Last reviewed: 21 Aug 2021
Last updated: 24 Jul 2018



Traumatic brain injury can be sustained during contact sports or high-risk recreational activities.[6] The initial approach is rapid assessment of airway, breathing, and circulation, and appropriate intervention if indicated.

Also called mild traumatic brain injury, this acute brain injury results from either a direct blow to the head or the transmission of an impulsive force to the head. Symptoms can be divided into 3 groups: cognitive, somatic, and affective. A combination of somatic and cognitive symptoms is most common.

Collection of blood between the dural and arachnoid coverings of the brain. May be acute or chronic, and the primary cause is trauma. It is the most common life-threatening injury encountered by boxers.[7] Typically presents with headache, nausea and vomiting, and confusion, which may be due to increased intracranial pressure, and diminished eye, verbal, and motor responses.

An acquired focal abnormal dilation of the wall of an artery in the brain. Usually hemodynamically induced, although trauma may contribute to formation. Stress and exertion can trigger rupture through hemodynamic effects. Patients typically present with new, not previously experienced, headache of variable character.

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space. This may be due to trauma or rupture of an intracranial aneurysm (which may be triggered by stress and physical exertion). Sudden severe headache, photophobia, and loss of consciousness are characteristic.

Sports are a frequent cause of these traumatic injuries. Blunt trauma to the globe of the eye (e.g., impact by a squash ball) can cause orbital floor and/or medial wall fractures. Fractures of the posterior orbit can also occur. In children, the bone of the orbit is more elastic and a "trapdoor" type of fracture may result. This can trap the inferior rectus muscle, or at least some orbital fat, preventing the eye from looking up. Without release of the entrapped muscle within 24 to 48 hours, irreversible ischemia of the muscle may occur, leading to a Volkmann ischemic contracture and irreversible visual mobility derangement, if not treated.

According to the United States Eye Injury Registry (USEIR) database, 13% of ocular injuries are the result of sports and recreational activities.[8] Contact sports not utilizing protective face gear and sports involving high-speed balls, such as field hockey, cricket, and squash, are notably dangerous in this regard. Injuries can range from minor abrasions through retrobulbar hematoma to open globe injuries.

Trauma is an important variable to determine in the history of a patient with retinal detachment. Depending on the type of trauma, detachment may occur within days or weeks (typically after an open globe injury) or months or years (typically after contusion).

Typical symptoms include a foreign body sensation (even if none is present), photophobia, excessive tearing, blepharospasm, and blurry vision. There may be a history of mild trauma, which can be followed by acute onset of ocular unease. Examination may find reduced visual acuity, conjunctival injection with corneal fluorescein stain seen in the affected eye, and the eyelid may be swollen.

Can be divided into nonspecific neck pain and whiplash. Nonspecific neck pain is pain with a postural or mechanical basis (cervical spondylosis), but excludes fibromyalgia pain. Nonspecific neck pain may include some patients with a traumatic basis for their symptoms, but does not include people for whom pain is specifically stated to have followed sudden acceleration-deceleration injuries to the neck (whiplash). Whiplash is commonly seen in sport-related injuries and road traffic accidents.

Acute spinal cord trauma is a medical emergency that requires swift diagnosis and treatment to prevent irreversible spinal cord injury and longterm disability.

Acute spinal cord injury should be suspected in any patient following trauma, particularly when the trauma is to the head or neck and when the patient is unresponsive due to hypotension and has respiratory compromise.

Can occur as a result of spine trauma, vertebral compression fracture, intervertebral disk herniation, primary or metastatic spinal tumor, or infection. The resulting spinal cord injury may be acute, subacute, or chronic, and occurs due to direct cord damage caused by compression and/or infiltration, or compromise of the vascular supply to the cord. Diagnosis is made by x-ray or MRI of the spine, but spinal cord injury may occur with no findings on imaging.

Most commonly results from contact sports, as well as from motor vehicle accidents, gunshot or stab wounds, or workplace accidents during heavy physical labor. May involve the upper 2 or 3 nerve roots (partial injury) or all 5 nerve roots (complete injury). Both partial and complete brachial plexus injuries can be successfully repaired, but complete injuries require multiple major operations over the course of several years, while partial injuries can often be corrected in a single operation.

Rotator cuff tears can result from an acute traumatic event, repetitive or vigorous overhead activity (such as throwing a baseball or weightlifting), or chronic degeneration. The most common presenting symptom is shoulder pain, which is typically aggravated by overhead activities. Other symptoms include shoulder weakness, loss of range of movement, and night pain.

Complete separation of 2 articulating bony surfaces, often the result of high-speed energy. Common dislocations include the shoulder, elbow, finger, patella, hip, and knee. Delayed treatment can result in irreparable damage to the joint surface with lifelong consequences and post-traumatic arthritis.

A chronic fibrosing condition characterized by insidious and progressive, severe restriction of both active and passive shoulder range of motion, in the absence of a known intrinsic disorder of the shoulder. It is generally considered to be a self-limited condition and usually resolves within 18 to 24 months; severe and protracted cases may require surgical intervention.

