFACES, EQUIPMENTS.
    • INTERNAL – DEFECTS IN SPORTSMAN.RELATED TO ANTHROPOMETRY AND FITNESS
  • 5. INTERNAL FACTORS
    • OVERWEIGHT
    • AGE
    • JOINT INSTABILITY
    • FEMALE GENDER
    • PREDISPOSING DISEASES
    • PES CAVUS/PLANUS
    • FOREFOOT- VALGUS/VARUS
    • TIBIA VARA/VALGA
    • PATELLA ALTA/ BAJA
    • HIP ANTE/RETROVERSION
    • LIMB LENGTH DISCREPANCY
  • 6. INTERNAL FACTORS
    • LIGAMENTOUS LAXITY
    • SOFT TISSUE TIGHTNESS
    • SOFT TISSUE CONTRACTURES
    • INSTABILITY OF JOINTS
    • MALALIGNMENT OF JOINT
    • LACK OF RANGE OF MOTION
    • LACK OF COORDINATION
    • DEFICIENT BALANCE / EQUILLIBRIUM
  • 7. MOVEMENTS FACTORS
    • EXTERNAL FACTORS
    • TYPE OF MOVEMENTS
    • VELOCITY OF MOVEMENTS
  • 8. EXTERNAL FACTORS
    • TYPES OF MOVEMENT-
    • AFFECT OF LOAD ON BODY AT VARIOUS MOVEMENTS.
    • IF THE LOAD IS SHIFTED THE EFFECT IS ALSO SHIFTED.
    • AN ANTERIOR SHIFT IS SEEN ON LANDING ON TOES
    • A POSTERIOR SHIFT IS SEEN ON LANDING ON HEEL.
  • 9. EXTERNAL FACTORS
    • VELOCITY OF MOVEMENT
    • WITH INCREASE IN THE VELOCITY THE FORCE IMPACT AND ACTIVE ALSO INCREASE.
    • VELOCITY OF LIMB AND SUDDEN DECELLERATION
    • NUMBER OF REPETITIONS
    • FOR TRAINING 10 MINS OF ACTIVITY AT 220-- HEART RATE, OR 20 MINS EVERY SECOND DAY.IS TAKEN UP WELL BY CVS.
  • 10. EXTERNAL RESPONSE
    • FATIGUE RESPONSE
    • BONES AND MUSCLES SHOW HIGHER EFFECT OF REPETITIONS THAN CARTILAGE AND TENDON AND LEAD TO REPETITIVE FATIGUE EXERCISES.
  • 11. WHAT IS AN IDEAL SHOE?
    • IT SHOULD ABSORB OR REDUCE IMPACT FORCES
    • PROVIDE MEDIOLATERAL STABILITY TO ANKLE.
    • AVOID HYPERPRONATION ON LANDING.
    • PROVIDE GUIDANCE TO TAKE OFF AND AVOID OVERPRONATION ON TAKE OFF.
    • SHOULD BE CUSHIONED TO REDUCE LOAD ON THE BODY.
    • FRICTION IS A CONTROVERSIAL ASPECT, LOW FRICTION SHOES ARE A CAUSE OF INJURY.GOOD FRICTION IS USED FOR BETTER GRIP DURING STANCE AND TAKE OFF.
  • 12. TYPES OF SHOES
    • Slip-lasted shoe is made by sewing together the upper like a moccasin and then gluing it to the sole. This lasting method makes for a lightweight and flexible shoe with no torsional rigidity.
    • A board-lasted shoe has the "upper" leather or canvas sewn to a cardboard-like material. A person with flat feet (pes planus) feels more support and finds improved control in this type of shoe.
    • A combination-lasted shoe combines advantages of both other shoes. It is slip-lasted in the front, and board-lasted in the back. These shoes give good heel control but remain flexible in the front under the ball of the foot. They are good for a wide variety of foot types.
  • 13. PLANNING A SHOE
    • Don't go just by size. Have your feet measured
    • Visit the shoe store at the end of a workout when your feet are largest
    • Wear the sock you normally wear when working out
    • Fit the shoe to the largest foot
    • Make sure the shoe provides at least one thumb's breadth of space from the longest toe to the end of the toe box.
