Spor ts Injuries

1. Sports Injuries

2. Objectives • Identify signs and symptoms of common sports injuries • Describe priority nursing interventions for the major sports injury categories

3. Types of Athletic Injuries • Overuse or Chronic Injury • Bursitis • Tendinitis • Stress Fracture • Acute Traumatic Injuries • Laceration • Abrasion • Sprains / Strains • Dislocations / Subluxations • Fractures

4. P-RICE-MM TreatmentFor Acute Sports Injuries • Protection • Stabilize Area • Rest • Stop All Activity • Ice • 20 Min. Application • Compression • Ace Wrap Under/Over Ice

5. P-RICE-MM TreatmentFor Acute Sports Injuries • Elevation • Above Heart • Medication • NSAIDs/ Analgesics • Muscle Relaxants • Modalities • Diagnostic Testing • Physical Therapy

6. Upper Body Injury

7. Head and Facial Injury • Protective Sports Equipment • Blunt/Penetrating Eye Injury • Lacerations • Fractures • Spinal Cord Injury • Closed Head Injury • Acceleration/ Deceleration Forces • Rotational Forces • Coup-countercoup Injury • Tetanus Immunization

8. Sports Injuriesof the Spine

9. Pinched Nerve Syndrome • Mechanism of Injury • Sudden Direct Blow to One Side of Head • Clinical Presentation • Paresthesia of Upper Extremity • Diagnostic Testing • X-Rays / EMGs / NCS / Bone Scan • Conservative Treatment • Initial Immobilization • P-RICE-MM • Protective Collars for Return to Play

10. Cervical Sprains / Strains • Mechanism of Injury • Direct Trauma – Whiplash Effect • Strain - Stretching or Tearing of Muscles • Sprain – Stretching or Tearing of Ligaments • Clinical Presentation • Immediate Onset of Pain & Muscle Spasms • Decreased Active Range of Motion • Conservative Treatment • P-RICE-MM • Muscle Relaxants

11. Sports Injuriesof theUpper Extremity

12. Shoulder InjuriesImpingement Syndrome  Rotator Cuff Injury • Multifactoral Mechanism of Injury • Overuse Syndrome • Clinical Presentation • Pain Over the Lateral and Anterior Shoulder Radiating Into Deltoid • Initially Pain Occurs With Activity Especially Overhead Motions – Progressing to Pain at Rest • Decreased and Painful Range of Motion • May Feel Shoulder Catch

13. Normal Shoulder Anatomy

14. Shoulder Injuries • Rotator Cuff Musculature • Four Distinct Muscles • Supraspinatus Muscle Is the First Damaged • Physical Examination • + Impingement Sign • Painful Arc Over 90 Degrees / ABD / ADD • + Hawkins Test – Cross Chest Adduction • Tenderness With Movement • + Drop Arm Test With Complete Rotator Cuff Tear

15. Rotator Cuff Tear

16. Diagnostic Testing X-rays to Rule Out Fracture MRI scan to Rule Out Impingement Vs. Tendinopathy Vs. Tear Conservative Tx. P-RICE-MM NSAIDs Cortisone Injections Surgical Intervention Arthroscopic Debridement & Anterior Acromioplasty Possible AC Joint Resection Open Acromioplasty Rotator Cuff Repair Mini Open Repair of the Rotator Cuff Shoulder Injuries

17. Question # 1 Injuries to the rotator cuff musculature initially involve damage to the • Supraspinatus • Infraspinatus • Subscapularis • Teres minor

18. Answer # 1 Injuries to the rotator cuff musculature initially involve damage to the • Supraspinatus

19. Shoulder Instability • Mechanism of Injury • Clinical Presentation • Patient Reports a “Slipping” Within the Joint • Can Be In One or Multiple Directions • PE + Relocation Test + Sulcus Sign • Diagnostic Testing • X-Rays / MRI Scan

20. Shoulder Instability • Conservative Management • P-RICE-MM • Essential to Stop Overhead Activities • Surgical Treatment • Capsulorrhaphy • Post-Op Rehab to Progress Slowly • Return to Play

21. AC Joint Separation • Mechanism of Injury • Direct Blow • Classifications • 1st Degree - Stretching with No Separation • 2nd Degree - Clavicle/Scapula Attachments Intact • 3rd Degree - Complete Separation AC Joint and Attachments • Clinical Presentation • Pain / Swelling • Deformity in Higher Degrees • Decrease Range of Motion

22. AC Joint Separation • Conservative Treatment • 1st & 2nd Degree AC Joint Separations • P-RICE-MM • Surgical Intervention • 3rd Degree and Higher • Fixation • Ligament Reconstruction • Resection of DistalClavicle

23. AC Joint Separation

24. Question # 2 A female high school swim team student presents with anterior right shoulder pain and a slipping sensation. As the nurse taking the history, the most important piece of info would be: 1. Her overall grown and physical maturation in the past six months 2. Her swim stroke specialization and training routine 3. Her weight loss or gain in the past six months 4. Her plans for a college swimming scholarship

25. Answer # 2 A female high school swim team student presents with anterior right shoulder pain and a slipping sensation. As the nurse taking the history, the most important piece of info would be: 2. Her swim stroke specialization and training routine

26. Question # 3 A preliminary diagnosis of right shoulder instability is made. On physical examination you would expect to find: 1. A positive McMurray test 2. Unilateral positive Relocation Test 3. Lack of tenderness over the affected joint 4. Unrestricted range of motion

27. Answer # 3 A preliminary diagnosis of right shoulder instability is made. On physical examination you would expect to find: 2. Unilateral positive Relocation Test