Occurs when the median nerve is compressed at the wrist. This results in muscle weakness, paresthesias, and pain in the hand. Wheelchair athletes have very high rates of carpal tunnel syndrome. The mechanism may be secondary to the inevitably higher force through the wrist, or the prolonged extremes of posture.[9][10]

Epicondylitis of the elbow is a condition associated with repetitive forearm and elbow activities.[11][12] Both lateral epicondylitis (commonly known as "tennis elbow") and medial epicondylitis (commonly known as "golfer's elbow") are characterized by elbow pain during or following elbow flexion and extension. Sporting activities commonly implicated include tennis, fencing, golf, rowing, and baseball (pitching). A combination of poor mechanics, microtears in areas of hypoperfusion, and a delayed healing response contribute to the pathophysiology of the condition.[13][14] A diagnosis can be made with a comprehensive history and physical exam.

Wrist fractures include fractures that affect the distal ends of the radius, ulna, and carpus. Fractures of the distal radius are the most common injury, and are usually located within the distal 2.5 cm.[15] In a small proportion of patients, concomitant fractures of the distal radius and scaphoid can occur.[16]

Arises as a stenosing tenosynovitis where a tendon passes through its corresponding retinacular sheath. Repetitive shear stress through the sheath canal causes irritation to the tendon and its synovial lining (tenosynovium) with inflammation and hypertrophy, along with fibrosis of the retinacular sheath. Over time, the canal will narrow to a point that precludes smooth gliding of the tendon. Participants in racquet sports, athletic throwing events, and rowing may be particularly vulnerable to developing this condition due to repetitive movements of the hand and wrists involved.

A general term that describes tendon degeneration characterized by a combination of pain, swelling, and impaired performance. Approximately 10% of runners develop Achilles tendinopathy, presenting with insidious onset of heel pain, often after a sudden increase in training intensity. Patellar tendinopathy (jumper's knee) is common in jumping sports or activities that involve repetitive knee extension (e.g., volleyball, basketball, and soccer). Patients present with an insidious onset of well-localized anterior knee pain located at the inferior pole of the patella.

Lower back pain (LBP) is a symptom, but not a diagnosis. The majority of patients (85% or more) who present to primary care have low back pain that cannot reliably be attributed to any specific cause (nonspecific low back pain).[17] Various spinal structures including ligaments, facet joints, paravertebral musculature and fascia, intervertebral disks, and spinal nerve roots have been implicated as pain generators.[18] Although the causes are numerous, a thorough history and physical examination helps elucidate the diagnosis in the majority of patients. Lumbar strain/sprain and compression fracture are examples of causes of mechanical back pain (pain that is elicited with spinal motion and decreases with rest) that may be connected to sport-related injuries.[19]

Muscular, fascial, and ligamentous sprain/injury can cause lower back pain (LBP). Muscle spasms may be associated with a dull, gnawing, tearing, burning, or electric pain. Typically, pain does not radiate to the legs or beyond the knee. LBP may arise as an overuse injury among sportsmen such as weightlifters.[20]

The character of chest pain should be determined to help differentiate between cardiac, respiratory, musculoskeletal, and other causes. Pain in the chest may be referred (e.g., from cervical spine or shoulders).[21]

Middle ribs are most commonly fractured. The lower rib can injure the diaphragm if fractured. The first rib is the least commonly fractured but fractures can result in brachial plexus injury.

Causes of acute/traumatic groin pain include muscle strains, contusions, hip subluxation or dislocation, labral tears, chondral injuries, and fractures. Chronic/overuse causes include bursitis, tendonitis, athletic pubalgia (sports hernia), osteitis pubis, snapping hip syndrome, and stress fractures.[22] In certain sports (e.g., soccer and ice hockey) the incidence of groin injuries may be as high as 18%.[4]

Disabling pain in the coccyx exacerbated by sitting or rising from sitting. The pain is often pulling or lancinating in quality, may radiate to the sacrum or buttock, and may coexist with lower back pain. Coccygodynia may be traumatic or idiopathic in origin and is more common in women.

Generally considered to be any fracture of the femur distal to the femoral head and proximal to a level a few centimeters below the lesser trochanter.

A strain is an injury to the muscle or musculotendinous junction, whereas a sprain is an injury to the ligament. Muscle contusion occurs when a muscle is subjected to a sudden, heavy compressive force, such as a direct blow to the muscle. Acute ankle injury is one of the most common musculoskeletal injuries in athletes, accounting for 20% of all sports injuries in the US.[23][24][25]

Traumatic knee injuries are usually differentiated based on contact versus noncontact knee injuries. In addition, they may be defined as either high-velocity or low-velocity injuries, especially in the case of knee dislocations.

Usually occurs as the result of an acute noncontact deceleration injury, forceful hyperextension, or excessive rotational forces about the knee.[26][27] Presenting signs and symptoms include an audible "pop," rapid knee swelling, inability to return to activity, and a sensation of knee instability. About 70% of anterior cruciate ligament (ACL) tears occur during sports activities. Sports associated with ACL injuries include football, soccer, basketball, and skiing.

