sports emergencies

8/17/2019 Sports Emergencies

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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 A L! "uidelines#. $anage c%spine injuries safely & approach' earlydiagnosis and management(. )ecognise common fractures in athletes *+pper andLo,er Limb-

. Diagnose and manage shoulder dislocation


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Lecture Outline

$ Approach to the injured player$ /ead 0njury$ C%!pine 0njury$ +pper Limb trauma

$ Lo,er Limb rauma


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Approach to the 0njury layer

Assume the worst % Assess the player2s surroundings before entering the 3eld of play % $echanism of 0njury % otential /ead 0njury4C%!pine injury

Basic Resuscitation

*i- Air,ay: Are they tal5ing to you' Dyspnoeic' !tridor'*ii- Breathing: Laboured' achypnoeic' Asymmetrical chest rise

*iii-Circulation: Alert' Conscious' ulse' Capillary )e3ll' Address ob6iousbleeding


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$ Le6els of 0njury riority

*i- 7irst riority: % 0mmediate threat to life % eg. Air,ay Obstruction4 $assi6e

/aemorrhage*ii- !econd riority: % +rgent 0njury ,hich are potentialthreat to life % eg. /ead 0njury4 !pinal 0njury

*iii- hird riorty: % $ost common


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$ $anual inline stabilisation %Cer6ical spine protection is indicated in the follo,ingtrauma settings *i- 8ec5 pain or neurological symptoms

*ii- Altered le6el of consciousness *iii- !igni3cant blunt injury abo6e the le6el of thecla6icles


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Concussion

Mild traumatic brain injury (TBI)% occurs ,ith head injury due to contact% 94% acceleration4deceleration forces

% )apid onset of short%li6ed impairment of

neurologic function% )esol6es spontaneously

% $ay result in neuropathological changes% Acute clinical symptoms largely re ect a

functional disturbance


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Concussion$ Epidemiology % he annual incidence of sports% related concussion in the +! is 1.;

to (.< million % Li5elihood of an athlete in a contact

sport e=periencing a Concussion is as

high as #> percent per season% /orse )acing has highest incidence of

reported concussions per 1>>> playing hours at #?' Bo=ing has 1@ per 1>>>


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Concussion$ Symptoms % acant stare

% Delayed 6erbal e=pression *slo,er to ans,er uestions or follo, instructions- % 0nability to focus attention *easily distracted- % Disorientation

% !lurred or incoherent speech % "ross obser6able incoordination *stumbling' inability to ,al5 tandem4straight line- % $emory de3cits

% Any period of loss of consciousness$ Tools % $addoc5s uestions % !CA (


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Concussion


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C%!pine 0njuryotentially life threatening injury

!ports and recreational acti6ities % @ percent of cer6ical spine fractures

%1 percent of spinal cord injuries *primarily cer6ical spine le6el-

0njury ype: ertebral Column: % 7racture

% !ublu=ation4Dislocation !pinal Cord rauma: % ransection % Compression

% Contusion.

% ascular injury


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C%!pine 0njury


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C%!pine 0njury

$ !uspect if: % layer is unconscious % Clear $echanism of head injury4potentialspinal injury % +nclear $echanism of injury

On 3eld $anagement: % $0L! ABCD % Do not mo6e the player unlessnecessary4appropriate

support present


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C%!pine 0njury

$ De3niti6e 0mmobilisation *i- /ard Collar

*ii- /ead 0mmobiliser *iii- !pinal Board


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+pper Limb rauma

$ Cla6icle fractures$ AC oint Disruption$ !houlder Dislocations$ !caphoid 7ractures


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+pper Limb rauma: Cla6icle7racture

$ $ost commonly fractured bone in body

$ (? of all +pper Limb0njuries

$ Appro=imately #.; percent ofall fractures

$ $echanism

%Appro=imately


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resentation *middle third of the cla6icle-

% Hell localised pain G e=acerbated by mo6ement of the arm.% $ay also report a snapping4crac5ing sensation at the time of injury

% $ay notice localiIed s,elling o6er the aJected area

resentation *distal third of cla6icle- % Easily confused ,ith acromiocla6icular *AC- separations % ain and tenderness around the AC joint 94%s,elling and ecchymosis

% Little or no deformity is seen on e=amination

resentation *pro=imal third of cla6icle- % pain near the sternocla6icular area % ,orsened by mo6ement of the shoulder % usually more comfortable if they sit up and support the arm


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$ "rades$ "rade 1 K $iddle 14($

$ "rade # K Lateral 14($ 1?

$ "rade ( K $edial 14($ ?


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$ On 3eld $anagement

%Broad arm sling%Analgesia


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+pper Limb rauma: AC ointDisruption

$echanism of 0njury % Direct trauma to the shoulder can displace theacromion and

scapula inferiorly ,ith respect to the cla6icle.

