Types of Musculoskeletal Injuries

Injuries to the musculoskeletal system that are common in athletes include fractures, dislocations, sprains, strains, tendinitis, or bursitis.

• Bone fracture. A fracture is a break in a bone that occurs from either a quick, one-time injury, known as an acute fracture, or from repeated stress, known as a stress fracture. Growth plate fractures are unique to children who are still growing.
  • Acute fractures. A fall, car accident, or blow can cause a fracture, and the severity depends on the force that caused the break. The bone may crack, break all the way through, or shatter. Injuries that break through the skin to the bone, which are known as compound fractures, are especially serious because there is an increased risk of infection. Most acute fractures are emergencies.
  • Stress fractures. Stress fractures occur largely in the weight-bearing bones of the lower extremity. These include the femur, tibia and fibula, and foot bones. They are common in sports where there is repetitive impact, primarily running or jumping sports such as gymnastics, tennis, basketball, or track and field. Running creates forces two to three times a person’s body weight on the lower limbs.
  • Growth plate fractures. The growth plate is an area of cartilage near the ends of long bones, and they enable the bones to lengthen until children reach their full height. Growth plates are especially vulnerable to injury until they are converted to bone, typically by the time a child reaches the age of 20. Growth plate fractures can result from a single traumatic event, such as a fall or car accident, or chronic stress and overuse.
• Dislocation. When the two bones that come together to form a joint become separated, the joint is described as dislocated. Contact sports such as football and basketball, as well as high-impact sports and sports that involve significant stretching or falling, cause most dislocations. A dislocated joint typically requires immediate medical treatment, but sometimes the bones move back into place on their own. A dislocation is a painful injury and is most common in south dees, elbows, fingers, kneecap, and femur-tibia or knee.
• Sprain. Sprains are stretches or tears of ligaments, the bands of connective tissue that join the end of one bone with another. Sprains are caused by trauma such as a fall or blow that knocks a joint out of position. Sprains can range from first-degree (minimally stretched ligament) to third-third-degree complete tear). Areas of the body most vulnerable to sprains are the ankles, knees, and wrists.
• Strain. A strain is a twist, pull, or tear of a muscle or tendon, a cord of tissue connecting muscle to bone. Athletes who play contact sports can get strains, but they can also happen from repeating the same motion again and again, as in tennis or golf. Like sprains, strains can range from a minor stretch to a partial or complete tear of a muscle or tendon. This is most common in musclmusclesendons between two joints.
• Tendinitis. Tendinitis is inflammation of a tendon, a flexible band of fibrous tissue that connects muscles to bones. It often affects the shoulder, elbow, wrist, hip, knee, or ankle. Tendinitis can be caused by a sudden injury, but it usually results from carrying out the same motion over and over. People such as carpenters, gardeners, musicians, and certain types of athletes, such as golfers and tennis players, have a higher risk of tendinitis. Tendons become less flexible as you age, so you are more likely to get tendinitis as you get older.
• Bursitis. Bursitis is inflammation of the bursae (plural of “bursa”), small, fluid-filled sacs that act as cushions between a bone and other moving parts, such as muscles, tendons, or skin. Bursitis can be caused by a one-time event like a blow or fall. It can also result from repeating the same motion many times, like throwing a ball, or from prolonged pressure, such as from kneeling on a hard surface or leaning on the elbows. It usually affects the shoulders, elbows, hips, or knees.

Common Sports Injuries

Most sports injuries involve one or more of the types of musculoskeletal injuries described above. The joints are particularly susceptible because a person’s body places significant demands on them. Joints must provide both stability and flexibility, and they are complex structures that include several interconnected parts.

Some of the common injuries experienced by athletes and people who have jobs or hobbies that involve doing a repetitive motion include:

• Shoulder Injuries
  • Rotator cuff injury. These are the most common shoulder injuries. A rotator cuff is a group of four muscles and tendons that stabilize the shoulder joint. Rotator cuff injuries happen when the tendons or bursae near the joint become inflamed from overuse or a sudden injury. They are common in people with jobs that involve overhead motions, like painters, or athletes who repeatedly reach upward, such as tennis players and swimmers.
  • Impingement. This happens when the top of the shoulder blade puts pressure on the soft tissues beneath it when the arm is lifted. Tendinitis and bursitis can develop, limiting movement and causing pain. Repeated overhead movements, such as those used by swimmers, increase the risk of impingement.
  • Instability. Shoulder instability happens when the round end of the upper arm bone is forced out of its shallow socket, either partially or completely. Once the tendons, ligaments, and muscles of the shoulder become stretched or torn, the shoulder becomes “loose” and dislocations can occur repeatedly.
• Elbow Injuries
  • Tennis elbow (lateral epicondylitis). When you play tennis or other racket sports, the tendons in the elbow can develop small tears and become inflamed, causing pain on the outside of the elbow. Painters, plumbers, carpenters, and others who repetitively use their forearms are also at higher risk of getting tennis elbow.
  • Golfer’s elbow (medial epicondylitis). This is a form of tendinitis that causes pain in the inner part of the elbow. Pain may spread to the forearm and wrist. Golfers and others who repeatedly use their wrists or clench their fingers can develop it.
  • Little league elbow. This is a growth plate injury to the elbow caused by repetitive throwing in youths. It is most common in pitchers, but any young athlete who throws repeatedly can get it. The pain is in the inner part of the elbow.
  • Ulnar collateral ligament injury. Repeated throwing can cause tears to this ligament on the inner part of the elbow, causing pain and decreased throwing effectiveness.
• Knee Injuries
  • Runner’s knee. Also called jumper’s knee or patellofemoral pain syndrome, this condition causes pain or tenderness close to or under the kneecap (patella) at the front of the knee. It is common in runners, but it also affects people who are active in other ways, such as those who hike or cycle.
  • Fracture. Fractures can happen in any bone around the knee, but the kneecap (patella) is the most common, usually as a result of an event like a bad fall or a blow to the knee.
  • Dislocation. A large impact to the knee can cause the kneecap to be forced from the groove in the thigh bone (femur) and pushed out of alignment, causing the kneecap to slip out of position.
  • Torn ligament. When the knee is over-extended or twisted, the ligaments within it can tear. Anterior cruciate ligament (ACL) injuries are especially common in athletes. They often happen when the person changes direction suddenly or lands from a jump.
  • Meniscal tear. Meniscal cartilage serves as a shock absorber in the knee. An awkward twist or pivot can cause a tear. They are commonly torn when the knee suffers a sprain or complete tear of the knee ligaments.
  • Tendon tear. Tendon tears tend to be more common in middle-aged people who play sports that involve running and jumping. They often happen because of a forceful landing and sometimes from an awkward jump.
• Leg Injuries
  • Groin pull. Quick side-to-side motions can strain the muscles of the inner thighs and lead to a groin pull. People who play sports such as hockey, soccer, football, and baseball have a higher risk of groin pulls.
  • Hamstring strain. Three muscles run along the back of the thigh and form the hamstring. Activities that involve a lot of running, jumping, and sudden starts and stops place you at risk of a hamstring strain. Basketball, football, and soccer players commonly get them.
  • Shin splints. Shin splints referreferhe pain caused by inflammation of the muscles, tendons, and bone tissue along the inside length of the shinbone (tibia), the large bone in the front of the lower leg. The pain is usually on the inner side of the lower leg. Shin splints are primarily seen in runners, particularly those just starting a running program.
• Ankle Injuries
  • Ankle sprain. You can sprain your ankle when you roll, twist, or turn awkwardly turn your angle etching or tear the ligaments in the joint. It can happen when you land awkwardly when jumping or pivoting, when walking on an uneven surface, or when someone else lands on your foot. People who play sports in which there is a lot of pivoting, such as volleyball and basketball, are at risk of an ankle sprain.
  • Achilles tendinitis. An Achilles tendon injury results from a stretch, tear, or irritation to the tendon connecting the calf muscle to the back of the heel. The Achilles is the largest tendon in the body and you use it when you walk, run, climb stairs, jump, and stand on the tips of your toes. People with Achilles tendinitis usually feel pain and stiffness at the back of the heel, especially in the morning. Achilles tendinitis is usually a chronic condition caused by overuse, but serious cases can lead to a tear that may require surgery.

Cause of Sports Injuries

The cause of an acute sports injury is a force of impact that is greater than the body part can withstand, while a chronic injury is typically due to repeating the same motion over and over again. Sometimes, overuse injuries can degrade tissues and joints and set the stage for an acute injury.

