Injuries Signs and Symptoms
Pain Swelling Heat Redness Loss of function Depends on severity of injury Treatment
R.I.C.E. and possible NSAIDs Range of Motion (Stretching!) Strength and Endurance Neuromuscular Control & Balance Functional and Sports Specific Progressions Maintain Cardio Fitness
All depend on severity. Begin rehab as soon as possible. What are the two categories of acute muscle injuries?
Contusions Strains How does one receive a contusion?
Sudden traumatic blow to the body What is typical in cases of severe contusions? a. the athlete reports being struck by a hard blow b. the blow causes pain and a transitory paralysis caused by pressure on and shock to the motor and sensory nerves c. palpation often reveals a hard area, indurated because of internal hemorrhage d. ecchymosis, or tissue discoloration, may take place What is a strain?
A stretch, tear, or rip in the muscle or adjacent tissue such as the fascia or muscle tendon How are strains most often produced?
Abnormal muscular contraction What is the cause of abnormal muscular contraction? It is fault in the reciprocal coordination of the agonist and antagonist muscles take place. The cause of this fault or un-coordination is a mystery. However, possible explanations are that it may be related to: a mineral imbalance caused by profuse sweating to fatigue metabolites collected in the muscle itself to a strength imbalance between agonist and antagonist muscles. What is a grade 1 (or 1st degree or 1°) strain?
Slight over-stretching to mild tearing (20%) of the muscle fibers. It is accompanied by local pain, which is increased by tension in the muscle, and a minor loss of strength. There is mild swelling, ecchymosis, and local tenderness. What is a grade 2 (or 2nd degree or 2°) strain?
Moderate tearing (20% - 70%) of the muscle fibers. It is similar to a grade 1, but has moderate signs and symptoms (moderate loss of strength, moderate swelling, ecchymosis, and local tenderness). What is a grade 3 (or 3rd degree or 3°) strain?
Has signs and symptoms that are severe (severe swelling, ecchymosis, and local tenderness) with a loss of muscle function and, commonly, a palpable defect in the muscle. What does a tendon attach?
Muscle to bone What does a ligament attach?
Bone to bone What is a cramp?
A painful involuntary contraction of a skeletal muscle or muscle group. Cramps have been attributed to what?
A lack of water or other electrolytes in relation to muscle fatigue. What is a spasm?
A reflexive reaction caused by trauma of the musculoskeletal system List and define the two types of spasms or cramps: a. clonic – alternating involuntary muscular contraction and relaxation in quick succession b. tonic – rigid muscle contraction that lasts a period of time. What are the four specific indicators of possible overexertion? a. acute muscle soreness b. delayed muscle soreness c. muscle stiffness d. muscle cramping List and define the two types of muscle soreness: a. Acute-onset muscle soreness – which accompanies fatigue. This muscle pain is transient and occurs during and immediately after exercise. b. Delayed-onset muscle soreness (DOMS) – becomes most intense after 24 to 48 hours and then gradually subsides so that the muscle becomes symptom-free after 3 or 4 days. (This second type of pain is described as a syndrome of delayed muscle pain leading to increased muscle tension, swelling, stiffness, and resistance to stretch). What are the possible causes for delayed-onset muscle soreness?
It may occur from very small tears in the muscle tissue, which seems to be more likely with eccentric or isometric contractions. It may also occur because of disruption of the connective tissue that hold muscle tendon fibers together. What is muscle stiffness?
Muscle stiffness does not produce pain. It occurs when a group of muscles have been worked for a long period of time. The fluids that collect in the muscles during and after exercise are absorbed into the bloodstream at a slow rate. As a result, the muscle becomes swollen, shorter, and thicker and therefore resists stretch. What can be done to assist in reducing muscle stiffness?
Light exercise Massage Passive mobilization What is muscle guarding?
Following injury, the muscle that surrounds the injured area contract, in effect, splint that area, thus minimizing pain by limiting movement. (Quite often this splinting is incorrectly referred to as a muscle spasm) The suffix “itis” means inflammation: Myositis/Fasciitis - inflammation of the muscle tissue Tendinitis – inflammation of a tendon Tenosynovitis - Inflammation of the synovial sheath surrounding a tendon Bursitis – inflammation of the bursa Periostitis – inflammation of the bone covering What are the major acute injuries that happen to synovial joints?
Sprains Subluxations Dislocations What is a sprain?
Stretching or total tearing of the stabilizing connective tissues (ligaments) What is a grade 1 (or 1st degree or 1°) sprain?
