Sports Medicine

Sports Medicine

Sports Medicine

Sports Medicine

Musculoskeletetal problems commonly occur as a result of both serious athletic pursuits and activities of daily living.

Most sports and recreational injuries are the results of:

contusions sprains (ligamentous injuries)

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strains (musculotendinous injuries) meniscal injuries bursitis fractures and dislocations. Though not describe in detail here, physical

therapy is an important adjunct to the management of these disorders.

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Injury to skeletal muscle can be the the result of a direct or indirect insult.

Direct injuries cause muscular contusions, hematomas, strains, lacerations, myositis ossificans, or rhabdomyolysis.

All of these result in destruction of all or part of a muscle with the degree of loss proportional to the severity of the trauma.

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Muscular contusion caused by direct trauma or blunt trauma , creates damage to the muscle fibers and capillary rupture that frequently results in an infiltrative type of bleeding with intramuscular hematoma formation.

Ecchymosis is seen externally and is followed internally by edema and an intense inflammatory reaction.

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Contusions can be classified according to the amount of loss of residual function remaining in the muscle group following the injury.

A mild contusion retains near normal and associated joint range of motion, localized tenderness, and no gait alteration.

A moderate contusion is characterized by a swollen, tender muscle mass, retention of 75% of the affected joint range of motion and an antalgic gait.

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A severe contusion presents with marked tenderness and swelling, less than 50% joint range of motion, and a severe limp.

Initial treatment consists of limiting range of motion of the affected extremity to minimize the risk of hemorrhage. This is accomplished through the acronym RICE.

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This is followed by restoration of active and active assisted range-of-motion exercises.

Treatment concludes with functional rehab and progressive resistance exercises.

Myositis ossificans is a frequent complication of muscular contusion and an associated hematoma.

Myositis ossificans may occur following a mild contusions but the risk is greatest with moderate to severe contusions.

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Myositis Ossificans refers to reactive formation of bone within muscle or the ossification of a muscular hematoma.

Although the muscles most commonly seen undergoing ossification are the quadriceps, the hamstrings and the brachialis, traumatic myositis ossifican can occur in any muscle.

Sports Medicine

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These type of lesions usually stabilizes by 3-6 months and then are slowly reabsorbed by the body, typically without any disability noted.

Treatment consists of ice, elevation, and rest to control initial swelling. Once bone formation has occurred, moist heat and mild exercise may help prevent stiffness.

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Physical therapy has been shown to exacerbate and prolong this condition.

Excision surgery is performed for painful local lesions or disability, but not recommended until complete formation of the bone mass has occurred.

Athletes generally need to be counseled to not resume physical activity or participate in sports until the bone mass has matured, which may take 6 months.

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Sprains are ligament injuries. Ligaments are like strong cords, tough and elastic, and that provide stability and strength between joints, but when pulled or stretched to their limit they can tear or rupture.

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Shoulder injuries

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Depending on the amount of ligament tearing, a sprain can be mild, moderate, or severe. An alternate classification is; a first-degree, second-degree or third-degree sprain.

Although classification of sprains is applicable to any ligament injury, it is most often used for injury of the collateral ligaments of the knee and ankle and the acromial-clavicular ligaments of the shoulder.

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Most sprains are associated with varying degrees of pain, swelling and impairment of range-of-motion or weight bearing.

The most commonly involved areas are the shoulder, the elbow, the knee and the ankle. Knee and ankle sprains are among the most common of all sports injuries.

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The medial collateral ligament is most commonly injured by a blow to the lateral aspect of the knee during a sporting event. The history of a valgus blow to the knee is frequently diagnostic.

Patients occasionally report hearing a pop at the time of injury; however, this is not always specific for collateral ligament injury.

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Swelling occurs quickly in the area of injury, and ecchymosis may develop 1 to 3 days after injury.Typically the physical exam reveals localized tenderness usually at the medial femoral epicondyle.

