ESS 150 Lecture 11: Lecture 11
9 May 2018
School
Department
Course
Professor
Quadriceps contusions
Compression of muscle against the femur
-
Grade 1: superficial intramuscular bruise
Mild hemorrhage, minimal pain, no swelling, mild tenderness no
restriction of ROM
○
-
Grade 2: moderate contusion
Pain, swelling and loss of ROM in knee flexion
○
-
Grade 3: severe contusion
Major disability, split fasciae, muscle herniation, severe pain, swelling and
hematoma, very limited knee ROM
○
-
Care and management
RICE and NSAID's
○
Knee flexed at 120 degree (12hours)
○
Crutches for more severe cases
○
Isometric quadriceps contractions gentle static stretching
○
heat, massage and ultrasound later to prevent myositis ossificans
○
Padding may be worn to protect and prevent
○
-
Myositis ossificans
Cause
Formation of tissue formations (cartilage or bone) following repeated
blunt trauma to the thigh
○
Attempting to run off a quadriceps contusion
○
Too vigorous treatment of contusion (direct massage or superficial heat)
○
-
Sign
X-ray shows calcium deposit 2-6 weeks following injury
○
Pain, weakness, swelling, decreased ROM
○
Tissue tension and point tenderness
○
-
Care
Treatment must be conservative
○
May require surgical removal if too painful
○
-
Quadriceps muscle strain
Cause
Sudden stretch or sudden contraction
○
Associated with weakened or over constricted muscle
○
-
Sign
Peripheral tear causes fewer symptoms than deeper tear
○
Pain, point tenderness, spasm, loss of function and little discoloration
○
Complete tear may leave athlete with little disability and discomfort but
wit some deformity
○
-
Care
RICE
○
Determine extent of injury early
○
Neoprene sleeve may provide some added support
○
Muscle has a good amount of blood flow, so it can recover quicker
○
-
Hamstring muscle strain
Cause
Highest incidence of strain in all thigh muscles
○
Multiple theories of injury
Hamstring and quad contract together
§
Change in role from hip extender to knee flexor
§
Fatigue, posture, leg length discrepancy, lack of flexibility, strength
imbalances
§
○
-
Sign
Muscle belly or point of attachment pain
○
Capillary hemorrhage, pain ,loss of function and possible discoloration
○
Grade I, II and III
○
-
Care
RICE
○
Restrict activity until soreness has subsided
○
Ballistic stretching and explosive sprinting should be avoided initially
○
-
Femoral fractures
Cause
More common in auto accidents, less common sports (femur is strong)
○
Involves significant force
○
Occurs in middle third due to structure and point of contact
○
-
Sign
Shock, pain, swelling and deformity
Must be aware of bone displacement and gross deformity
§
○
Loss of function
○
-
Care
Treat for shock, verify neurovascular status, splint before moving, reduce
following X-ray
○
Secure immediate emergency assistance
○
-
-
Recognition and management of groin injuries
Groin strain (between the thigh and the abdomen)
Cause
One of the more difficult problems to diagnose
§
Often seen in early part of season due to poor strength and
flexibility
§
Occurs from running, jumping, twisting with hip external rotation or
severe stretch
§
○
Sign
Sudden twinge or tearing during active movement
§
Produce pain, weakness and internal hemorrhaging
§
○
Care
RICE and analgesics for 48-72 hours
§
Determine exact muscle or muscles involved
§
Rest is critical
§
Restore normal ROM and strength- provide support with wrap
§
Refer to physician if severe groin pain is experiences
§
○
○
-
Hip strain
Hip is strongest and best protected joint in the body
-
Cause
Many ligamentous tissue
○
-
Hip flexor strain
Cause pain at the front of the hip
-
A group of muscles which work to life the thigh upwards
-
Dislocated hip
Cause of injury
Rarely occurs in sport
○
Result of traumatic force directed along the long axis of the femur with
bent knee
○
-
Sign
Flexed, adducted and internally rotated hip
○
Palpation reveals displaced femoral head, posteriorly
○
Serious pathology
○
-
Care
Immediate medical care
○
-
Complications
Muscle contractures
○
Muscle paralysis due to nerve injury
○
Degeneration of femoral head
○
-
-
Hip labral tears
Cause
Result of repetitive overuse (i.e. running or pivoting)
○
May occur due to acute trauma (i.e. dislocation)
○
-
Sign
Often present as asymptomatic
○
Cause clicking, locking or catching
○
Pain in the groin; stiffness; limited motion
○
-
Care
Exercises to maintain ROM, strength and stability
○