    • If you have bunions or hammertoes, find a shoe with a wide toe box. You should be able to fully extend your toes when you're standing and shoes should be comfortable from the moment you put them on. They will not stretch out. Women who have big or wide feet should consider buying men's or boys' shoes which are cut wider for the same length.
  • 14. When Foot Problems Develop?
    • If you begin to develop foot or ankle problems, simple adjustments in the shoes sometimes can relieve the symptoms. A heel cup provides an effective way to alleviate pain beneath the heel (plantar fasciitis). Made of plastic or rubber, the heel cup is designed to give support around the heel while providing relief of pressure beneath the tender spot.
  • 15.
    • An arch support (orthosis) can help treat pain in the arch of the foot. Made of many types of materials, arch supports can be placed in a shoe after removing the insole that comes with the shoe.
  • 16.
    • A metatarsal pad can help relieve pain beneath the ball of the great toe (sesamoiditis) or beneath the ball of the other toes (metatarsalgia). Made of a felt material or firm rubber, the pad has adhesive on its flat side. Fixed to the insure behind the tender area, the pad shares pressure normally placed on the ball of the foot. This relieves pressure beneath the tender spot.
  • 17. WEATHER PROBLEMS
    • AN IDEAL CLIMATE FOR GOOD EVENT IS 28 DEGREE TO 30 DEGREES.
    • TIME 9.00– 4.00 P.M
    • 500ML. OF FLUID 15 MINS BEFORE THE EVENT, WITH 2.5 GMS OF GLUCOSE/ 100ML OF WATER.
    • MOST INJURIES OCCUR IN NIGHT, LESS LIGHT, COLD CLIMATE, HUMIDITY.
    • -----------------------------------------------------
    AMERICAN COLLEGE OF SPORTS MEDICINE
  • 18. SPORTS SURFACES
    • SURFACE PROVIDES GROUND REACTION IN OPPOSITE DIRECTION
    • IMPACT FORCES ARE HIGHER ON RUNNING ON ASPHALT THAN GRASS.
  • 19. PAIN AND INJURY IN ORDER OF APPEARANCE ON VARIOUS SURFACES SAND—5% SYNTHETIC SAND—8% SYNTHETIC SURFACE—15% ASPHALT—18% CARPET—18% GRASS—20%
  • 20. Common Extrinsic factors of Injury
    • Equipment - improper grip size of tennis racquet, worn out running shoes
    • Playing surface - playing soccer on hard surfaces, uneven treadmill
    • Improper technique - improper golf grip or swing
    • Poor conditioning - doing activity when out of shape
    • Lack of warm-up - not stretching or preparing for activity
    • Increased frequency or duration - not building up slowly
    • Flexibility - too stiff to do activity correctly
    • Stress - being tired or stressed can cause number 3 or 7
  • 21. SOFT TISSUE INJURIES
    • MUSCULAR
    • TENDON
    • LIGAMENTOUS
    • BURSAL
    • SYNOVIAL
  • 22. BONY INJURIES
    • FRACTURES
    • SUBLUXATIONS
    • DISLOCATIONS
  • 23. Skin Injury Classifications
    • Skin (Integument)
      • Epidermis
        • Outer sheath
        • Three layers
      • Dermis-Connective Tissues
  • 24. Skin Injury Classifications
    • Mechanical Forces
      • Friction or Rubbing
      • Scraping
      • Compression
      • Tearing
      • Cutting
      • Penetrating
    • Wound Classifications
      • Blister
      • Contusion
      • Laceration
      • Avulsion
      • Incision
      • Puncture
  • 25. Skin Trauma
    • Blister
    • Contusion
  • 26. Skin Trauma
    • Laceration
      • May require sutures
      • Wound ends must be approximated for proper healing
    • Avulsion
      • Segment of tissue torn away
  • 27. MUSCULAR INJURIES
    • INADEQUATE MUSCLE LENGTH
    • INADEQUATE STRENGTH
    • INADEQUATE SKILLS
    • MUSCLE FATIGUE
    • TWO JOINT MUSCLES
    • MORE WITH ECCENTRIC LOADING
  • 28. TYPES
    • CONTUSION
    • PARTIAL RUPTURE
    • COMPLETE RUPTURE
  • 29.  