Slight over-stretching to mild tearing (20%) of the ligament. It is characterized by some pain, minimum loss of function, mild point tenderness, little or no swelling, and no abnormal motion when tested. What is a grade 2 (or 2nd degree or 2°) sprain?
Moderate tearing (20% - 70%) of the ligament. There is pain, moderate loss of function, swelling, and in some cases slight to moderate instability. What is a grade 3 (or 3rd degree or 3°) sprain?
It is extremely painful, with major loss of function, severe instability, tenderness, and swelling. What is a subluxation?
Partial dislocations in which an incomplete separation between two articulating bones occurs. What is a dislocation (luxation)?
Total disunion of bone apposition between articulating surfaces What are several factors that are important in recognizing and evaluating dislocations?
Loss of limb function Deformity Swelling Point tenderness What is an acute bone fracture?
A partial or complete interruption in a bone’s continuity What is a stress fracture?
Rhythmic muscle action performed over a period of time at a sub-threshold level causes the stress-bearing capacity of a bone to be exceeded What are the typical causes of stress fractures in sports?
Coming back into competition too soon after an injury or illness Going from one event to another without proper training in the second event Starting initial training too quickly Changing habits or the environment Strains
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Groin Strain (Hip) Running, Jumping, Twisting (ER) Typical Typical, May need crutches, compression wrap during activity Quadriceps Strain (Thigh) Sudden stretch from knee flexion Typical Typical, May need crutches, compression wrap during activity Hamstring Strain (Thigh) Sudden stretch from knee extension Typical Typical, May need crutches, compression wrap during activity
Gastrocnemius Strain (Leg) Quick starts & stops, jumping, Typical Typical, heel wedge, compression sudden knee extension. wrap during activity
Achilles Tendon Strain (Ankle) Usually after ankle sprains or sudden Typical Typical, heel lift, compression wrap excessive ankle dorsiflexion. during activity
Achilles Tendon Rupture (Ankle) Sudden pushing-off action of the Typical, hears a pop, indentation at RICE, X-ray to rule out fracture, forefoot with the knee being forced site, positive Thompson’s Test possible surgical repair, into complete extension. immobilization for 4 to 6 weeks, begin rehab. Heel lifts in both shoes
Longitudinal Arch Strain Repetitive contact with a hard Typical Typical, Reduce weight bearing playing surface. It may appear activity, possible arch support taping suddenly or slowly over time.
Metatarsal Arch Strain Excessive pronation and weak Typical Typical, orthotic or pad to elevate intertarsal ligaments will allow the the fallen arch. foot to abnormally spread resulting in a fallen arch Patellar Tendon Rupture Sudden powerful contraction of the Typical, Defect can be palpated, Typical, surgery quadriceps athlete cannot extend the knee, swelling, initial significant pain followed by a feeling that the injury is not serious Strains
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Elbow strain Excessive resistive motion, repeated Typical Typical microtears Lumbar strain Sudden extension on an overloaded, Typical Typical unprepared, or underdeveloped spine, usually in combination with trunk rotation; chronic strain, commonly associated with faulty posture that involves excessive lumbar lordosis. Neck and Upper Back strain Turn the head suddenly or forced Typical, muscle guarding and Typical, possible soft cervical collar flexion, extension, or rotation reluctance to move the neck in any direction Cervical sprain (Whiplash) Turn the head suddenly or forced Typical, muscle guarding and Typical, X-rays to rule out fracture. flexion, extension, or rotation, but reluctance to move the neck in any and possible soft cervical much more violently than the direction; this pain may persist much cervical strain longer than that of the cervical strain. Sprains
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Hip Sprain Sudden stretch from knee flexion Typical Typical, May need crutches
MCL Sprain (Knee) Direct blow (valgus force), severe Typical, positive valgus stress test Typical, May need crutches outward twist LCL Sprain (Knee) Direct blow (varus force) Typical, positive varus stress test Typical, May need crutches
ACL Sprain (Knee) Direct blow, rotation, hyperextension Typical, positive anterior drawer test, Typical, crutches, immobilization, positive Lachman’s test physician referral, possible surgery
PCL Sprain (Knee) Direct blow, knee flexion, landing on Typical, positive posterior drawer Typical, crutches, immobilization, a flexed knee test physician referral, possible surgery
Inversion (Lateral) Ankle Sprain Foot inversion, plantar flexion, Typical, positive anterior drawer test, Typical, possible crutches, possible adduction positive Talar tilt test immobilization, possible physician referral, possible surgery
