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Injections in the Athlete

General Principles Knowledge of anatomy is essential in administering injections safely and effectively. Use of local anesthetic injections in athletes may reduce the number of games missed because of injury but carries a theoretical risk of worsening the injury. Corticosteroid injections are widely used in the treatment of athletic injuries because of their potent anti-inflammatory properties, but these are not without undesirable side effects. Corticosteroid injections…

Taping and Bracing

Acknowledgment The author would like to acknowledge Thomas A. Frette, MD, for his contribution to the previous edition. General Principles Taping and bracing are used as adjuncts to sports protective equipment, treatment, and rehabilitation of an injury. Should not take the place of appropriate diagnostic, treatment, and rehabilitation of an injury Role in prevention, treatment, rehabilitation, and return-to-play decisions Functions of Taping and Bracing Prevention: Aid…

Foot Problems

General Principles Overview: Injuries and disorders of the foot can impose considerable dysfunction in an athlete. Although most foot problems will improve with appropriate care, a clear understanding of normal anatomy and physical examination findings is vital to recognize injuries and abnormal processes to prevent worsening and long-term damage. Anatomy and Physiology of the Foot Bones: Normal bony architecture includes 28 bones (7 tarsals, 5 metatarsals,…

Stress Fractures

General Principles Definition Stress fractures are fatigue-failure injuries of the bone affecting physically active people, including military recruits, track and field athletes, and ballet dancers. With the increased role of exercise for elderly people and patients with chronic disease, stress fractures should not be overlooked in nontraditional populations. Etiology Stress fractures are overuse injuries that present over a continuum of fatigue failure of the bone, from…

Acute Fractures and Dislocations In Athletes

Transportation of an Athlete with a Fracture or Dislocation The need for and mode of transporting an injured athlete is determined after primary and secondary evaluations by the first responder. It must always be executed so that further injury is prevented. Planning the mode of transport and necessary equipment can help ensure that an appropriate technique is used (see Chapter 4 : “Sideline Preparedness and Emergencies”).…

Cartilage Problems in Sports

Types of Cartilage Hyaline Cartilage Functions to decrease joint friction and distribute load across the joint; also referred to as articular cartilage Composition: Water (65%–80%), collagen (10%–20%, predominantly type II), proteoglycans (10%–15%, aggrecan is most responsible for the hydrophilic property), and chondrocytes (5%) ( Fig. 57.1 ) Viability: Articular cartilage is avascular, and chondrocytes are nourished via diffusion from synovial fluid Structure: Organized into three primary…

Ankle And Leg Injuries

General Principles Leg and ankle injuries often occur concomitantly. Evaluation of one must include the other ( Fig. 56.1 ). A neurovascular examination is essential in addition to making note of the amount of swelling. Injuries that require immediate treatment include open fractures, dislocations, neurovascularly compromised extremities, and acute compartment syndrome. Ankle sprains are the most common injury of the ankle. Chronic pain and disability may…

Knee Injuries

Acknowledgment The authors would like to acknowledge the contributions of W. Michael Walsh, MD, in the previous edition. PHYSICAL Examination Anatomy of the Knee See Fig. 55.1 . Observation and Measurement Standing Alignment of lower extremities: View the patient from the front, side, and back. Angular and rotational deformities: Excessive valgus, varus, recurvatum, flexion contracture, and femoral or tibial torsion Foot alignment and mechanics: Excessive cavus…

Pelvis, Hip, and Thigh Injuries

General Principles Overview The understanding of hip pathology has substantially improved recently because of more specific clinical tests, better imaging diagnosis, and discovery of new entities. Hip pathologies include femoroacetabular impingement (FAI), borderline dysplasia, femoral anteversion, hip instability, and femoral head deformities such as slipped capital femoral epiphysis (SCFE) and Perthes disease. Understanding of the hip anatomy, physiology, biomechanics, different pathologies, and treatment options is key…

Thoracic and Lumbosacral Spine Injuries

General Principles With an increased number of adults and adolescents participating in fitness programs and competitive sports, there has been an increase in thoracic and lumbar spinal problems. Most injuries are soft tissue injuries, and appropriate training and avoidance of aggravating activities may allow participation while the pain resolves. Treatment of an athlete can be complicated by his or her competitiveness and the fact that the…