Occurs when excessive valgus stresses or external rotational forces are placed on the knee joint. The most common symptom is medial-sided knee pain above or below the joint line. Patients are usually able to walk. The incidence of medial collateral ligament (MCL) injury is highest in sports such as football (55%),[28] skiing (15% to 20% of all injuries and 60% of all knee injuries),[29] and rugby (29%)[30], where valgus (twisting outward away from the midline) and external rotational forces on the knee are commonly experienced. MCL injuries can also occur in noncontact sports.

An injury of 1 or both menisci, which are located in the knee joint between the femoral and tibial articulating surfaces. A meniscus tear can occur suddenly through a traumatic incident or it can develop gradually within the course of age-related wear of the knee. It usually causes pain in the knee joint.

Defined as knee pain resulting from mechanical and biochemical changes to the patellofemoral joint. Patellofemoral problems are the most common symptom in a sports medicine practice and very common in a general orthopedic practice. The causes of patellofemoral problems are multifactorial. There is no one physical exam test that is a standard for a diagnosis.

In bursitis there is thickening and proliferation of the synovial lining, bursal adhesions, villus formation, tags, and deposition of chalky deposits. This may result from repetitive stress, infection, autoimmune disease, or trauma. Key diagnostic findings are localized pain and tenderness over a bursa and swelling if superficially sited.

An overuse syndrome that typically affects young athletes during their adolescent growth spurt. It presents with pain, tenderness to palpation, and swelling directly over the tibial tubercle. It is typically self-limited and resolves after a period of activity modification and when the patient reaches skeletal maturity.[31] High-risk sports are those that demand repeated forceful knee extension (e.g., running, jumping, squatting, and deep knee bending), including track, football, rugby, basketball, baseball, and soccer.[31][32]

Popliteal cyst, also known as Baker cyst, is the result of an accumulation of synovial fluid outside the joint that forms behind the knee. This occurs via increased intrasynovial pressure and causes the synovial capsule to bulge at an area where there is a lack of external anatomic support.[33] The most common underlying conditions that lead to overproduction of synovial fluid include arthritis and meniscal tears, both of which can arise from sporting injury.

An acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration, with or without articular cartilage involvement and instability.[34][35][36] Increasingly seen as a cause of joint pain (knee, ankle, or elbow) in adolescent and young adult athletes due to earlier and more demanding participation in competitive sports. Osteochondritis dissecans is strongly associated with baseball, gymnastics, weightlifting, racquet sports, and cheerleading.[37] Key diagnostic factors depend on the affected joint, but include effusion and pain exacerbated by increased activity and use of the involved joint,[38][39] and pain at the posteromedial aspect of the dorsiflexed ankle, anterolateral aspect of the plantar flexed ankle,[40] anteromedial aspect of the knee when flexed to 90 degrees, or lateral aspect of the elbow.

The most common cause of lateral knee pain in runners. Characterized by a sharp or burning pain roughly 2 cm superior to the lateral joint line. Pain may radiate and there may be local edema and crepitation. Runners predisposed to iliotibial band syndrome (ITBS) are typically overtraining and often have an underlying weakness of the hip abductor muscle.[41][42][43][44] ITBS is also common in cyclists, and may be seen in athletes participating in volleyball, tennis, soccer, skiing, weightlifting, and aerobics. It is unusual in nonathletes.

Although the majority of cases of muscle cramps are of a benign, self-limited nature, muscle cramps can also be symptomatic of a wide variety of potentially serious systemic disorders.

Compartment syndrome is characterized by elevated interstitial pressure in a closed osseofascial compartment, resulting in restriction of capillary blood flow. The anterior and deep posterior compartments of the leg and the volar compartment of the forearm are most commonly affected. It can arise acutely from bony or soft-tissue traumatic injury, or can occur as a chronic and recurrent condition as a result of intense muscular activity.

The term "ankle fracture" generally refers to a fracture of the medial, lateral, or posterior malleolus. A "pop" is commonly heard on falling. Tenting of the skin over the medial malleolus and ankle deformity is a common sign of dislocation. Sporting injury is the third most common cause of ankle fractures (10.2%).[45]

Acute or chronic pain in the inferior heel at the attachment of the medial band of the plantar fascia to the medial calcaneal tubercle. It has been described as a chronic inflammatory process and may be an overuse injury.[46] Pain is self-limited and usually resolves after 6 to 18 months without treatment.[47] Patients may not be able to recall any preceding trauma to the foot. Occurs in approximately 10% of people who run regularly.[48][49]

May occur after some acute injuries, as part of degenerative diseases, or as primary conditions (e.g., migraine, fibromyalgia). The causes of chronic pain are many and may be due to musculoskeletal (mechanical) causes, neurologic causes, causes of headache, psychological causes, or localized disease, or as part of a generalized disease process.

The preparticipation physical examination (PPE) is a clinical examination used to evaluate athletes for injuries, illnesses, or other conditions that might increase the risk of harm to them or others when participating in sports.[50][51][52][53] A PPE is a legal or administrative requirement for many competitive athletes in the US. Although the PPE is often considered a screening tool, it can also be used to evaluate the suitability of athletes with known conditions to participate in a particular athletic endeavor.



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