Avoid aggravating activities
○
Surgical repair
○
-
Piriformis syndrome
Cause
Compression of sciatic nerve under piriformis
○
Irritation due to tightness or spasm of muscle
○
May mimic sciatica (lumbar disc compression)
○
-
Sign
Pain, numbness and tingling in bitt- may extend below knee and into foot
○
Pain may increase following periods of sitting, climbing stairs, walking or
running
○
-
Care
Stretching and massage
○
Cessation of aggravating activities will be prescribed
○
Corticosteroid injection may also be suggested
○
-
-
Hip bursitis
Inflammation of a bursa or small sack of fluid between tendon and bone which
prevents friction
-
The bursa can become inflamed causing pain in the hip
-
Hip problems in young athletes
Perthes' disease
Affects children, commonly aged between 4-8
○
-
Ilium apophysitis
Overuse injury
○
Apophysitis is a muscle attachment site and a site of growth
○
-
Slipped capital femoral epiphysis
Cause
May be growth hormone related
○
25% of cases are seen in both hips
○
Epiphysis slips from femoral head in backwards direction due to weakness
in growth plate
○
May occur during periods of elevated growth (adolescence): boys 10-17,
tall and thin
○
-
Sign
Pain in groin that comes on over weeks and months
○
Hip and knee pain
○
-
Management
With minor slippage, rest and non-weight bearing may prevent further
slippage
○
Major displacement requires surgery
○
If undetected or surgery fails, severe problems will result
○
-
Iliac crest confusion "hip pointer"
Cause
Contusion of iliac crest or abdominal musculature
○
Result of direct blow
○
-
Sign
Pain, spasm, and transitory paralysis of soft structures
○
Decreased rotation of trunk or thigh/hip flexion due to pain
○
-
Care
RICE for at least 48 hours
○
Bed rest of 1-2 days
○
-
Osteoarthritis in the hip
Degenerative condition resulting from wear and tear in the hip
-
management
More calcium
○
Stay active
○
-
Acute fracture of the pelvis
Cause
Result of direct blow or blunt trauma
○
-
Sign
Severe pain, loss of function, shock
○
-
Care
Immediate treat for shock
○
Refer to physician
○
-
Avulsion fractures
Tendon tears away part of the bone after forceful contraction of a muscle
-
Cause
Avulsions seen in sports with sudden accelerations and decelerations
○
Pulling of tendon away and off of bony insertion
○
-
Sign
Sudden localized pain with limited movement
○
Pain, swelling, point tenderness
○
-
Care
Rest, limited activity and graduated exercise
○
-
Rectus femoris avulsion
Occurs where a strong contraction of the rectus femoris muscle pulls the
tendon and a small piece of bone away from the attachment point
-
Lecture 11
Wednesday, May 2, 2018
9:01 AM
Quadriceps contusions
Compression of muscle against the femur
-
Grade 1: superficial intramuscular bruise
Mild hemorrhage, minimal pain, no swelling, mild tenderness no
restriction of ROM
○
-
Grade 2: moderate contusion
Pain, swelling and loss of ROM in knee flexion
○
-
Grade 3: severe contusion
Major disability, split fasciae, muscle herniation, severe pain, swelling and
hematoma, very limited knee ROM
○
-
Care and management
RICE and NSAID's
○
Knee flexed at 120 degree (12hours)
○
Crutches for more severe cases
○
Isometric quadriceps contractions gentle static stretching
○
heat, massage and ultrasound later to prevent myositis ossificans
○
Padding may be worn to protect and prevent
○
-
Myositis ossificans
Cause
Formation of tissue formations (cartilage or bone) following repeated
blunt trauma to the thigh
○
Attempting to run off a quadriceps contusion
○
Too vigorous treatment of contusion (direct massage or superficial heat)
○
-
Sign
X-ray shows calcium deposit 2-6 weeks following injury
○
Pain, weakness, swelling, decreased ROM
○
Tissue tension and point tenderness
○
-
Care
Treatment must be conservative
○
May require surgical removal if too painful
○
-
Quadriceps muscle strain
Cause
Sudden stretch or sudden contraction
○
Associated with weakened or over constricted muscle
○
-
Sign
Peripheral tear causes fewer symptoms than deeper tear
○
Pain, point tenderness, spasm, loss of function and little discoloration
○
Complete tear may leave athlete with little disability and discomfort but
wit some deformity
○
-
Care
RICE
○
Determine extent of injury early
○
Neoprene sleeve may provide some added support
○
Muscle has a good amount of blood flow, so it can recover quicker
○
-
Hamstring muscle strain
Cause
Highest incidence of strain in all thigh muscles