Eversion (Medial) Ankle Sprain Foot pronation, hypermobility, Typical, positive anterior drawer test, Typical, possible crutches, possible depressed medial longitudinal arch positive Talar tilt test immobilization, possible physician referral, possible surgery Syndesmotic (High) Ankle Sprain External rotation, forced dorsiflexion Typical Typical, may take months to heal
Sprained Toes or Turf Toe Force against an unyielding object Typical, Valgus & Varus Stress Tests, Typical, tape Anterior & Posterior Drawer Tests Acromioclavicular (AC) Sprain Direct Impact Typical Typical, immobilization, possible physician referral Sprains
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Elbow sprain Hyperextension or valgus forces Typical Typical
Wrist sprain Fall on hyperextended wrist; any Typical Typical abnormal, forced movement of the wrist Finger sprain Fall on hyperextended wrist; any Typical Typical abnormal, forced movement of the wrist Finger fractures Direct trauma or violent twisting Typical Typical
Lumbar sprain Forward bending and twists while Typical Typical lifting or moving some object
Sacroiliac sprain Twisting with both feet on the Typical, associated muscle guarding. Typical, Bracing may be helpful. Joint ground, stumble forward, fall Possible asymmetry with the ASIS should be mobilized to correct backward, step too far down and and/or PSIS, difficulty with forward existing asymmetry lands heavily on one leg, or bends bending, straight leg raising forward with the knees locked while increases pain after 45º, as well as lifting side bending toward the painful side. Bursitis
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Trochanteric Bursitis Repetitive Typical, pain may radiate to the knee Typical, May need crutches, NSAIDs causing a limp and analgesics. Patellar Bursitis Continual kneeling, overuse Typical, ballotable Typical, eliminate the cause, NSAIDs
Shoulder bursitis Overuse Typical, positive impingement test Typical
Olecranon Bursitis Direct force, overuse Typical Typical Dislocations and Subluxations
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Shoulder dislocation/subluxation Forced abduction, external rotation, Typical, possible deformity, unable to Typical, Immediate immobilization, direct blow touch opposing shoulder (Apley’s RICE, pillow under the arm for scratch test comfort, physician referral, x-rays to rule out a fracture Elbow dislocation Fall on the outstretched hand with Typical, Rupturing or tearing most of Typical, sling, physician referral the elbow in a position the stabilizing ligaments, profuse hyperextension; or a severe twist hemorrhage and swelling. Severe while it is in a flexed position. pain and disability, possible radial head fracture. Lunate Dislocation Forced hyperextension Typical, difficulty in executing wrist Typical, possible physician referral and finger flexion. There may be numbness or even paralysis of the flexor muscles because of lunate pressure on the median nerve Finger dislocations/subluxations Direct trauma or violent twisting Typical Typical
Lumbar Vertebrae Dislocation Compression fracture may occur as a Typical Typical, X-ray, physician referral, put result of hyperflexion of the trunk; athlete on a spine board falling from a height and landing on the feet or buttocks; direct impact from a sudden blow Cervical dislocation Violent flexion and rotation of the Point tenderness, restricted C-spine, Physician referral head movement, cervical spasm, cervical pain and pain in the chest and extremities, numbness in the trunk and/or limbs, weakness or paralysis in the trunk and/or limbs, loss of bladder and/or bowel control Contusions
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Hip Contusion (Hip Pointer) Direct blow Typical, spasms, transistory Typical, physician referral to r/o paralysis, unable to rotate the trunk fracture, 1 to 2 days bed rest, ice or to flex the thigh without pain massage, ultrasound, NSAIDs Quadriceps Contusion Direct blow Typical, transitory loss of function Typical, RICE with the knee in flexion, NSAIDs Joint Contusion Direct blow Typical Typical, possible physician referral, return to activity with protective padding when initial pain and irritation subsides. Shin contusion Blow to the anterior aspect of the Typical, rapid hematoma formation, Typical, NSAIDs and analgesics, lower leg. can be associated with compartment maintaining compression is critical syndrome or fracture. (may have to aspirate hematome), ROM exercises and PRE within pain limits, doughnut padding and orthoplast shell for protection. Calcaneal Contusion Occurs by impact from running or Typical Typical, moderate activity with the jumping protection of a heel cup or doughnut may resume if pain when walking has subsided by the 3rd day, shock absorbent footwear shoe be worn. Finger contusions Direct trauma Typical Typical
Rib contusion Direct blow Typical, Sharp pain during breathing, Typical, possible bed rest and point tenderness, pain when the rib cessation of sports activities cage is compressed Fractures
