- Clinical science
Sports injuries are usually the result of a sudden increased load on the joints, ligaments, and/or muscles. Acute joint and ligament injuries typically result from non-physiological movements in the joints. (e.g., twisting the ankle → supination injury). Treatment of acute sport injuries usually follows the RICE protocol (rest, ice, compression, elevation). Definitive therapy depends on the extent of the injury (e.g., the presence or absence of fractures) and ranges from immobilization of the affected region (e.g., casts, braces, supportive wraps) to surgical repair.
List of topics covered in this card:
Sport injuries covered in other cards:
- Commonly a result of eccentric contraction of the quadriceps muscle when the knee is partly flexed and the foot planted (e.g., during falls)
- Trauma (e.g., direct blow) to the suprapatellar region (rare)
- Risk factors: hyperparathyroidism, gout, SLE, diabetes, rheumatoid arthritis, and glucocorticoid therapy
- Clinical features
- X-ray(AP and lateral view): lack of quadriceps shadow, suprapatellar mass present
- Ultrasound: hypoechogenic section seen across the tendon
- MRI: used if other techniques are inconclusive; will show tear across all three layers of the tendon
- Treatment: surgical repair (suturing) of the quadriceps tendon with follow-up physical therapy
- Trauma to the infrapatellar region (common)
- Rarely as a result of contraction of the quadriceps muscle with the foot planted (e.g., due to a fall)
- Chronic tendon degeneration
- Clinical features:
- X-ray; (AP, lateral, axial): a high-riding patella; calcification seen in chronic causes
- Ultrasound: hypoechogenic section seen across the tendon (suggests an acute tear)
- MRI: used if other techniques are inconclusive; shows disrupted tendon fibers with adjacent hemorrhage or edema
|I||No macroscopic tears|
- Clinical features
- Conservative therapy
- Surgical treatment
- Differential diagnosis:
- Most ankle sprains heal well.
- Recurrent ankle sprains may lead to ankle instability, which may require surgical reconstruction of the ankle ligaments (e.g., with periosteal flaps).
- The recurrence of an ankle sprain can be prevented by proprioceptive training.
- Definition: painful feeling of tension in the muscles 1–2 days after increased physical activity
- Etiology: climbing uphill; eccentric strength training; sports that involve jumping, acceleration, deceleration, and sudden changes in direction
- Microtears close to the Z-line of the sarcomere → stimulation of muscle hypertrophy
- If the load or the level of physical activity is too high → inflammatory reaction near the Z-line → greater muscle repair and less muscle hypertrophy and pain due to muscle edema
- Based on current knowledge, the build-up of lactate does not play a role in muscle soreness.
- Pain on moving and/or stretching the affected muscles, muscle tenderness; peaks after 1–3 days
- Muscle stiffness
- Diagnostics: clinical diagnosis
- Avoid rest!
- Cycling, jogging at low intensity
- Warmth (e.g., applied heat)
- Careful passive stretching
- Prognosis: Spontaneous healing usually occurs within a few days.
- Definition: excessive stretching of a muscle, which can lead to a tear
- Longitudinal stretching of the muscle to a point beyond the elastic limit during active contraction
- The musculotendinous junction is the most common site of injury.
|I||< 5% of muscle fibers are damaged|
|II||Numerous muscle fibres are torn, incomplete rupture|
|III||Complete tear of muscle or tendon|
- Clinical features
- X-ray: to rule out fracture or dislocation
- MRI: to determine if a full rupture is present
- Grade III strains may require surgery to reattach the muscle.
- Prognosis: Grade I strains may recover spontaneously within a couple of weeks; high grade strains may take months.
RICE protocol: "RICE" = Rest → Ice → Compression → Elevation
- Rest: All athletic activity should be discontinued; continued physical exertion can worsen the injury or delay healing.
- Cool the affected area for 20–30 min, followed by a break, and resume after a couple of hours.
- Ice should not be directly applied to the skin! → risk of frostbite!
- The affected limb/joint should rest in a position that minimizes pain.
- Elastic bandage (wrapped in a caudal to cranial direction)
- A change in the character of pain (throbbing pain) may imply that the bandage is too tight → remove the bandage and reapply after 5–10 min
- Taping (tape bandages) should not be used during the first 12–24 hours.
- Elevation: The extremities should be raised above the level of the heart.
- Alcohol should not be consumed for at least 24 hours after injury.
- Saunas and warm baths increase circulation in the injured region and should not be used during the initial period after injury.