○
Multiple theories of injury
Hamstring and quad contract together
§
Change in role from hip extender to knee flexor
§
Fatigue, posture, leg length discrepancy, lack of flexibility, strength
imbalances
§
○
-
Sign
Muscle belly or point of attachment pain
○
Capillary hemorrhage, pain ,loss of function and possible discoloration
○
Grade I, II and III
○
-
Care
RICE
○
Restrict activity until soreness has subsided
○
Ballistic stretching and explosive sprinting should be avoided initially
○
-
Femoral fractures
Cause
More common in auto accidents, less common sports (femur is strong)
○
Involves significant force
○
Occurs in middle third due to structure and point of contact
○
-
Sign
Shock, pain, swelling and deformity
Must be aware of bone displacement and gross deformity
§
○
Loss of function
○
-
Care
Treat for shock, verify neurovascular status, splint before moving, reduce
following X-ray
○
Secure immediate emergency assistance
○
-
-
Recognition and management of groin injuries
Groin strain (between the thigh and the abdomen)
Cause
One of the more difficult problems to diagnose
§
Often seen in early part of season due to poor strength and
flexibility
§
Occurs from running, jumping, twisting with hip external rotation or
severe stretch
§
○
Sign
Sudden twinge or tearing during active movement
§
Produce pain, weakness and internal hemorrhaging
§
○
Care
RICE and analgesics for 48-72 hours
§
Determine exact muscle or muscles involved
§
Rest is critical
§
Restore normal ROM and strength- provide support with wrap
§
Refer to physician if severe groin pain is experiences
§
○
○
-
Hip strain
Hip is strongest and best protected joint in the body
-
Cause
Many ligamentous tissue
○
-
Hip flexor strain
Cause pain at the front of the hip
-
A group of muscles which work to life the thigh upwards
-
Dislocated hip
Cause of injury
Rarely occurs in sport
○
Result of traumatic force directed along the long axis of the femur with
bent knee
○
-
Sign
Flexed, adducted and internally rotated hip
○
Palpation reveals displaced femoral head, posteriorly
○
Serious pathology
○
-
Care
Immediate medical care
○
-
Complications
Muscle contractures
○
Muscle paralysis due to nerve injury
○
Degeneration of femoral head
○
-
-
Hip labral tears
Cause
Result of repetitive overuse (i.e. running or pivoting)
○
May occur due to acute trauma (i.e. dislocation)
○
-
Sign
Often present as asymptomatic
○
Cause clicking, locking or catching
○
Pain in the groin; stiffness; limited motion
○
-
Care
Exercises to maintain ROM, strength and stability
○
Avoid aggravating activities
○
Surgical repair
○
-
Piriformis syndrome
Cause
Compression of sciatic nerve under piriformis
○
Irritation due to tightness or spasm of muscle
○
May mimic sciatica (lumbar disc compression)
○
-
Sign
Pain, numbness and tingling in bitt- may extend below knee and into foot
○
Pain may increase following periods of sitting, climbing stairs, walking or
running
○
-
Care
Stretching and massage
○
Cessation of aggravating activities will be prescribed
○
Corticosteroid injection may also be suggested
○
-
-
Hip bursitis
Inflammation of a bursa or small sack of fluid between tendon and bone which
prevents friction
-
The bursa can become inflamed causing pain in the hip
-
Hip problems in young athletes
Perthes' disease
Affects children, commonly aged between 4-8
○
-
Ilium apophysitis
Overuse injury
○
Apophysitis is a muscle attachment site and a site of growth
○
-
Slipped capital femoral epiphysis
Cause
May be growth hormone related
○
25% of cases are seen in both hips
○
Epiphysis slips from femoral head in backwards direction due to weakness
in growth plate
○
May occur during periods of elevated growth (adolescence): boys 10-17,
tall and thin
○
-
Sign
Pain in groin that comes on over weeks and months
○
Hip and knee pain
○
-
Management
With minor slippage, rest and non-weight bearing may prevent further
slippage
○
Major displacement requires surgery
○
If undetected or surgery fails, severe problems will result
○
-
Iliac crest confusion "hip pointer"
Cause
Contusion of iliac crest or abdominal musculature
○
Result of direct blow
○
-
Sign
Pain, spasm, and transitory paralysis of soft structures
○
Decreased rotation of trunk or thigh/hip flexion due to pain
○
-
Care
RICE for at least 48 hours
○
Bed rest of 1-2 days
○
-
Osteoarthritis in the hip
Degenerative condition resulting from wear and tear in the hip
