The Lecture Series in Athletic Training and Sports Medicine

Transcription

1 The Lecture Series in Athletic Training and Sports Medicine Jim Berry, MEd, ATC, SCAT/NREMT Director of Sports Medicine Head Athletic Trainer Myrtle Beach High School Myrtle Beach, South Carolina 2003 Author s Note The information contained within this lecture series is based upon over 17 years professional experience in the athletic training, sports medicine, and emergency medical fields, and numerous athletic training and sports medicine references and resources. A list of those references and resources is located at the end of this presentation. The purpose of this series is to provide instructors in athletic training and sports medicine, primarily in the secondary schools, another educational resource that they may use to enhance the educational studies of their students. 1

2 SPORTS MEDICINE Unit 16, Part A The Thigh, Hip, & Pelvis Anatomy of the Thigh That part of the upper leg between the hip and the knee Consists of basically one bone the FEMUR Proximally, important aspects include the head, neck, lessor trochanter, and greater trochanter Distally, important aspects include the medial and lateral condyle 2

3 Musculature of the Thigh SARTORIUS Flexes knee/thigh Abducts thigh RECTUS FEMORIS VASTUS LATERALIS VASTUS INTERMEDIUS VASTUS MEDIALIS All of these assist with knee extension POPLITEUS PSOAS MAJOR & ILLIACUS Flex thigh Musculature of the Posterior Thigh BICEPS FEMORIS Flexes knee/extends thigh SEMITENDONOSIS Flexes knee/extends thigh SEMIMEMBRANOSIS Flexes knee/extends thigh GLUTEUS MAXIMUS Extends thigh/tilts pelvis GLUTEUS MEDIUS & MINIMUS Abducts thigh/medially rotates thigh 3

4 GRACILLIS Adducts thigh, flexes knee, medially rotates leg ADDUCTOR LONGUS Adducts, flexes, outwardly rotates thigh ADDUCTOR MAGNUS Adducts, extends, medially rotates thigh ADDUCTOR BREVIS PECTANEUS Hip Adductors Blood Vessels, Nerves, and Fascia FEMORAL ARTERY FEMORAL VEIN FEMORAL NERVE MUSCLE FASCIA Envelopes the entire thigh 4

5 SURFACE ANATOMY OF THIGH SOFT TISSUE THIGH INJURIES Quadriceps Contusion Show all the classic signs of a muscle bruise Usually develop as the result of being hit by someone or something, while thigh muscles were relaxed forcing the soft tissues against the hard surface of the femur At the moment of injury, the athlete will experience pain, transitory paralysis or loss or function, and immediate capillary effusion The extent of the force and the degree of thigh relaxation usually determines the depth of the injury and amount of structural and functional disruption that occurs 5

6 SOFT TISSUE THIGH INJURIES Quadriceps Contusion, cont d Early detection is essential to a quick recovery for the athlete Signs and Symptoms the ATC should look for»the mechanism of injury (a direct blow)»intense pain and weakness with muscle testing»a circular, swollen area at the location of the injury with point tenderness SOFT TISSUE THIGH INJURIES Contusions to the thigh are classified into 3 degrees of severity: 1 st Degree Contusions (2 grades)» Grade 1 Very superficial bruise with little bleeding, little pain, no swelling, and mild point tenderness, normal ROM» Grade 2 Deeper than Grade 1; produces pain, mild swelling, mild point tenderness, athlete s ROM at knee is greater than 90 degrees 6

7 SOFT TISSUE THIGH INJURIES Contusion severity, continued 2 nd Degree Contusions» Sometimes referred to as a Grade 3 contusion» Moderately severe, causing pain, swelling, and knee ROM that is less than 90 degrees flexion» Athlete will also have an obvious limp with this injury 3 rd Degree Contusions» Sometimes referred to as a Grade 4 contusion» This is a severe injury» The blow may have been so severe that it caused the fascia covering the muscles and other structures to protrude or herniate» There will be deep intramuscular hematoma with an indention in the thigh» Severe pain and swelling» Knee ROM is severely limited as is ambulation SOFT TISSUE THIGH INJURIES Care and treatment for contusions by the ATC includes management in 3 stages Stage 1» Application of ice, compression, and elevation» Isometric quad contractions» Crutches for 2 nd and 3 rd degree cases» Gentle passive stretching w/cold application Stage 2» Recovery of ROM through the use of warm whirlpool or moist heat packs, ultrasound, ice, and stretching Stage 3» Recovering full function through PRE s and gradual return to activity 7

8 SOFT TISSUE THIGH INJURIES Care and rehabilitation of thigh contusions should be handled relatively conservatively Exercises should not be used if pain is present Never use deep, penetrating therapies and manual therapies until you are convinced swelling and bleeding have stopped Once an athlete has suffered an injury like this, care should be taken to insure that the athlete is not re-injured by providing protective padding, etc. MYOSITIS OSSIFICANS TRAUMATICA Severe and repeated blows to the same area of the thigh can result in ECTOPIC BONE FORMATION Bone formation in an abnormal place Usually occurs after bleeding into the quadriceps/thigh and formation of a hematoma (blood tumor) This causes a disruption in the tissues, which may result in inflammation This irritation, in turn, cause tissue formation resembling cartilage or bone 8

9 MYOSITIS OSSIFICANS TRAUMATICA X-ray Images of Myositis Ossificans Traumatica Left = Normal View Right = Closer View Below = Isolated View MYOSITIS OSSIFICANS TRAUMATICA Examples of ossified tissues removed from patients suffering from Myositis Ossificans 9

10 MYOSITIS OSSIFICANS TRAUMATICA The most common cause of this condition is improper care of a thigh contusion The following are classic ways in which this condition can be caused or aggravated Attempting to run off the quad contusion Treating a quad contusion too vigorously by using therapeutic methods such as massage, ultrasound, superficial heat, etc, when contraindicated Care and treatment for this condition involves referral of the athlete to an orthopedic physician and management of pain with ice and other analgesics when appropriate In most cases the bony growth will have to be surgically removed, after which a recovery of up to one year can be expected End Unit 16, Part A 10

11 References & Resources American Academy of Orthopedic Surgeons, Emergency Care and Transportation of the Sick and Injured 8 th Edition, Jones & Bartlett Publishers, Anderson, Marcia, & Susan J. Hall, Fundamentals of Sports Injury Management Arnheim, Daniel D., & William E. Prentice, Essentials of Athletic Training 5 th Edition, McGraw-Hill, Arnheim, Daniel D., & William E. Prentice, Modern Principles of Athletic Training, McGraw-Hill, Cartwright, Lorin A., & William A. Pitney, Athletic Training for Student Assistants, Human Kinetics, Kapit, Wynn, & Lawrence M. Elson, The Anatomy Coloring Book, Harper-Collins Publishers, Mistovich, Joseph J., Brent Q. Hafen, Keith J. Karren, & Howard A. Werman, Pre-hospital Emergency Care, Pfeiffer, Ronald P., & Brent C. Mangus, Concepts of Athletic Training 2 nd Edition, Times Mirror/Mosby College Publishing, Roy, Steven, Richard Irvin, & Duane Iverson, Sports Medicine: Prevention, Evaluation, Management, and Rehabilitation of Athletic Injuries 2 nd Edition, Prentice-Hall, Inc., American Academy of Orthopedic Surgeons ( American College of Sports Medicine ( National Athletic Trainers Association ( 11