  • 30. CONTUSION
    • LACERATION OF MUSCLE
    • SEEN AROUND ELBOW, HIP, KNEE
    • HAEMATOMA BETWEEN MUSCLE FIBRES
    • SEEN DURING REPETITIVE LOAD EVEN AFTER FATIGUE
    • SIGNS AND SYMPTOMS OF ACUTE INFLAMMATION ARE PRESENT.
    • TREATMENT—REDUCE HAEMATOMA AND SCARRING.
  • 31. TREATMENT
    • FIRST 24 HOURS– R.I.C.E., MEGAPULSE ULTRASOUND
    • BEYOND 24 HOURS– USE ULTRASOUND AND TENS FO DECREASING HAEMATOMA AND SCARRING, PASSIVE ROM FOR JOINT AND ISOMETRICS STARTED AS SOON AS PAIN SUBSIDES.
    • BEYOND 72 HOURS– RESISTED EXERCISE WITH 10-12 REPETITIONS
  • 32. PARTIAL TEAR
    • ALSO CALLED MUSCLE STRAIN
    • ONLY FEW FIBRES TEAR
    • DUE TO INADEQUATE CONTRACTION OF MUSCLES
    • COMMON INJURY IN SPORTS
    • USUALLY AT MUSCULOTENDINOUS JUNCTION
    • HEALS BY SCARRING IF LEFT AS SUCH
    • REQUIRES ADEQUATE MOBILIZATION TO KEEP TISSUE SUPPLE.
  • 33. COMPLETE TEAR
    • LIKE PARTIAL TEAR ONLY BUT THE BLOW IS VERY SEVERE.
    • ASSOCIATED WITH AVULSION OF TENDINOUS INSERTION.
    • THERE IS A GAP IN THE CONTINUITY OF THE MUSCLE
    • RESTRICTED JOINT MOVEMENT
    • LOSS OF ACTIVE MOVEMENT
    • SWELLING IS HUGE
  • 34. TRETAMENT
    • SURGICAL REPAIR IS MUST AND REQUIRES IMMOBILIZATION FOR 8-10 WEEKS
    • ALLOW ISOMETRIS AND ISOTONIC EXERCISES IN PLASTER
    • STRETCHING IS DELAYED FOR 4-8 WEEKS
    • PASSIVE STRETCHING IS PROGRESSED CAREFULLY
    • ULTRASOUND ON REMOVAL OF PLASTER, MAY BE USED.
  • 35.  
  • 36. LIGAMENT INJURY
    • LIGAMENT HAVE COLLAGEN FIBRES (>150NM)TIGHTLY PACKED TOGETHER WITH SMALL AMOUNT OF ELASTIC FIBRES AND PROTEOGLYCANS.
    • THEY HAVE A SPECIAL FEATURE CALLED “CRIMP” A PLANAR WAVE PATTERN FOUND EXTENDING IN PHASE ACROSS THE WIDTH OF LIGAMENT THEY HELP TO ATTENUATE MUSCLE LOADING FORCES
  • 37.  
  • 38.
    • LIGAMENTS HAVE NO NERVE SUPPLY BUT DUE TO SAME NERVE SUPPLY AS JOINT AND MUSCLE GROUPS THEY CAUSE MUSCLE TONE TO INCREASE.
    • IT TAKES LONG TIME TO HEAL AS HAS POOR BLOOD SUPPLY.
    • HEALS BY FIBROSIS IF NOT PROTECTED AFTER INJURY
  • 39.  
  • 40. DEGREE OF TEAR
    • 1 PART OF LINEAR CURVE- 1DEGREE
    • II PART OF LINEAR CURVE-II DEGREE
    • LAST PART– COMPLETE TEAR
  • 41. 1 AND II DEGREE STRAIN
    • FIRST 24 HOURS
    • II DAY
    • BEYOND 72 HOURS
    • RICE
    • ISOMETRICS NOIce ONLY I.C.E.