-
management
More calcium
○
Stay active
○
-
Acute fracture of the pelvis
Cause
Result of direct blow or blunt trauma
○
-
Sign
Severe pain, loss of function, shock
○
-
Care
Immediate treat for shock
○
Refer to physician
○
-
Avulsion fractures
Tendon tears away part of the bone after forceful contraction of a muscle
-
Cause
Avulsions seen in sports with sudden accelerations and decelerations
○
Pulling of tendon away and off of bony insertion
○
-
Sign
Sudden localized pain with limited movement
○
Pain, swelling, point tenderness
○
-
Care
Rest, limited activity and graduated exercise
○
-
Rectus femoris avulsion
Occurs where a strong contraction of the rectus femoris muscle pulls the
tendon and a small piece of bone away from the attachment point
-
Lecture 11
Wednesday, May 2, 2018 9:01 AM
Quadriceps contusions
Compression of muscle against the femur
-
Grade 1: superficial intramuscular bruise
Mild hemorrhage, minimal pain, no swelling, mild tenderness no
restriction of ROM
○
-
Grade 2: moderate contusion
Pain, swelling and loss of ROM in knee flexion
○
-
Grade 3: severe contusion
Major disability, split fasciae, muscle herniation, severe pain, swelling and
hematoma, very limited knee ROM
○
-
Care and management
RICE and NSAID's
○
Knee flexed at 120 degree (12hours)
○
Crutches for more severe cases
○
Isometric quadriceps contractions gentle static stretching
○
heat, massage and ultrasound later to prevent myositis ossificans
○
Padding may be worn to protect and prevent
○
-
Myositis ossificans
Cause
Formation of tissue formations (cartilage or bone) following repeated
blunt trauma to the thigh
○
Attempting to run off a quadriceps contusion
○
Too vigorous treatment of contusion (direct massage or superficial heat)
○
-
Sign
X-ray shows calcium deposit 2-6 weeks following injury
○
Pain, weakness, swelling, decreased ROM
○
Tissue tension and point tenderness
○
-
Care
Treatment must be conservative
○
May require surgical removal if too painful
○
-
Quadriceps muscle strain
Cause
Sudden stretch or sudden contraction
○
Associated with weakened or over constricted muscle
○
-
Sign
Peripheral tear causes fewer symptoms than deeper tear
○
Pain, point tenderness, spasm, loss of function and little discoloration
○
Complete tear may leave athlete with little disability and discomfort but
wit some deformity
○
-
Care
RICE
○
Determine extent of injury early
○
Neoprene sleeve may provide some added support
○
Muscle has a good amount of blood flow, so it can recover quicker
○
-
Hamstring muscle strain
Cause
Highest incidence of strain in all thigh muscles
○
Multiple theories of injury
Hamstring and quad contract together
§
Change in role from hip extender to knee flexor
§
Fatigue, posture, leg length discrepancy, lack of flexibility, strength
imbalances
§
○
-
Sign
Muscle belly or point of attachment pain
○
Capillary hemorrhage, pain ,loss of function and possible discoloration
○
Grade I, II and III
○
-
Care
RICE
○
Restrict activity until soreness has subsided
○
Ballistic stretching and explosive sprinting should be avoided initially
○
-
Femoral fractures
Cause
More common in auto accidents, less common sports (femur is strong)
○
Involves significant force
○
Occurs in middle third due to structure and point of contact
○
-
Sign
Shock, pain, swelling and deformity
Must be aware of bone displacement and gross deformity
§
○
Loss of function
○
-
Care
Treat for shock, verify neurovascular status, splint before moving, reduce
following X-ray
○
Secure immediate emergency assistance
○
-
-
Recognition and management of groin injuries
Groin strain (between the thigh and the abdomen)
Cause
One of the more difficult problems to diagnose
§
Often seen in early part of season due to poor strength and
flexibility
§
Occurs from running, jumping, twisting with hip external rotation or
severe stretch
§
○
Sign
Sudden twinge or tearing during active movement
§
Produce pain, weakness and internal hemorrhaging
§
○
Care
RICE and analgesics for 48-72 hours
§
Determine exact muscle or muscles involved
§
Rest is critical
§
Restore normal ROM and strength- provide support with wrap
§
Refer to physician if severe groin pain is experiences
§
○
○
-
Hip strain
Hip is strongest and best protected joint in the body
-
Cause
Many ligamentous tissue
○
-
Hip flexor strain
Cause pain at the front of the hip
-
A group of muscles which work to life the thigh upwards
-
Dislocated hip
