Stress Fractures of the Femoral Neck

Stress fractures are caused by repetitive overload and overuse. Stress fractures are classified into two types based on etiology insufficiency fractures and fatigue fractures. Insufficiency fractures are most commonly seen in the elderly population with osteoporosis and other underlying bone diseases and are defined as fractures of abnormal bone subjected to normal forces. Fatigue fractures are most often seen in young athletes, especially those involved in running and jumping, and are seen in...

Medial Epicondylitis

Commonly referred to as golfer's elbow, medial epicondylitis is an injury to the common flexor tendons (i.e., flexor carpi radialis). Compared with lateral epicondylitis, it is seen < 10 of the time, and results from repetitive microtrauma from valgus stress on the medial epicondyle. Athletes typically present with pain and tenderness over the medial elbow. In more chronic cases, weakness can be reported the forearm and wrist. Diagnosis is based primarily on physical exam and history. Pain on...

Heel Fat Pad Contusion

The fat pad over the heel of the foot serves as a shock absorber. It may be injured either by excessive forces being placed repetitively on the heel or due to a traumatic event such as a direct blow to the bottom of the heel. This type of injury occurs in sports players such as runners, long jumpers, and hurdlers, who have repetitive stresses placed on the heel. Footwear with poor heel cushioning also predisposes patients to this type of injury. Heel pain that occurs with weight-bearing and...

Internal Disc Disruption

As has been discussed, the nerve fibers in the disc are present in the outer third of the annulus. There have been limited reports of these fibers extending into the middle third of the annulus. For a disc to cause pain there must be irritation of these fibers by a tear in the annulus. Once there is an annular tear, mechanical pressures as well as chemical irritation from inflammatory substances within the nucleus pulposus leads to back pain. X-rays may reveal decreased disc space, but they may...

Key Cardiovascular Risk Factors

Persistent high blood pressure (upper limits of normal 130 75 in children less than 10 years old, 140 85 in children over 10). 4. High cholesterol (elevated serum total and LDL cholesterol and low serum HDL cholesterol). 6. History of cardiac symptoms palpitations, dizziness collapse, shortness of breath, or chest pain. Table 1.1 Preparticipation physical evaluation Explain Yes answers. Circle questions you don't know answers to. 1. Have you had a medical...

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve. Although compression of the median nerve can occur at multiple levels, CTS refers to compression at the wrist by the transverse carpal ligament. The degree of symptoms depends on the chronicity and degree of compression. Symptoms can progress from purely sensory to include motor loss with associated atrophy. Sensation loss occurs at the tips of the first three fingers and may travel to the forearm and wrist. Weakness...

Facet Joint Syndrome

The facet joints in the back are paired synovial joints. They allow the spine to flex and extend and help prevent anterior and posterior displacement. Trunk extension and oblique extension in particular loads the facet joints. Just like any other synovial joint (e.g., knee), the facet joints can become arthritic and painful. In fact, as much as 40 of chronic lower back pain in older individuals, and 20 of younger individuals is thought to be due to facet joint disease. Sports that involved...

Transient Brachial Plexopathy and Radiculopathy 341 Mechanism of Injury

Transient brachial plexopathies and radiculopathies, commonly referred to as stingers or burners result from trauma to the brachial plexus or nerve roots. The mechanism of injury is traction to these neurological structures that occur when the head is forcibly laterally tilted and extended as the contralateral shoulder is depressed. They often occur at the time of a block or tackle in football. As many as 65 of collegiate football players are diagnosed with at least one career stinger most of...

Ankle Sprains

Lateral ankle sprains are the most common form of ankle sprains and are caused by excessively inverting the ankle. This injury occurs in sports involving jumping (e.g., basketball, volleyball) when an athlete lands incorrectly and in sports involving abrupt direction changes (e.g., football, soccer). These ankle sprains involve partial or complete tears of the (ATFL, CFL, and or PTFL, which are listed from most to least often injured. Damage to the medial ligamentous structures (i.e., deltoid...

Spondylolysis and Spondylolisthesis

One of the most common causes of lower back pain in the young athlete involves a stress fracture of the pars interarticularis. The pars interarticularis is stressed with lumbar extension. Athletes who participate in activities involving repetitive extension (e.g., gymnasts, ballet dancers, divers, baseball pitchers) are at increased risk to suffer a pars stress fracture. Once a pars fracture has occurred, particularly if it occurs bilaterally, the athlete may go on to develop a...

Lower Face

The mandible is a U-shaped bone, composed of the body, two rami, and their articulating temporomandibular joints. It is the only mobile bone of the facial skeleton, and proper motion is essential for adequate mastication. Fractures of the mandible are common. These fractures can involve any region of the body, ramus, condyle, or joint. The direction and magnitude of the force influence the sites of the fracture and the amount and direction of bone displacement. Complicated mandible fractures...