% his displacement increases the load on the ACligaments' ,hichstretch and then fail


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+pper Limb rauma: AC ointDisruption

On 7ield $anagement: % )emo6e from play % Broad Arm !ling


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+pper Limb rauma: !houlderDislocation

$ ?> of all major joint dislocations % Anterior Dislocation: ?% @

$ $echanism of 0njury: % Blo, to the abducted' e=ternally rotated' and e=tended arm

$ E=amination *anteriorly dislocated shoulder-: % he arm is slightly abducted and e=ternally rotated % atient resists all mo6ement % Loss of the normal rounded appearance of the shoulder

% 8euro6ascular e=amination *6ery 8B & pulses and a=illary ner6e in particular-


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+pper Limb rauma: !houlderDislocation

$ $anagement:

% )emo6al from play

% Analgesia

% )eduction


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+pper Limb rauma: !caphoid7ractures$ Carpal Bones arranged in # ro,s

$ !caphoid bridges gap$ E=posed to diJerent stresses

$ 7ractures occurs due to$ iolent /ypere=tension$ 7all on e=ed Hrist

$ resentation$ A8A O$0CAL !8+77 BOM tenderness$ Decreased )O$$ !,elling

$ 8o bruising or deformity

$ /igh ris5 of A 8


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Lo,er Limb rauma

$ Qnee Ligamentous 0njury:% ACL )upture

% CL )upture % $CL )upture

% LCL )upture$ Qnee $eniscal 0njury$ 7oot 7ractures


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Lo,er Limb rauma: ACL )uptureAnterior Cruciate Ligament: 7unction: % o control anterior translation of the tibia % is a secondary restraint to tibial rotation as ,ell as 6arusor 6algus stressAnatomy:

% originates at the posteromedial aspect of the lateralfemoral condyle % to the anteromedial aspect of the tibia bet,een the

condyles


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Lo,er Limb rauma: ACL )upture

$ost commonly injured ligament in the 5neeMechanism :8on Contact injuries: %!udden deceleration and changing

direction% i6ots or lands in a ,ay that

in6ol6es rotationor lateral bending *ie' 6algus

stress- of the 5neeContact 0njuries: %direct blo, causing hypere=tension4

6algus deformation


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Lo,er Limb rauma: ACL )upture

$resentation : % feeling a RpopR in their 5nee at the time of injury'% acute s,elling thereafter'% feeling that the 5nee is unstable or Rgi6ing ,ay

$ O4E: Anterior Dra,er test positi6e


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Lo,er Limb rauma: CL )upture

$osterior Cruciate ligament!unction :

% primary restraint to posterior translation of the tibia atthe 5nee jointMechanism o" Injury : % isolated CL injuries are uncommon

% he CL is the 5nee ligament least fre uently injuredduring sports

% Athlete falls on their e=ed 5nee ,hile the foot islantar e=ed


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Lo,er Limb rauma: CL )upture

$ resentation % may present ,ith gross instability of the 5nee

% mild to moderate 5nee eJusion % slight limp

% ain in posterior aspect of 5nee

% loss of terminal 5nee e=ion *3nal 1> to #> degrees-

#$E : osterior Dra,er est positi6e osterior sag sign positi6e


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Lo,er Limb rauma: $CL )upture

$ $edial Collateral Ligament

%Often accompanied by damage to other structures%$edial meniscal tears occur in up to ? percent of $CL injuries% rauma to other ligaments occurs in #> to @< percent of cases

%"rading 1%( in se6erity


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Lo,er Limb rauma: $CL )upture

Mechanism o" Injury : % Direct 6algus stress from a blo, to the lateral aspectof the 5nee

% 0ndirect stress through abduction or rotation of thelo,er leg.

% Direct blo,s typically cause more se6ere injury

Assessment : algus !tress


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Lo,er Limb rauma: LCL )upture

$ Lateral Collateral Ligament

Mechanism o" injury% arus !tress *Qnee is struc5 from the inside-%)arely occur in isolation%0njury may also in6ol6e lateral meniscus' anterior4posterior cruciate

ligaments

Assessment% algus !tress


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Lo,er Limb rauma: Qnee Ligament0njuryOn 7ield $anagement % Compression G 0mmobilise for comfort % Apply 0ce G administer analgesia48!A0Ds % 8on ,eight bearing until further in6estigation

De3niti6e $anagement % $)0 % +ltimately depends on the e=tent of and ,hichligaments in6ol6ed

b $ l


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Lo,er Limb rauma: $eniscalinjuries$eniscal tears:

% Acute meniscal tears occur most often from t,isting injuries % $eniscal injuries can occur in isolation or in association ,ith collateral or cruciate ligament tears

% eg. $edial $eniscus 9 $CL 9 ACL

$echanism % ypically occur ,hen a person changes direction in a manner that in6ol6es rotating or Rt,istingR the 5nee ,hile the 5nee is e=ed

and the corresponding foot is planted

L Li b $ i l


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Lo,er Limb rauma: $eniscalinjuries

resentation % Large comple= tears impair smooth motion of the5nee *loc5ing- % Cause joint eJusions % Lead to premature osteoarthritis % Degree of pain at the time of injury is 6ariable % opping' loc5ing' catching' and the 5nee Rgi6ing,ayN

#$E%


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Lo,er Limb rauma: urf oe

$ urf oe % Dislocation 94% 7racture of hallu= % $echanism: 7orced dorsi e=ion of joint eg layer 5ic5ing ground

% resentation: ain G !,elling around hallu= %On 7ield $=: )0CE ape hallu= in plantar e=ion


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Lo,er Limb rauma:

$ &ones !racture$A'ulsion !racture%7racture of the pro=imal 3fth metatarsal% $echanism: 7orced in6ersion of the foot and an5le

,hile they are in plantar e=ion% resentation: % 0n6ersion injury *!imilar to an5le sprain- % Otta,a An5le )ules * ender at base of? th $ -%On 3eld $anagement: )0CE


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