RCSI Royal College of Surgeons in Ireland Coliste Roga na Minle in

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Sports Injuries
Class
Course
Title
Lecturer
Date

Intermediate Cycle 3
Musculoskeletal Education
Sports Injuries
Dr. Martin Kelly
06/01/2016

Learning Outcomes
By the end of this lecture the student should be able to:
1. Carry out a basic approach to an injured athlete:
ABCDE as per ATLS Guidelines
2. Manage c-spine injuries safely approach, early
diagnosis and management
3. Recognise common fractures in athletes (Upper and
Lower Limb)
4. Diagnose and manage shoulder dislocation

Lecture Outline
Approach to the injured player
Head Injury
C-Spine Injury
Upper Limb trauma
Lower Limb Trauma

Approach to the Injury Player

Assume the worst
- Assess the players surroundings before entering the field of play
- Mechanism of Injury
- Potential Head Injury/C-Spine injury
Basic Resuscitation
(i) Airway: Are they talking to you, Dyspnoeic, Stridor,
(ii) Breathing: Laboured, Tachypnoeic, Asymmetrical chest rise
(iii)Circulation: Alert, Conscious, Pulse, Capillary Refill, Address obvious
bleeding

Approach to the Injury Player

Levels of Injury Priority
(i) First Priority: - Immediate threat to life
- eg. Airway Obstruction/ Massive
Haemorrhage
(ii) Second Priority: - Urgent Injury which are potential
threat to life
- eg. Head Injury/ Spinal Injury
(iii) Third Priorty: - Most common

Approach to the Injury Player

Approach to the unconscious player/ Suspected C-spine
injury
MILS Manual inline stabilisation
A - Airway
B - Breathing
C - Circulation
D - Disability

Approach to the Injury Player

Manual inline stabilisation
-Cervical spine protection is indicated in the following
trauma settings
(i) Neck pain or neurological symptoms
(ii) Altered level of consciousness
(iii) Significant blunt injury above the level of the
clavicles

Concussion
Mild traumatic brain injury (TBI)
- occurs with head injury due to contact
- +/- acceleration/deceleration forces
- Rapid onset of short-lived impairment of
neurologic function
- Resolves spontaneously
- May result in neuropathological changes
- Acute clinical symptoms largely reflect a
functional disturbance

Concussion
Epidemiology
- The annual incidence of sportsrelated concussion in the US is 1.6
to 3.8 million
- Likelihood of an athlete in a contact
sport experiencing a Concussion is as
high as 20 percent per season
- Horse Racing has highest incidence of
reported concussions per 1000 playing
hours at 25, Boxing has 17 per 1000

Concussion
Symptoms

- Vacant stare
- Delayed verbal expression (slower to answer questions or follow instructions)
- Inability to focus attention (easily distracted)
- Disorientation
- Slurred or incoherent speech
- Gross observable incoordination (stumbling, inability to walk tandem/straight line)
- Memory deficits
- Any period of loss of consciousness
Tools

- Maddocks Questions
- SCAT 3

Concussion

C-Spine Injury
Potentially life threatening injury
Sports and recreational activities
- 7 percent of cervical spine fractures
-14 percent of spinal cord injuries (primarily cervical spine level)
Injury Type: Vertebral Column: - Fracture
- Subluxation/Dislocation
Spinal Cord Trauma: - Transection
- Compression
- Contusion.
- Vascular injury

C-Spine Injury

C-Spine Injury
Suspect if: - Player is unconscious
- Clear Mechanism of head injury/potential
spinal injury
- Unclear Mechanism of injury
On field Management:
- MILS ABCD
- Do not move the player unless
necessary/appropriate
support present

C-Spine Injury
Definitive Immobilisation
(i) Hard Collar
(ii) Head Immobiliser
(iii) Spinal Board

Upper Limb Trauma

Clavicle fractures
AC Joint Disruption
Shoulder Dislocations
Scaphoid Fractures

Upper Limb Trauma: Clavicle

Fracture

Most commonly fractured bone in body

35% of all Upper Limb

Injuries
Approximately 2.6 percent of
all fractures

Mechanism
-Approximately 87 percent of
clavicle fractures are caused by
a fall onto the shoulder

Primarily landing injury

Direct force

CC joint & AC ligaments of shoulder stronger than bone

Fracture

Upper Limb Trauma: Clavicle

Fracture
Presentation (middle third of the clavicle)
- Well localised pain & exacerbated by movement of the arm.
- May also report a snapping/cracking sensation at the time of injury
- May notice localized swelling over the affected area
Presentation (distal third of clavicle)
- Easily confused with acromioclavicular (AC) separations
- Pain and tenderness around the AC joint +/-swelling and ecchymosis
- Little or no deformity is seen on examination
Presentation (proximal third of clavicle)
- pain near the sternoclavicular area
- worsened by movement of the shoulder
- usually more comfortable if they sit up and support the arm

Upper Limb Trauma: Clavicle

Fracture
Grades
Grade 1 = Middle 1/3
80%

Grade 2 = Lateral 1/3

15%

Grade 3 = Medial 1/3

5%

Upper Limb Trauma: Clavicle

Fracture
On field Management
- Broad arm sling
- Analgesia

Upper Limb Trauma: AC Joint

Disruption
Mechanism of Injury
- Direct trauma to the shoulder can displace the
acromion and
scapula inferiorly with respect to the clavicle.
- This displacement increases the load on the AC
ligaments, which
stretch and then fail

Upper Limb Trauma: AC Joint

Disruption
On Field Management:
- Remove from play
- Broad Arm Sling

Upper Limb Trauma: Shoulder

Dislocation
50% of all major joint dislocations

- Anterior Dislocation: 95-97%

Mechanism of Injury:

