Musculoskeletal Injuries in Sports


The authors would like to acknowledge the contributions of previous edition authors W. Michael Walsh, MD; Ronnie D. Hald, PT, ATC; Laura E. Peter, MD; and Morris B. Mellion, MD .

General Classification of Musculoskeletal Sports Injuries

Musculoskeletal sports injuries can be classified as traumatic or overuse injuries.

Traumatic Injuries

  • Description: Result from specific episode(s) of trauma, whether recent (acute) or in the more distant past (subacute or chronic)


  • Description: Traumatic injury to a bone most commonly results in a fracture , although rarely, another injury such as subperiosteal hematoma can occur.

Descriptive terms:

    • Closed fracture is a fracture that does not produce an open wound in the skin.

    • Open fracture is when an open wound in the skin communicates with the fracture site.

    • Descriptive terms for direction of fracture line:

      • Fracture at right angles to the long axis of a bone is called transverse.

      • Fracture line at other angles to the long axis of a bone is called oblique.

      • Bone twisted apart creates spiral configuration of fracture.

    • Comminuted fracture is when a bone is broken into three or more pieces.

    • Avulsion fracture is a “pull-off” fracture; a piece of bone is pulled off by the ligament or by tendon attachment.

    • Greenstick fracture is an incomplete fracture in children: one side of a bone is broken, whereas the other side appears bent.

    • Torus fracture is localized buckling in the cortex of the bone, common in children.

    • Epiphyseal fracture is a fracture that involves the growth center at the end of a long bone in children.


  • Description: Traumatic injury to a joint and supporting structures (capsule or ligaments) often results in an instability episode referred to as dislocation or subluxation. Rarely, other results such as joint contusion or hemarthrosis occur from a direct blow.

  • Classification:

    • Dislocation is a complete displacement of joint surfaces so that they no longer make normal contact at all; important to distinguish first-time or recurrent dislocation

    • Subluxation is a partial displacement of joint surfaces, usually transient in nature; important to distinguish first-time or recurrent subluxation

    • Dislocation or subluxation implies damage to ligaments or other supporting structures of a joint; important to ascertain injury to those tissues; discussed in the following section


  • Description: Traumatic injury to a ligament is referred to as sprain ( Fig. 42.1 )

    Figure 42.1, Grading of ligament sprains.


    • First-degree sprain: Tear of only a few ligament fibers; mild swelling, pain, disability; no instability of joint created

    • Second-degree sprain: Tear of a moderate number of ligament fibers, but ligament function is still intact; however, ligaments may be somewhat stretched. Moderate amount of swelling, pain, disability; slight to no instability of joint.

    • Third-degree sprain: Complete rupture of a ligament; severe swelling and disability; definite joint instability; instability may be classified as:

      • 1+ joint surfaces normally stabilized by ligament(s) displaced 3–5 mm from their normal position

      • 2+ joint surfaces separated by 6–10 mm

      • 3+ joint surfaces separated by >10 mm

Muscle–Tendon Unit


  • Description: Traumatic injury to muscle or tendon caused by indirect force (i.e., contraction of muscle itself) is referred to as a strain

  • Classification:

    • First-degree strain: Tear of only a few muscle or tendon fibers; mild swelling, pain, disability; can also be characterized by patient’s ability to produce strong, but painful, muscle contraction

    • Second-degree strain: Disruption of moderate number of muscle or tendon fibers, but muscle–tendon unit still intact; moderate amount of pain, swelling, disability; characterized by patient’s weak and painful attempts at muscle contraction

    • Third-degree strain: Complete rupture of muscle–tendon unit; may be at origin, muscular portion, musculotendinous junction, within tendon itself, or at tendon insertion; characterized by extremely weak attempts at muscle contraction

Deep Muscle Contusion

  • Description: Traumatic injury to muscle caused by direct force may produce deep muscle contusion; typically affects quadriceps or brachialis muscles involved in contact or collision sports; may lead to myositis ossificans and therefore permanent loss of function

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