L18 Sport & Soft Tissue Injuries

Young adults or children.

Certain risk factors such as low bone density, menstrual irregularities, and inadequate nutrition.

Dynamic stabilizers (tendons/muscles) and static stabilizers (ligaments ± meniscus).

Muscle, tendon, knee, shoulder, and ankle injuries.

The first 72 hours.

Quadriceps tendon and Patellar tendon.

An avulsion fracture occurs when a small chunk of bone attached to a tendon or ligament gets pulled away from the main part of the bone.

Psoas muscle.

Reconstruction, as torn ACLs do not heal.

Complete disruption of the lateral ligamentous complex with significant swelling and instability.

Tibia.

The tendon remains intact while the bone is broken.

Through imaging techniques such as MRI.

Prevents varus deformities.

A direct blow to the proximal aspect of the tibia.

Females are 2-4 times more likely to suffer ACL injuries than males.

Immediate swelling (hemarthrosis) is noted within 1-2 days of the injury.

To resist valgus and external rotation loads.

90%.

Patellar tendon rupture.

Excision of abnormal tendon tissue and longitudinal tenotomies after failed conservative treatment for at least 3-6 months.

Conservative treatment, including crutches, PRICE, and anti-inflammatory medication.

Very rarely, if conservative treatment fails and there is a complete tear associated with other ligament injuries.

Jumper’s knee.

Immediate pain, localized tenderness, +/- swelling, and pain/weakness with resisted contraction.

Protect, Rest, Ice, Compression, Elevation.

Prevents anterior translation of the tibia relative to the femur.

To prevent further joint damage and to plan appropriate treatment.

Joint line tenderness.

To prevent weakness and tendon rupture.

Autograft from the patellar tendon or hamstring tendon.

Muscle injuries.

30 to 50%.

Vascular injury, particularly to the popliteal artery or peroneal nerve.

Repair whenever possible.

Increased risk of osteoarthritis progression.

6 to 8 hours.

It is associated with ACL injuries.

Arthroscopic partial meniscectomy.

Rectus femoris.

Valgus deformities.

Approximately 10%.

To reduce pain and return function.

Nonsurgical treatment, which includes rehabilitation and activity modification.

Rehabilitation to strengthen hamstrings and quadriceps, along with proprioceptive training.

Shortening, lengthening, and no change of length.

Most patients present with no dislocation due to spontaneous reduction.

The tibial MCL.

Approximately 10%.

Pain when flexing the wrist, pain extending from the elbow to the pinky, a weak grip, and pain when shaking hands.

Conservative treatment with rest and gradual reintroduction of activity.

Swelling around the quad tendon, sensitivity to touch, warmth or burning pain, and stiffness in the knee in the morning.

The most common muscle injury in sports, often due to overuse or improper use.

The space between ruptured muscle fibers fills with blood that clots and is gradually converted into connective tissue, forming scar tissue.

Load-sharing across the knee joint by increasing contact area and decreasing contact stress.

Low bone density and inadequate nutrition.

Lateral sprains, accounting for 85% of all ankle sprains.

Magnetic Resonance Imaging (MRI).

Repair has poor healing outcomes, while reconstruction replaces the ligament with a new one.

McMurray and Apley tests.

In individuals under 40 years old.

MRI.

Osteotendinous junction.

Conservative treatment, as they are unlikely to participate in sports.

Complete fracture.

Valgus stress test.

Lack of plantar flexion when squeezing the calf.

An injury caused by a non-penetrating blunt force resulting in hematoma and inflammation.

Pyomyositis caused by S. aureus.

Stop using the injured limb and pad to protect it.

Injuries that occur with overuse in the setting of normal bone mineral density (BMD).

Moderate injury with partial tear, localized swelling, and possible mild laxity.

About 70%.

To protect the limb, minimize swelling, decrease inflammation, and decrease pain.

Intense and repetitive exercise without adequate rest.

Lachman’s test.

MRI.

When nonsurgical treatment fails to control symptoms for grade III ankle instability.

If there are mechanical symptoms, failure of conservative treatment, or a locked knee.

LCL injuries are less common than MCL injuries.

Muscles do not have the ability to regenerate, leading to fibrosis and permanent weakness.

Surgical repair.

Reduced bone mineral density and elastic resistance.

Bone formation (calcification) within muscle secondary to blunt trauma.

Muscular pain that occurs 1-3 days after vigorous exercise, primarily associated with eccentric loading.

Irrigation and debridement followed by suture repair of the fascia, if possible.

A type of meniscus tear that resembles a handle of a bucket.

Hamstring.

Anterior tibial translation over the femur.

Conservative treatment.

ACL, MCL, LCL, PCL injuries.

Mainly diagnosed by H&E; investigations are usually not needed.

Bone resorption exceeds bone formation.

The ligament did not heal, leading to intermittent episodes of instability.

A direct blow to the lateral aspect of the knee.

Quadriceps tendon rupture.

Conservative treatment including RICE, analgesia, and immobilization.

Immediate non-weight bearing cast immobilization and possibly surgical intervention if nonoperative treatment fails.

Excessive tensile force (eccentric load) leading to overstraining of myofibers.