    • GRADUAL USE OF JOINT
    • WEIGHT BEARING AFTER PAIN RELIEF.
  • 42. III DEGREE STRAIN
    • INITIAL TREATMENT AS I AND II DEGREE
    • WEIGHT BEARING DEFFERED TILL 3 WEEK OF POP REMOVAL
    • PROGRESSIVE WEIGHT BEARING
    • FRICTION MASSAGE
    • PASSIVE ROM
    • ACTIVE RESISTED EXERCISES
  • 43. TENDON INJURY
    • THE ROPE LIKE STRUCTURES ATTACH MUSCLE TO THE BONE.
    • COMPLEX COMPOUND OF COLLAGEN TYPE 1, GLYCOSAMINOGLYCAN AND WATER
    • CROSS LINKING OF COLLAGEN MOLECULE CONTIBUTE TO TENSILE STRENGTH AND PREVENT ENZYMATIC MECHANICAL AND CHEMICAL BREAKDOWN.
    • TENDON ARRANGE IN FIBRILLAR PATTERN ON LOAD.
  • 44.  
  • 45. MECHANICAL BEHAVIOUR
    • TENDON IS ELASTIC AT LOW LOADS
    • REMOVAL OF LOADS ALLOW IMMEDIATE RECOVERY OF TENDON TO UNDEFORMED STATE.
    • FURTHER APPLICATION OF FORCE BEYOND THE REGION RESULTS IN DEFORMATION OF TENDON
  • 46.  
  • 47. Cause of Tendon Injury
    • COLLAPSE OF COHESION BETWEEN FIBRILLAR COMPONENTS
    • REDUCED TENSILE STRENGTH DUE TO RAPID UNLOADING– SHEARING WITHIN TENDON.
  • 48. TENDINITIS
    • EXTRINSIC
    • FORCES FROM OUTSIDE THE TENDON
    • EITHER BY SHOE , SPLINT OR SKATES.
    • EXAMPLES- LARGE ACROMION– SHOULDER IMPINGEMENT, EXTENSOR TENOSYNOVITIS OF ANKLE DUE TO SHOE.
    • INTRINSIC
    • OVERUSE INJURIES
    • USUALLY CHRONIC
    • RESULT OF FATIGUE FAILURE
    • SUDDEN LOADING OR UNLOADING LEADS TO INJURIES
    • ECCENTRIC LOADING
    • IMPROPER AND SIMULTANEOUS APPLICATION OF FORCE AND MAXIMUM ELONGATION LEADS TO TEAR
  • 49.
    • EXTRINSIC TENDINITIS
    • IMPINGEMENT SYNDROME
    • CARPAL TUNNEL SYNDROME
    • EXTENSOR TENOSYNOVITIS
    • I.T.B. FRICTION SYNDROME
    • De’QUERVIAN’S DISEASE
    • GREATER TROCHANTRIC BURSITIS
    • POSTERIOR TIBIAL TENOSYNOVITIS
    • FACTORS
    • LARGE ACROMION
    • TIGHT RETINACULUM
    • TIGHT RETINACULUM
    • PRONATED FOOT
    • EXTENSOR RETINACULUM
    • GREATER TROCHANTER
    • FLEXOR RETINACULUM TIGHTNESS.
  • 50. Myositis Ossificans
    • Occurs secondary to trauma
    • Hematoma  ossification
    • Involves fascial covering of muscle
  • 51. OVERUSE INJURIES
    • ROTATOR CUFF TENDINITIS
    • GOLFER’S ELBOW
    • GROIN PULL
    • TENNIS ELBOW
    • JUMPER’S KNEE
    • ABDUCTOR TENDINITIS
    • POPLITEAL TENDINITIS
    • ACHILLIS TENDINITIS
    • HAMSTRING’S PULL
    • INSTABILITY
    • GRIP
    • OVERSTRETCHED MUSCLES
    • OVERUSE WRIST EXTENSORS
    • OVERUSE PATELLAR TEND.