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Femoral Stress Fractures Repetitive Typical, Groin pain along with an Typical, Rest, for 2 to 5 months, x- aching sensation in the thigh that rays and possible bone scan, increases with activity and decreases swimming with rest. Standing on one leg may be impossible Acute Femoral Fracture Direct Trauma Typical, pain over the fracture site, Ice, Treat for shock, verify deformity neurovascular status, splint, physician referral Patellar Fracture Direct or indirect trauma Typical, Hemorrhage and joint Typical, physician referral effusion Acute Leg Fracture Direct traumatic blow Typical, Soft tissue insult and Splint and ice, refer to a physician hemorrhaging, intense pain and disability, leg appears hard and swollen. Tibia or Fibular Stress Fracture Repetitive or Overuse Typical, positive percussion or Typical, NSAIDs, no activity for at compression test, positive x-ray or least 14 days, possible cast and/or bone scan crutches, weight bearing when pain subsides, correct biomechanics, running may resume when the athlete is completely pain free. Ankle Fracture (misnomer) Forced abduction or planting in Typical, possible deformity Typical, x-ray examination, a walking combination with forced internal cast or brace may be applied once rotation, trauma. swelling is reduced, for 6 to 8 weeks, PNF exercises, isometrics (during immobilization), PRE, and balance activites up to 4 weeks. Fractures (cont.)
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Talus Fracture Occurs either laterally from a severe Typical, History of repeated trauma Typical, X-ray is essential for an inversion and dorsiflexion force or to the ankle, feels pain on weight accurate diagnosis, non-surgical medially from an inversion and bearing, complaint of snapping or management for a non-displaced plantar flexion force with external catching, intermittent swelling, sub-chondral compression fracture, rotation of the tibia on the talus. anteromedial or anterolateral joint protective immobilization, non-weight line of the talar dome is tender when bearing progression to full weight palpated. bearing depending on symptoms, if conservative treatment fails surgery may be required, expect to resume activity 6 to 8 months after surgery. Calcaneal Fracture Occurs most often after a jump or Typical, inability to bear weight Typical, X-ray is essential for an fall from a height. An avulsion accurate diagnosis, non-surgical fracture can also occur with this management for a non-displaced injury fracture, protective immobilization, non-weight bearing progression to full weight bearing depending on symptoms, Calcaneal Stress Fracture Occurs from repetitive impact during Typical, Feels pain on weight Typical, Conservative management heel strike and characterized by a bearing, pain tends to continue after for the first 2 to 3 weeks, rest, active sudden onset of constant pain in the exercise stops, bone scan may be ROM exercises of the foot and ankle, plantar-calcaneal area. required. non-weight bearing cardiovascular exercises, may resume activities within pain limits when pain subsides, must wear a cushioned shoe. Jone’s Fracture Inversion and plantar flexion of the Typical, Immediate swelling and pain Typical, Crutches with no foot, direct forces, or repetitive over the 5th metatarsal, high non- immobilization, gradually progress to stress. union rate, coarse of healing is full weight bearing as pain subsides, unpredictable. return to activity is possible in 6 weeks, non-union may cause re- fracture to occur. Fractures (cont.)
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Metatarsal Stress Fracture (March Most commonly involves the shaft of Typical Typical, Bone scan is the best way to Fracture) the 2nd metatarsal (March fracture). detect this injury, 3 or 4 days of Occurs in the runner suddenly partial weight bearing after two changing training patterns, such as weeks of rest, return to running increasing mileage, running hills, or should be gradual, orthotics can help running on a harder surface. An to reduce stress atypical condition such as a structural forefoot varus, hallux valgus, or a short 1st metatarsal will predispose to a 2nd metatarsal stress fracture. A stress fracture of the 5th metatarsal at the insertion of the peroneous brevis tendon can occur, but should not be confused with a Jones fracture. Phalanges Occurs by either kicking an object, Typical, deformity. Stiffness and Typical, buddy tape, possible stubbing a toe, or being stepped on. residual pain may last for several physician referral Dislocations are less common than days fractures. Clavicular Fracture Fall on the outstretched, a fall on the Typical, Clavicle appears slightly Typical, Sling and swathe, treat for tip of the shoulder, or direct impact. lower than the opposite side. shock, X-ray, immobilization for 6 to possible deformity 8 weeks. After immobilization, begin gentle isometrics and mobilization exercises. May require surgery. Scapular Fracture Direct impact or force transmitted Typical, Pain during shoulder Typical, Sling, x-ray, begin overhead through the humerus to the scapula. movement strengthen in 1 week. Fracture of the Humerus Direct blow or fall on the Typical, inability to move arm Typical, Sling and swathe, treat for outstretched arm shock, physician referral, immobilization for 6 to 8 weeks Fractures (cont.)
