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Soccer

Introduction Soccer, or football, is the world’s most popular sport. Although its origins trace back over 3000 years, the current organized form of soccer originated in 1863 in Britain. Federation Internationale de Football Association (FIFA) is the governing body for soccer in the world, and it includes 211 affiliated national associations. There are six different confederations within FIFA, and the United States is a member of…

Football

Introduction Football developed in the United States, in what is commonly recognized as the first American football game between Rutgers and Princeton, on November 6, 1869. Since its inception, over 1.5 million athletes participate today and contribute to football being considered the most popular sport in the United States. There are well over 700 schools sponsoring varsity college football, which represent approximately 70,000 student-athletes involved in…

Injury Prevention Protocols

Introduction Sport-specific injury prevention training programs are used across the country as an aid to increase performance and decrease injury rates. Two common areas of injury include the athletic shoulder and knee. Among the athletic population, injuries to the throwing shoulder are becoming more apparent as a result of overuse and poor conditioning. Likewise, anterior cruciate ligament (ACL) knee injuries continue to rise each year among…

Sports Ultrasound

Sports Ultrasound The use of ultrasound to evaluate and guide treatment for injuries and medical conditions associated with sport and exercise; this may involve both clinical and in-the-field applications. Evaluations are most often performed to answer a specific clinical question; need for further imaging and involvement of other medical imaging experts should be considered General Principles Physics Electric voltage from the base unit is converted to…

Diagnostic Imaging in Sports Medicine

General Principles Imaging in sports medicine plays an increasingly important role in the diagnosis of injury and decision-making regarding return to play. Increasingly sophisticated imaging modalities allow for precise diagnosis of various patterns of injury but also present the care provider with a bewildering range of tests. The continued participation of older athletes in sporting activities makes the interpretation of imaging studies challenging as degenerative findings…

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…