Diagnosis

The musculoskeletal system (MSK) forms the structural components of the body; muscles, bones, joints, and connective tissues like tendons and ligaments surrounding these structures. The musculoskeletal examination is composed of several clinical tests. Broadly, a musculoskeletal system exam could classify as a:

• Screening MS exam- a quick assessment of overall structure and function
• Comprehensive MS exam – detailed exam is typically done by rheumatologists
• Regional/focused MS exam – more specific evaluation of partial color joint or other structure

Depending on the patient’s chief complaint, the ma appropriate musculoskeletal system exam is an option. Screening MS exam is typically a part of a complete physical examination or pre-participation physical examination of an athlete. The basic techniques of the musculoskeletal system exam are observation, palpation, and manipulation.[1]

Observation begins with accessing any visible gross abnormalities of skin and other components of the musculoskeletal system. Palpation uses firm pressure to identify and quantify the abnormalities of the musculoskeletal system, pain/tenderness, and triggand er points. Normal or abnormal findings that could be elicited by observation and palpation include symmetry/asymmetry – skin color and appearance, rash, ulcers, lack of sweating hair abnormalities – warmth and heat – Swelling including effusions, nodules, and inflammatory findings like synovial and periarticular thickening – muscle atrophy, tone, contractures, and spasms – crepitations – Joint deformities including spine like kyphosis and scoliosis. Manipulation consists of different techniques to access the range of motion (ROM), strength, sensations, reflexes, and gait. The proper evaluation consists mainly of testing strength (evaluate individually the muscle capacity and integrity), range of motion (evaluate the joint independently, its restrictions, and hypo or hypermobility), reflex and sensory function (evaluate dermatomes, reflex, and sensory function, to identify possibles correlations and dysfunctions between musculoskeletal and neural system), gait analysis (evaluate the integrated functions of locomotion), and trigger points (to evaluate myofascial pain, presence of trigger points and association with patient symptoms).

Range of Motion (ROM)

ROM could be either active or passive. An active ROM is patient-initiated, which can access not only joint mobility but also an intact musculoskeletal and nervous system. Passive ROM examination is done by undone initiating manipulation of the joint. ROM depends on the type of joint, and also it is important to know whether ROM is limited due to pain or guarding, weakness, or muscle or joint disease. CompaComparedhe unaffected side is indispensable. The assessment of a range of motion needs to be quantified (to avoid subjectivity bias), and for this, the use of a goniometer is indispensable. There are two types of goniometers; the first one is to use the universal goniometer and manually scale the ROM.[2] The second is to use the smartphone goniometric application. It has indications for greater precision methane as the thanuniversal goniometer.[3]

Strength

To evaluate strength, the Medical Research Council scale of muscle strength (MCR-scale) is commonly used that grades the strength into 0 to 5[4]:

• 0 – No contraction
• 1 – Flicker or trace of contraction
• 2 – Full range of active movement, with gravity eliminated
• 3 – Active movement against gravity
• 4 – Active movement against gravity and resistance
• 5 – Normal power

The bias of this scale is subjectivity depending on the experience, sensibility, and judgment of the health care professional. To avoid this bias, it is suggested to use a dynamometer.[2] Another way to evaluate the strength in more conditioned patients is by doing the 1RM (maximum load capacity for one repetition) strength test.[5]

Reflexes and Sensory Examination

The neuropathy impairment score (NIS) is one of the most direct scales to evaluate the correlations between the nervous system and the musculoskeletal system. It is possible to enhance the NIS by adding the dermatomal knowledge to the sensation test.[6] It scores the reflexes and sensation (touch-pressure, pin-prick, and vibration) as[7]:

• 0 – Normal
• 1 – Decreased
• 2 – Absent

Gait Analysis 

The most important human locomotion method is gait; it provides independence and allows functionality, being the basis of daily living activities. Clinical gait analysis is the evaluation and measurement of the biomechanical walking function, the relation between the upper body and the lower body, and the dislocation of the gravity center. The gait analysis can support and enhance clinical diagnosis, decision making, and patient clinical case follow-up.[8]

Trigger Points

Myofascial trigger points (MTrP) are common in individuals with musculoskeletal pain. A palpable taut band characterizes the trigger point with a hypersensitive spot in the muscle. There are active and latent trigger points; the difference between them is that the active trigger point causes spontaneous and referred pain when palpated, and the land patent trigger point causes local, and not spontaneous pain. The evaluation of the trigger points is based on the clinical exam, but the provider can use thermography and ultrasound images to avoid clinical misinterpretations and clarify the diagnosis. The clinical palpation exam should identify the following criteria:

Necessary Sign

• Palpable taut band in skeletal muscle
• Hypersensitive tender spot within the taut band
• Reproduction of referred pain in response to MTrP compression

Confirmatory Sign

• Local twitch response elicited by the snapping palpation of the taut band.[9][10][11]