Thorax and Abdominal Injuries

General Principles Overview Injuries to the thorax and abdomen are more often seen in sports involving sudden deceleration and impact (e.g., football, ice hockey, skiing, and snowboarding). Early recognition and management of these potentially life-threatening injuries are imperative. Serial assessments and a high index of suspicion are essential for accurate evaluation. Once severe injury is recognized, emergency medicine fundamentals and stabilization should be initiated until transfer…

Hand and Wrist Injuries

General Principles Overview Fortunately, most sports-related hand and wrist injuries, when addressed in a timely manner, do not represent a significant threat to limb viability, long-term function, or eventual return to sports. Perhaps the greatest morbidity from these injuries results from delayed presentations or missed injuries, a common feature in athletes motivated to compete. Hand function is closely linked to full flexion of the ulnar three…

Elbow Injuries

General Principles History and Physical Examination History Hand dominance Location: medial, lateral, anterior, or posterior Type of pain: radiating, numbness/tingling, stiffness, mechanical symptoms (locking/catching) Duration of symptoms Mechanism of injury Pain modifiers Activity related: gripping, lifting, pushing, throwing, punching History of previous injuries Recent changes in technique or training regimen Treatments rendered and response Physical Examination Inspection Compare with uninjured side Skin changes Swelling Ecchymosis Muscle…

Shoulder Injuries

Acknowledgment The authors would like to acknowledge the work of Charles T. Crellin, MD, and Kevin M. Honig, MD, for their contribution to the previous edition. History A careful history will help establish the diagnosis and formulate a treatment plan. Important factors include the chief complaint, mechanism of injury, hand dominance, what sport the athlete plays, and prior treatments. Common complaints are “pain with overhead activities,”…

Maxillofacial Injuries

General Principles Epidemiology Three to twenty-nine percent of facial injuries are a result of sporting activities. Sixty to ninety percent of facial injuries in sports occur in males aged 10–29 years. Approximately 75% of facial fractures involve the zygoma, mandible, or nose. Most commonly injured teeth are maxillary central incisors, followed by lateral incisors and mandibular incisors. Initiation of Care of the Head-Injured Athlete Airway Injury…

Eye Injuries

General Principles A 2013 study estimated over 30,000 emergency department visits annually for sports- and recreation-related eye injuries. The majority of these injuries occurred in individuals younger than 25 years, with a peak during adolescence, and 80% occurred in males. Approximately 1.5% of all sports-related injuries involve the eye or ocular adnexa. These injuries have a high morbidity rate, and long-term visual impairment can lead to…

Neck Injuries

General Principles Cervical spine injuries are most often seen in football and hockey but have occurred in wrestling, rugby, baseball, lacrosse, skiing, snowboarding, equestrian sports, and mountain biking. Anatomy There are seven cervical vertebrae and eight cervical nerves. Spinal nerves exit above the vertebral body for which they are named; for example, the sixth cervical nerve exits at the C5–C6 disc space. The cervical spine is…

Head Injuries

General Principles Head injuries in sports are comparatively mild compared with those in high-velocity motor vehicle accidents (MVAs), yet they remain significant and important injuries for team physicians to evaluate and manage. Concussion is the most common head injury in sports. Information is evolving regarding pathophysiology, diagnosis, natural history, and treatment of concussion in sports. Consider focal, vascular, and associated injuries (e.g., cervical spine, skull fractures,…

Physical Modalities in Sports Medicine

General Principles A modality is the application of a therapeutic treatment in order to elicit an adaptive response within the body. The aim of modalities is to create an optimal healing environment. They are external treatments best thought of as an adjunct to the body’s own recovery process. Although they should not be the only treatment, they show value in the sports medicine realm by speeding…

Comprehensive Rehabilitation of the Athlete

General Principles The overall goal of rehabilitation is to enhance the recovery of injured tissues and avoid stresses that may prove deleterious to the healing process. This is accomplished by understanding normal function, pathomechanics, and the healing processes of specific tissues. Current research and scientific evidence must establish guidelines for rehabilitation. Rehabilitation specialists must integrate the medical team’s diagnosis and conduct a functional examination of the…