28. Question # 4 The patient was placed on a conservative course of treatment. A primary nursing consideration for this patient is: 1. Allow her to continue to swim without any change in training 2. Encourage her not to swim if pain is present 3. Order her to cease all swimming and overhead activities 4. Tell her to swim per her coach and parents dictate

29. Answer # 4 The patient was placed on a conservative course of treatment. A primary nursing consideration for this patient is: 3. Order her to cease all swimming and overhead activities

30. Clavicle Fractures • Direct Blow to Clavicle Region • Presentation • Disfigure /Pain / Movement with Palpation • Diagnostic Testing • Radiograph R/O SC Joint Derangement • Conservative Treatment • Figure of 8 Harness • Surgical Intervention • Plate & Screw Fixation

31. Clavicle Fracture

32. Epicondylitis • Location • Medial - Golfers Elbow • Lateral - Tennis / Pitchers / Swimmer / Little League • Mechanism of Injury • Overuse Syndrome • Differential Diagnosis • Obtain X-Rays to Rule Out • Loose Bodies • Fracture • Occult Injury • Exostosis • Radial Nerve Entrapment • Radiocapitellar Degeneration

33. Epicondylitis • Clinical Presentation • Well Localized Pain & Swelling • Difficulty / Pain w/ Supination & Pronation • Conservative Treatment • P-RICE-MM • Cock-Up Splint for Wrist

34. Lateral Epicondylitis (Tennis Elbow)

35. Question # 5 Mr. Woods is a 38 year old tennis player who has developed lateral epicondylitis and has begun conservative treatment to prevent progression of this condition. If left untreated, a potential long term effect of epicondylitis is: 1. Compartment syndrome 2. Osteomyelitis 3. Flexion contracture 4. Carpal Tunnel

36. Answer # 5 Mr. Woods is a 38 year old tennis player who has developed lateral epicondylitis and has begun conservative treatment to prevent progression of this condition. If left untreated, a potential long term effect of epicondylitis is: 3. Flexion contracture

37. Hand Injuries • Most Commonly Injured Body Site • Least Protected / Padded Area • Growth Plate Deformities • Mechanism of Injury • Direct Trauma Most Common

38. TRIGGER FINGER - Locking of Digit in Flexion - Often Self-Limiting - Direct Trauma - Stenosis of Tendon Sheath Conservative Treatment P-RICE-MM Surgical Intervention A1 Pulley Release MALLET FINGER - Extensor Tendon Injury at DIP Joint – Extensor Lag - Sudden Forced Flexion - Conservative Treatment P-RICE-MM 6-8 weeks immobilization - Surgical Intervention K Wire Fixation Rare – Open Cases Only Hand Injuries

39. GAMEKEEPER THUMB - Stiff PIP Joint – Degenerative Abduction Deformity MP UCL Insufficiency Possible Avulsion Fracture - Conservative Treatment P-RICE-MM Surgical Intervention Early – UCL Reconstruction Late – MP Fusion & Arthroplasty NAIL BED INJURIES - Disfigurement - Avulsion of Nail - Direct Trauma or Torsional Conservative Treatment P-RICE-MM Drilling of Nail - Protective Padding for Return to Sports Hand Injuries

40. Hand / Wrist Fractures • Boxer’s Fracture • Metacarpal Neck Fracture • Palmer Angulation of Fracture • Colles Fracture • Distal Radial Fracture • Silver Fork Deformity • Scaphoid Fracture • Difficult Fracture to Heal

41. Sports Injuriesof theLower Extremity

42. Knee: Normal A & P

43. Knee – Ligamentous Injuries • Function • Attaches Bone to Bone • Stabilizes Knee • Mechanism of Injury • Torsional Injury Often with Direct Blow • Medial & Lateral Collateral Ligaments • Grade 1 • Grade 2 • Grade 3

44. AUTOGRAFT Patient Graft Harvested Bone / Middle 1/3 Patella Tendon / Bone Graft Arthrotomy Post-Op 2 Areas for Healing Potential for Scarring / Osteophyte Formation at Patella ALLOGRAFT Cadaver Bone / Patella Tendon / Bone Graft Arthroscopically Assisted Post-Op Fixation Site of Allograft Patella / Patella Tendon Complex Left Undisturbed ACL Substitution Surgery

45. ACL Arthroscopy

46. Knee – Meniscal Injuries • Function • Crescent Shaped Plates that Provide Stability • Transmits Axial Loads • Shock Absorbers / Joint Fillers • Mechanism of Injury • Torsional / Rotational Injury • “Pop” or “Snap” Frequently Heard at Impact • Incidence • 3-7 X Incidence of Injury to Medial Meniscus

47. Meniscal Injuries • Clinical Presentation • Exquisite Joint Line Pain • Inability to Full Extend Lower Extremity • Buckling / Locking of Affected Joint • (+) McMurray Test • Diagnostic Testing • X-Rays Rule Out Loose Bodies • MRI scan / Diagnostic Arthroscopy • Conservative Treatment • P-RICE-MM

48. Meniscal Injury Arthroscopic Surgery • Meniscal Repair • Smaller Vertical Tears • Surgically Sutured • Partial / Total Removal (Meniscectomy) • Cut Out Tear – Back to a Stable Rim • Good For Large or Unstable Tears • Bucket Handle / Vertical • Allografting

49. Meniscal Injury Arthroscopic Surgery

50. Question # 6 You respond to an on field injury during a football game. The injured athlete reports hearing a “pop” in his knee. He is now unable to fully extend his knee. You would suspect an injury to the 1. Anterior Cruciate Ligament 2. Iliotibial Band 3. Articular Cartilage 4. Meniscus