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Forearm fracture Direct trauma or fall on the Typical, Audible pop or crack Typical, sling, physician referral outstretched arm Colle’s Fracture Fall on an outstretched armforcing Typical, Possible silver fork Typical, sling, physician referral the radius and ulna into deformity, and possible median hyperextension, or falling on the nerve damage backward hand Scaphoid (Navicular) Fracture Force on the outstretched arm Typical Typical, splint, physician referral
Hamate fracture Fall or from contact from a sports Typical Typical, splint, physician referral implement Lumbar Vertebrae Fracture Compression fracture may occur as a Typical Typical, X-ray, physician referral, put result of hyperflexion of the trunk; athlete on a spine board falling from a height and landing on the feet or buttocks; direct impact from a sudden blow Cervical fracture Axial loading; sudden forced Point tenderness, restricted C-spine, Physician referral hyperextension movement, cervical spasm, cervical pain and pain in the chest and extremities, numbness in the trunk and/or limbs, weakness or paralysis in the trunk and/or limbs, loss of bladder and/or bowel control Rib Fracture Direct or indirect trauma, violent Typical, Sharp pain during Typical, physician referral, rest and muscular contractions inspiration, possible crepitus during immobilization palpation Tendinitis
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Osgood-Schlatter repetitive stress at the tibial Typical, hemorrhage, gradual Typical, reduce irritating activities, tuberosity degeneration, severe pain when cast may be required, isometric kneeling, running, or jumping, point strengthening for quads and tenderness hamstrings
Larsen Johansson repetitive stress at the inferior Typical, hemorrhage, gradual Typical, reduce irritating activities, patellar pole degeneration, severe pain when cast may be required, isometric kneeling, running, or jumping, point strengthening for quads and tenderness hamstrings Patellar Tendinitis Repetitive running, jumping, and Typical, Pain and tenderness at the Typical, thermal agents, ultrasound, (Jumper’s or Kicker’s Knee) kicking posterior, inferior patellar pole brace (counter-force) massage Runner’s (Cyclist’s) Knee Repetitive, overuse Typical, Malalignment and structural Typical, Correction of foot and leg asymmetries of the foot and lower alignment problems, RICE, proper leg. Contributes to iliotibial band warm-up and stretching, avoidance friction syndrome and pes anserinus of aggravating activities, NSAIDs. tendonitis or bursitis Achilles Tendinitis Excessive tensile stresses placed on Typical, uphill running and hill Typical, may be resistant to quick it during repetitive movements and workouts aggravate the condition, resolution, address structural faults presents with a gradual onset. weak gastrocnemius-soleus complex, (i.e. footwear, orthotics, etc.) morning stiffness, discomfort walking ultrasound to increase blood flow, after prolonged sitting, tendon is friction massage may be helpful, warm and painful upon palpation, strengthening of the gastrocnemius- palpable crepitus with active plantar soleus unit. May be resistant to quick and dorsiflexion, pain on passive resolution, address structural faults stretching, chronic inflammation. (i.e. footwear, orthotics, etc.) RICE, ultrasound to increase blood flow, friction massage may be helpful, strengthening of the gastrocnemius- soleus unit. Tendinitis (cont.)