Patients with tears of the medial collateral ligament usually walk with a limp and are unable to fully extend the knee, because extension stretches the ligament, causing pain.

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Since it is essential to rule out other injuries, the Lachman test is used to to detect injury of the ACL; the posterior drawer test, to rule out injury to the PCL; and the McMurray test, to evaluate the medial meniscus.

If the physical exam is difficult to perform or damage to other intra-articular structures is suspected, an MRI can help determine the full extent of injury.

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Patients with isolated injuries of the MCL have been successfully treated with range-of-motion exercises, early weight bearing, and strengthening of the quadriceps femoris muscle with exercises for 4 to 12 weeks, depending on the severity of the injury.

First-degree sprains heal faster than third degree sprains. Although the medial collateral ligament may heal in a slightly lengthened state, this has little effect on knee function.

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Ankle sprains commonly involve the lateral ligament complex, particularly the anterior talofibular ligament. In more severe injuries, the calcaneofibular ligament may also be involved.

If both of these ligaments are ruptured, the injury results in significant joint instability and is classified as a grade III (severe) sprain.

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Most ankle sprains occur when the foot is suddenly turned inward (supinated-varus), tearing the outside (lateral) ligaments.

Sprains of the medial (deltoid) ligaments are less common because it is less likely for the foot to be forced outward (pronated-valgus), and because the deltoid ligament is much stronger.

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Most ankle sprains, even grade III sprains, usually are treated identically. The acronym “RICE” applies even more to ankle sprains than to any other injury.

Surgical repairs of ruptured lateral ligaments provide excellent outcomes but are usually necessary only in cases of chronically unstable ankle joints.

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A strain is the tearing of a muscle-tendon unit. These injuries are termed musculo-tendonitis or more frequently as tendonitis. They can be either acute or chronic.

These injuries are caused by overuse, and the pain results from minor tears in the tendons, from accumulated injuries (repetitive micro-trauma) that outpaces the body’s ability to repair itself.

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This may result in pathologic changes of the soft-tissue and bones:

tendon degeneration, osteophytes, stress fractures, or nerve entrapment.

Chronic strains may be caused by prolonged overuse or by a single episode of over activity.

Strains are also graded as either mild, moderate or severe.

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Severe strains are characterized by rupture of any part of the tendon complex e.g biceps, patella or Achilles. Treatment of these injuries usually requires reconstruction of the musculotendinous unit.

Lateral and medial epicondylitis are better known by their sports association: “tennis elbow” and “golf elbow” respectively. Lateral epicondylitis is the more common of the two.

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Lateral epicondylitis is tendonitis of the extensor musculature at the lateral epicondyle.

Baseball players, fencers, and swimmers may also be subject to this problem.

Patients between 35 and 50 years of age are most commonly affected.

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The patient presents with pain at the site of tendon insertion and usually have point tenderness over the involved site.

The characteristic pain may also be reproduced by extension and flexion of the wrist against pressure.

Treatment is with rest and avoidance of activities that exacerbate the condition. Useful adjuncts are soft splints, NSAIDs and cortisone injections.

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A substantial majority of shoulder problems stem from disorders of the rotator cuff.

The tendons of the rotator cuff form a musculotendinous unit near their insertions into the proximal humerus. Among the relevant muscles, the supraspinatus is the one most affected.

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Distinguishing between the various soft tissue disorders that cause shoulder pain may be difficult.

Rotator cuff tendonitis, subacromial bursitis, partial and complete rotator cuff tears, and calcific tendonitis frequently cause similar symptoms.

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In addition, these disorders often occur together, though precise distinction is important, it is frequently unimportant for therapy.

For most rotator cuff disorders, the central tenets of therapy are rest and abstention from the inciting activities.

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Slings, NSAIDs and moist heat provide symptomatic relief.

Orthopedic referral and physical therapy are indicated for more refractory cases e.g. those who fail to improve after months of conservative therapy or who have complete tears.