    • OVERUSE OF ABDUCTORS
    • OVERUSE
    • REPEATED LOADING
    • OVERSTRETCH
  • 52. CLASSIFICATION OF TENDINITIS
    • TENOSYNOVITIS, TENOVAGINITIS
    • (PARATENON INFLM.)
    • TENDINITIS– ACUTE-- <2WEEKS
    • SUBACUTE>2,<6 WEEKS
    • CHRONIC>/= 6WEEKS
    • TENDINOSIS-DEGENERATION
    • INTERSTITIAL
    • PARTIAL
    • ACUTE RUPTURE
  • 53. UNABLE TO PARTICIPATE DAILY ACTIVITY 6 UNABLE TO PARTICIPATE IMMEDIATE 5 SEVERE SIGNIFICANTLY LASTS4-6HRS 4 AFFECTED ON ACTIVITY LAST 1-2 HRS 3 MODERATE NO EFFECT ON EXERT 2 NO EFFECT NONE 1 MILD PERFORMANCE PAIN LEVEL DEGREE
  • 54. >20 DAYS 5-12 DAYS 0-6 DAYS TIME IN DAYS OPTIMIZE HEALING PREVENT MUSCLE ATROPHY AVOID NEW DISRUPTION AIM -- STRESS MODALITY INTRODUCED RICE ANTIINFLAMMATORY TREATMENT REMODELLING STAGE PROLIFERATIVE STAGE INFLAMMATORY STAGE
  • 55. BURSITIS
    • BURSAE ARE LOOSE FLUID FILLED CAVITIES HELP IN JOINT MOVEMENT BY ALLOWING GLIDING.SEEN WHERE BONE IS EXPOSED DIRECTLY UNDER THE SKIN.
  • 56. BURSITIS
    • CAUSES—
    • DIRECT TRAUMA-- HAEMOBURSAE
    • FRICTION BURSITIS
    • CHEMICAL BURSITIS– FROM DEGENERATING TENDONS
    • INFECTION
  • 57. MODALITIES OF TREATMENT
    • ULTRASOUND– PULSED/CONTINUOUS
    • LASER
    • ELECTRIC STIMULATION
    • CORTICOSTEROIDS
    • SURGERY
  • 58. Nervous Tissue
    • Neuron/Nerve = basic unit
      • Cell Body
      • Axon
      • Dendrites
    • Link between CNS and periphery
      • Afferent (dermatomes)
      • Efferent (myotomes)
  • 59. NERVE INJURIES
    • NERVE ENTRAPMENT SYNDROMES
    • OVERUSE
    • SOFT TISSUE SWELLING
    • MALFORMED BONES
    • TRAUMA
    • COMMONEST– CARPAL TUNNEL, TARSAL TUNNEL,EXTENSOR TEUNNEL(POSTERIOR INTERROSEOUS NERVE IN TENNIS PLAYERS) GROIN– ILIOINGUINAL NERVE IN SOCCER PLAYERS.
  • 60.
    • NEUROMA
    • MORTON’S NEUROMA IN TOE IN RUNNER.
    • PAIN RELEIVED ON REMOVING SHOES.
    • NEURITIS
    • MECHANICAL STRETCHING , FRICTION, COMPRESSION- SEEN IN THROWING GAMES, IN ULNAR NERVE
    • TREATMENT-R.I.C.E., ANTIINFLAMMATORY, ORTHOTICS,RELEASING SURGERY.
  • 61. Dislocations
    • Partial (subluxation) or complete disruption of articulation
    • Obvious deformity present
    • Potential injury to other structures exists
    • Need to check pulse and sensation distally; immobilize; then refer for further treatment
  • 62. Bones
    • Dense Connective Tissue
    • Functions
      • Body Support
      • Organ Protection
      • Movement
      • Calcium Reservoir
      • Formation of blood cells
    • Types
      • Flat
      • Irregular
      • Short
      • Long
  • 63. Bony Injuries
    • Fractures—Terms
      • Open vs. Closed
      • Displaced vs. Non-Displaced
  • 64. Fracture Types
    • Avulsion
    • Blowout
    • Comminuted
    • Contrecoup
    • Depressed
    • Greenstick
    • Impacted
    • Longitudinal
    • Oblique