Injury Mechanism of Injury (Etiology) Signs & Symptoms Treatment
Anterior Tibialis Tendinitis Common when running downhill for Typical Typical, avoid hills extended periods of time. Posterior Tibialis Tendinitis Overuse injury among runners with Typical, Swelling of the medial Typical, non-weight bearing short-leg hypermobility or pronated feet malleolus area, edema and point cast with the foot in inversion may tenderness behind the medial be used, Low Dye taping or orthotic malleolus area, pain can become can be used to correct pronation. more intense during resistive inversion and plantar flexion Peroneal Tendinitis Problem in athletes with pes cavus Typical, Pain of the lateral malleolus Typical, tape with elastic tape, where the foot tends to excessive area when rising on the ball of the appropriate warm-up and flexibility supinate. foot, tenderness behind the lateral exercises, Low Dye taping or orthotic aspect of the calcaneous distally can be used to prevent excessive beneath the cuboid. supination. Wrist tendinitis Repetitive pulling movements Typical Typical Chondramalacia (Patellofemoral Arthralgia) Etiology: Abnormal patellar tracking Signs & Symptoms: Pain in the anterior aspect while running, walking, ascending stairs, and squatting. Recurrent swelling, grating sensation during flexion and extension, patellar grind test produces crepitus. Treatment: Avoid irritating activities, pain-free isometric exercise to strengthen the quads, anti-inflammatories, orthotics to correct pronation and reduce tibial torsion, possible surgery. Patellofemoral Stress Syndrome (PFSS) (Patellofemoral Arthralgia) Etiology: Hamstrings, gastrocnemius, IT band, or lateral retinaculum tightness; increased Q angle, foot pronation, patella alta, VMO insufficiencies Signs & Symptoms: Tenderness over the patellar lateral facet, swelling, dull ache in the center of the knee, patellar compression will elicit pain and crepitis, positive apprehension test Treatment: Strengthen VMO; stretching for hamstrings, gastrocnemius, and IT band; orthotics and/or taping to correct alignment Cramps and Spasms Etiology: Excessive loss of fluids through sweating, inadequate muscle coordination. Signs & Symptoms: Pain, tonic contraction. Treatment: Athlete should relax, gradual stretching, ice or gentle ice massage. Medial Tibial Stress Syndrome Etiology: Repetitive microtrauma, weak leg muscles, inadequate footwear, inappropriate training, malalignment problems. Signs & Symptoms: Grade 1: pain after activity Grade 2: pain before and after activity, but does not affect performance Grade 3: pain before, during, and after activity, affects performance Grade 4: constant pain that makes performance impossible Pain is along the lower medial anterior tibialis. Treatment: Physicians referral to rule out other problems, RICE, NSAIDs and analgesics, ice massage, modify activity, correct biomechanics, orthotics and/or arch taping. Lateral Epicondylitis (Tennis Elbow) Etiology: Repetitive microtrauma, hyperextension activities Signs & Symptoms: Aching pain over the region during and after exercise, pain worsens with continued activity, weakness in the hand and wrist Treatment: RICE, NSAIDs and analgesics, immobilization, strengthening and stretching exercises, correct biomechanics, counterforce brace Medial Epicondylitis (Pitcher’s Elbow, Racquetball Elbow, Golfer’s Elbow, Javelin-Thrower’s Elbow)
Etiology: Repeated forceful extension of the wrist and valgus torques of the elbow. Signs & Symptoms: Pain, possible radiating pain, point tenderness, mild swelling, AROM produces pain. Treatment: RICE, NSAIDs and analgesics, immobilization (sling), strengthening and stretching exercises, correct biomechanics, counterforce brace. For severe cases, splint and complete rest for seven to 10 days. Carpal Tunnel Syndrome
Etiology: Repetitive wrist flexion, direct trauma Signs & Symptoms: Sensory or motor deficits; tingling, numbness, and paresthesia over the thumb, index and middle fingers, and palm of the hand; muscular weakness Treatment: RICE, immobilization, and NSAIDs. Surgical decompression may be necessary de Quervain’s Disease (Hoffman’s Disease)
Etiology: Constant wrist movement Signs & Symptoms: Aching pain which may radiate into the hand or forearm, positive Finklestein’s test; point tenderness and weakness during thumb extension and abduction; there may be a painful snapping and catching of the tendons Treatment: Immobilization, rest cryotherapy, NSAIDs, ultrasound, ice massage Wrist Ganglion
Etiology: Appears slowly after a wrist sprain Signs & Symptoms: Occasional pain with a lump at the site. Pain increases with use Treatment: RICE, pressure with a felt pad, ultrasound, possible surgical removal Sciatica
Etiology: Torsion or direct blow to the back causing inflammation or compression of the sciatic nerve Signs & Symptoms: Pain may be abrupt or gradual, produces a sharp shooting pain that follows the nerve pathway along the posterior and medial thigh; there may be tingling and numbness along its path; nerve may be extremely sensitive to palpation; straight leg raises intensifies pain. Treatment: Rest is essential. Stretching of a tight piriformis muscle may decrease symptoms; NSAIDs and RICE, surgery may be necessary. Brachial Plexus Neurapraxia (Burner or Stinger)
Etiology: Stretching or compression of the brachial plexus Signs & Symptoms: Burning sensation, numbness, tingling, and pain extending from the shoulder down to the hand with some loss of function of the arm and hand that lasts for several minutes. Treatment: RICE; strengthening exercises; Athlete may return to full activity once symptoms have completed resolve and there are no associated neurological symptoms.