Cause of injury
Rarely occurs in sport
○
Result of traumatic force directed along the long axis of the femur with
bent knee
○
-
Sign
Flexed, adducted and internally rotated hip
○
Palpation reveals displaced femoral head, posteriorly
○
Serious pathology
○
-
Care
Immediate medical care
○
-
Complications
Muscle contractures
○
Muscle paralysis due to nerve injury
○
Degeneration of femoral head
○
-
-
Hip labral tears
Cause
Result of repetitive overuse (i.e. running or pivoting)
○
May occur due to acute trauma (i.e. dislocation)
○
-
Sign
Often present as asymptomatic
○
Cause clicking, locking or catching
○
Pain in the groin; stiffness; limited motion
○
-
Care
Exercises to maintain ROM, strength and stability
○
Avoid aggravating activities
○
Surgical repair
○
-
Piriformis syndrome
Cause
Compression of sciatic nerve under piriformis
○
Irritation due to tightness or spasm of muscle
○
May mimic sciatica (lumbar disc compression)
○
-
Sign
Pain, numbness and tingling in bitt- may extend below knee and into foot
○
Pain may increase following periods of sitting, climbing stairs, walking or
running
○
-
Care
Stretching and massage
○
Cessation of aggravating activities will be prescribed
○
Corticosteroid injection may also be suggested
○
-
-
Hip bursitis
Inflammation of a bursa or small sack of fluid between tendon and bone which
prevents friction
-
The bursa can become inflamed causing pain in the hip
-
Hip problems in young athletes
Perthes' disease
Affects children, commonly aged between 4-8
○
-
Ilium apophysitis
Overuse injury
○
Apophysitis is a muscle attachment site and a site of growth
○
-
Slipped capital femoral epiphysis
Cause
May be growth hormone related
○
25% of cases are seen in both hips
○
Epiphysis slips from femoral head in backwards direction due to weakness
in growth plate
○
May occur during periods of elevated growth (adolescence): boys 10-17,
tall and thin
○
-
Sign
Pain in groin that comes on over weeks and months
○
Hip and knee pain
○
-
Management
With minor slippage, rest and non-weight bearing may prevent further
slippage
○
Major displacement requires surgery
○
If undetected or surgery fails, severe problems will result
○
-
Iliac crest confusion "hip pointer"
Cause
Contusion of iliac crest or abdominal musculature
○
Result of direct blow
○
-
Sign
Pain, spasm, and transitory paralysis of soft structures
○
Decreased rotation of trunk or thigh/hip flexion due to pain
○
-
Care
RICE for at least 48 hours
○
Bed rest of 1-2 days
○
-
Osteoarthritis in the hip
Degenerative condition resulting from wear and tear in the hip
-
management
More calcium
○
Stay active
○
-
Acute fracture of the pelvis
Cause
Result of direct blow or blunt trauma
○
-
Sign
Severe pain, loss of function, shock
○
-
Care
Immediate treat for shock
○
Refer to physician
○
-
Avulsion fractures
Tendon tears away part of the bone after forceful contraction of a muscle
-
Cause
Avulsions seen in sports with sudden accelerations and decelerations
○
Pulling of tendon away and off of bony insertion
○
-
Sign
Sudden localized pain with limited movement
○
Pain, swelling, point tenderness
○
-
Care
Rest, limited activity and graduated exercise
○
-
Rectus femoris avulsion
Occurs where a strong contraction of the rectus femoris muscle pulls the
tendon and a small piece of bone away from the attachment point
-
Lecture 11
Wednesday, May 2, 2018 9:01 AM
Document Summary
Mild hemorrhage, minimal pain, no swelling, mild tenderness no restriction of rom. Pain, swelling and loss of rom in knee flexion. Major disability, split fasciae, muscle herniation, severe pain, swelling and hematoma, very limited knee rom. Isometric quadriceps contractions gentle static stretching heat, massage and ultrasound later to prevent myositis ossificans. Padding may be worn to protect and prevent. Formation of tissue formations (cartilage or bone) following repeated blunt trauma to the thigh. Too vigorous treatment of contusion (direct massage or superficial heat) X-ray shows calcium deposit 2-6 weeks following injury. Peripheral tear causes fewer symptoms than deeper tear. Pain, point tenderness, spasm, loss of function and little discoloration. Complete tear may leave athlete with little disability and discomfort but wit some deformity. Muscle has a good amount of blood flow, so it can recover quicker. Highest incidence of strain in all thigh muscles. Change in role from hip extender to knee flexor.