- Blow to the abducted, externally rotated, and extended arm

Examination (anteriorly dislocated shoulder):

- The arm is slightly abducted and externally rotated

- Patient resists all movement
- Loss of the normal rounded appearance of the shoulder
- Neurovascular examination (very NB pulses and axillary nerve in particular)

Upper Limb Trauma: Shoulder

Dislocation

Management:
- Removal from play
- Analgesia
- Reduction

Upper Limb Trauma: Scaphoid

Fractures
Carpal Bones arranged in 2 rows
Scaphoid bridges gap
Exposed to different stresses

Fractures occurs due to

Violent Hyperextension
Fall on flexed Wrist

Presentation
ANATOMICAL SNUFF BOX tenderness
Decreased ROM
Swelling
No bruising or deformity

High risk of AVN

Upper Limb Trauma: Scaphoid

Fractures
On Field Management:

- Remove from play

- Send for Xray
May not always show up on Plain Film xray
If patient has pain in ASB
Place in Pint Glass cast
Re Image in 10-14 days
Fracture line more obvious
If still absent ?Sprain

Treatment
Immobilisation above and below the joint
Wrist & MCPs
6-12 weeks

Lower Limb Trauma

Knee Ligamentous Injury:
- ACL Rupture
- PCL Rupture
- MCL Rupture
- LCL Rupture
Knee Meniscal Injury
Foot Fractures

Lower Limb Trauma: ACL Rupture

Anterior Cruciate Ligament:
Function:
- To control anterior translation of the tibia
- is a secondary restraint to tibial rotation as well as varus
or valgus stress
Anatomy:
- originates at the posteromedial aspect of the lateral
femoral condyle
- to the anteromedial aspect of the tibia between the
condyles

Lower Limb Trauma: ACL Rupture

Most commonly injured ligament in the knee
Mechanism:
Non Contact injuries: -Sudden deceleration and changing
direction
- Pivots or lands in a way that
involves rotation
or lateral bending (ie, valgus
stress) of the knee
Contact Injuries: -direct blow causing hyperextension/
valgus deformation

Lower Limb Trauma: ACL Rupture

Presentation:
- feeling a "pop" in their knee at the time of injury,
- acute swelling thereafter,
- feeling that the knee is unstable or "giving way
O/E: Anterior Drawer test positive

Lower Limb Trauma: PCL Rupture

Posterior Cruciate ligament
Function:
- primary restraint to posterior translation of the tibia at
the knee joint
Mechanism of Injury:
- isolated PCL injuries are uncommon
- The PCL is the knee ligament least frequently injured
during sports
- Athlete falls on their flexed knee while the foot is
plantarflexed

Lower Limb Trauma: PCL Rupture

Presentation

- may present with gross instability of the knee

- mild to moderate knee effusion
- slight limp
- Pain in posterior aspect of knee
- loss of terminal knee flexion (final 10 to 20 degrees)
O/E: Posterior Drawer Test positive
Posterior sag sign positive

Lower Limb Trauma: MCL Rupture

Medial Collateral Ligament
- Often accompanied by damage to other structures
- Medial meniscal tears occur in up to 5 percent of MCL injuries
- Trauma to other ligaments occurs in 20 to 78 percent of cases
- Grading 1-3 in severity

Lower Limb Trauma: MCL Rupture

Mechanism of Injury:
- Direct valgus stress from a blow to the lateral aspect
of the knee
- Indirect stress through abduction or rotation of the
lower leg.
- Direct blows typically cause more severe injury
Assessment: Valgus Stress

Lower Limb Trauma: LCL Rupture

Lateral Collateral Ligament
Mechanism of injury
- Varus Stress (Knee is struck from the inside)
- Rarely occur in isolation
- Injury may also involve lateral meniscus, anterior/posterior cruciate
ligaments
Assessment
- Valgus Stress

Lower Limb Trauma: Knee Ligament

Injury
On Field Management
- Compression & Immobilise for comfort
- Apply Ice & administer analgesia/NSAIDs
- Non weight bearing until further investigation
Definitive Management
- MRI
- Ultimately depends on the extent of and which
ligaments involved

Lower Limb Trauma: Meniscal

injuries
Meniscal tears:
- Acute meniscal tears occur most often from twisting injuries
- Meniscal injuries can occur in isolation or in association with
collateral or cruciate ligament tears
- eg. Medial Meniscus + MCL + ACL
Mechanism
- Typically occur when a person changes direction in a manner that
involves rotating or "twisting" the knee while the knee is flexed
and the corresponding foot is planted

Lower Limb Trauma: Meniscal

injuries
Presentation
- Large complex tears impair smooth motion of the
knee (locking)
- Cause joint effusions
- Lead to premature osteoarthritis
- Degree of pain at the time of injury is variable
- Popping, locking, catching, and the knee "giving
way
O/E:

Lower Limb Trauma: Turf Toe

Turf Toe
- Dislocation +/- Fracture of hallux
- Mechanism: Forced dorsiflexion of joint
eg Player kicking ground
- Presentation: Pain & Swelling around hallux
-On Field Mx: RICE
Tape hallux in plantarflexion

Lower Limb Trauma:

Jones Fracture/Avulsion Fracture
- Fracture of the proximal fifth metatarsal
- Mechanism: Forced inversion of the foot and ankle
while they are in
plantar flexion
- Presentation: - Inversion injury (Similar to ankle sprain)
- Ottawa Ankle Rules (Tender at base of
5th MT)
- On field Management: RICE

Thank You