Painless swelling with decreased range of motion.

Female athletes with specific risk factors.

A piece of bone attached to a ligament or tendon breaks away from the main part of the bone.

Pain, swelling, and instability.

Immobilize in maximum muscle length position and apply the PRICE protocol.

Achilles tendon rupture is more common than patellar tendon rupture.

Steroid use, chronic disease, tendinopathy, and fluoroquinolone antibiotics like Ciprofloxacin.

RICE (Rest, Ice, Compression, Elevation) and functional treatment.

Overuse tendinopathies and tendon rupture.

Avulsion fractures.

30% - 40%.

Because the ACL is an intracapsular ligament with low blood supply.

Contraction, elongation (eccentric), and isometric.

During sporting activities.

A 'pop' or the sensation of being kicked in the heel.

Non-operative treatment.

Pain and swelling near the base of the thumb, difficulty moving the thumb and wrist, and a 'sticking' sensation in the thumb.

Patients with bleeding disorders, such as hemophilic patients.

They can occur from squatting or falling due to degenerative changes in the meniscus cartilage.

Sartorius muscle.

Grade I: Mild injury with no ligamentous disruption, mild swelling, and no laxity.

To restrain posterior tibial translation in the intact knee.

Conservative treatment.

Rest, physiotherapy (stretching and eccentric strengthening), corticosteroid injections, ice, analgesics, orthotics, and braces.

For athletes wishing to return to cutting and pivoting sports or for individuals in physically demanding occupations.

Muscles whose origin and insertion cross two joints.

ACL, PCL, and one of the collateral ligaments.

A bicruciate injury (ACL+PCL) or a multiligament knee injury involving three or more ligaments.

They have not been shown to prevent abnormal anterior tibial translation.

The treatment is totally different based on the type of side affected.

Increasing pain at the back of the leg or heel, stiffness in the tendon, swelling and tenderness at the ankle, and crepitus when moving the ankle.

Quadriceps and Brachialis muscles.

Grade 1: Mild, Grade 2: Partial tear, Grade 3: Complete tear.

A 'pop' sound.

To help relieve swelling, control damage, and prevent further injury.

As high as 20%.

A syndesmosis injury, accounting for 1-10% of all ankle sprains.

High-energy trauma, low-energy trauma in obese patients.

It is important as proprioception is often affected in ankle injuries.

Pain and swelling in the front of the shoulder, pain triggered by arm movement, a clicking sound, and stiffness.

Ice, NSAIDs, and physical therapy for range of motion and strengthening.

Repeated mechanical loading and hypovascularity of the tendon.

They can become complete fractures and often occur in bones with tension and compression sides.

Varus strain, often resulting from motor vehicle accidents and athletic injuries.

Emergent closed reduction and splinting or bracing.

Twisting injuries or changes in direction, often during weight-bearing activities.

A displaced meniscal fragment that appears as a 'handle' on imaging.

Small joint effusions and joint line tenderness with palpation.

Prevents posterior tibial translation over the femur.

To transfer force from muscle to bone to produce joint motion.

It is considered a red flag.

X-ray and MRI.

Microfractures can lead to stress fractures with continued intense exercise.

Cutting or pivoting movements.

Single-leg hop test.

Pain near the knee joint radiating up the thigh, swelling in or around the knee or thigh, especially with repetitive activity.

ACL injuries.

Injuries to other ligaments, such as MCL sprains.

Bone contusions where there is edema on both surfaces of the joint.

Approximately 2 to 4 weeks post-injury.

A fall onto the flexed knee with the foot in plantar flexion.

Non-operative treatment is preferred unless there is a combined ligament injury or symptomatic grade 3, which may require PCL reconstruction.

Insidious onset of pain worsened by impact activity and alleviated by rest.

Inability to perform active knee extension.

Tenderness on the outside of the elbow, morning stiffness, persistent aching, and worsened pain when grasping objects.

The LCL is the primary restraint to varus stress at 5° and 25° of knee flexion.

The impact between the tibial and femoral condyles.

Scar formation and muscle weakness.

Immediate vascular surgery consultation with intraoperative exploration.

89% for medial meniscus (MM) and 92% for lateral meniscus (LM).

Compartment syndrome.

A high index of suspicion.

In individuals over 40 years old.

70% to 75%.

Tendinopathy involves degeneration, not inflammation, as confirmed by biopsy.

A 'pop' sound.

Lateral femoral condyle.

An ABI of less than 0.90 is considered abnormal and may indicate vascular injury.

Ultrasound (U/S), extracorporeal shockwave therapy (ESWT), iontophoresis, and phonophoresis.

The menisci are crescent-shaped with a triangular appearance on cross-section; the lateral meniscus covers 84% of the condyle surface, while the medial meniscus covers 64%.

Post-reduction radiographs should be taken.

Conservative management unless it is large, then surgical excision may be necessary.

Pain, swelling, decreased range of motion, erythema, warmth, induration, and tenderness.

Skeletal muscle necrosis that can occur due to crush injuries, leading to myoglobin in circulation and renal impairment.

An effusion may develop slowly hours after injury, with localized pain to the joint line and mechanical symptoms like locking or catching.