This page compiles our content related to sport-related injuries. For further information on diagnosis and treatment, follow the links below to our full BMJ Best Practice topics on the relevant conditions and symptoms.
Introduction
Relevant conditions
go to our full topic on Evaluation of acute traumatic brain injury
Traumatic brain injury (TBI) is a disruption of the normal function or structure of the brain caused by a head impact or external force.[7][8] Blunt trauma, penetrating injuries, and blast injuries may all cause TBI. The initial approach is rapid assessment of airway, breathing, circulation, and disability, with appropriate interventions as indicated.
go to our full topic on Concussion
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.
go to our full topic on Subdural hematoma
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.[9] Typically presents with headache, nausea and vomiting, and confusion, which may be due to increased intracranial pressure, and diminished eye, verbal, and motor responses.
go to our full topic on Cerebral aneurysm
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.
go to our full topic on Subarachnoid hemorrhage
Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space and is an emergency. 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.
go to our full topic on Orbital fractures
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.Urgent surgery is indicated in pediatric patients with signs of soft tissue (muscle) entrapment.
go to our full topic on Eye trauma
A leading cause of visual loss and blindness that frequently affects young people. Injuries range from mild, non-sight-threatening (e.g., corneal abrasions or superficial corneal foreign bodies) to extremely serious with potentially blinding consequences (e.g., open globe injuries or intraocular foreign body injuries). Sports and recreational injuries are an important cause of ocular trauma worldwide.
go to our full topic on Retinal detachment
An acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium with accumulation of subretinal fluid and loss of retinal function. Trauma is an important risk factor for retinal detachment.[10] 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).
go to our full topic on Corneal abrasions
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, followed by acute onset of ocular unease. Examination may find reduced visual acuity, conjunctival injection with corneal fluorescein stain in the affected eye, and ciliary flush.
go to our full topic on Evaluation of neck pain
The most common causes of neck pain are cervical spondylosis (osteoarthritis of the spine) and whiplash; other causes include musculoskeletal, neurologic, neoplastic, and infectious processes. Whiplash is commonly seen in sport-related injuries and road traffic accidents. Injury is a strong predictor of chronic neck pain.[11]
go to our full topic on Acute cervical spine trauma
Cervical spine injuries result primarily from motor vehicle accidents, falls, sports (e.g., rugby, American football, trampolining), and diving into shallow water. Higher-energy mechanisms of injury, as well as those associated with head or face strikes, carry a higher risk of an unstable cervical spine injury. In all cases, careful investigation is required to ensure that the stability of the cervical spine has not been compromised, because, in extreme cases, cervical spine instability can lead to progressive neurologic deficit, quadriplegia, and even death.
go to our full topic on Thoracolumbar spine trauma
Thoracolumbar spine trauma usually occurs as a result of high-energy trauma; approximately 10% are sport-related.[12] Thoracolumbar fractures are the usual outcome of thoracolumbar trauma. 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.
Spinal cord compression
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. Acute spinal cord compression is a medical emergency that requires swift diagnosis and treatment to prevent irreversible spinal cord injury and long-term disability.
go to our full topic on Brachial plexus injury
Brachial plexus injuries are usually caused by trauma to the roots of the plexus as they exit the cervical spine.[13] 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.
go to our full topic on Rotator cuff injury
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 functional weakness, loss of range of movement, night pain, and deltoid pain.
go to our full topic on Joint dislocation
Complete separation of 2 articulating bony surfaces, often the result of sudden impact to the joint. Common dislocations include the shoulder, elbow, finger, patella, and hip. Treatment is usually closed reduction, as soon as possible, to decrease potential complications, which may include soft tissue injury, articular surface injury, and neurovascular compromise.
go to our full topic on Adhesive capsulitis
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.
go to our full topic on Carpal tunnel syndrome
Occurs when the median nerve is compressed at the wrist. Typical symptoms include numbness and tingling mainly in the thumb and radial fingers, aching and pain in the anterior wrist and forearm, and clumsiness 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.[14][15]
go to our full topic on Epicondylitis
Epicondylitis of the elbow is a condition associated with repetitive forearm and elbow activities.[16][17] 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.[18][19]
go to our full topic on Wrist fractures
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 typically caused by a fall on the outstretched hand.[20] In a small proportion of patients, concomitant fractures of the distal radius and scaphoid can occur.[21]
go to our full topic on Tenosynovitis of the hand and wrist
A group of entities with a common pathology involving the extrinsic tendons of the hand and wrist and their corresponding retinacular sheaths. They usually start as tendon irritation manifesting as pain, and can progress to catching and locking when tendon gliding fails. Trigger digits and de Quervain disease are the two most common forms of stenosing tenosynovitis.
go to our full topic on Tendinopathy
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.
go to our full topic on Evaluation of back pain
Lower back pain (LBP) is a symptom, not a diagnosis. Various spinal structures including ligaments, facet joints, paravertebral musculature and fascia, intervertebral disks, and spinal nerve roots have been implicated as pain generators.[22] However, most low back pain is nonspecific and the cause cannot be identified.[23][24] A thorough history and physical examination helps elucidate the diagnosis.
go to our full topic on Musculoskeletal lower back pain
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. An exclusion diagnosis is made by eliminating specific causes of lower back pain arising from neurologic compromise, neoplasia, inflammatory arthritis, fracture, and referred pain from other locations or organ systems.
go to our full topic on Evaluation of chest pain
Chest pain may be caused by either benign or life-threatening aetiologies and is usually divided into cardiac and noncardiac causes. The character of chest pain can help differentiate between cardiac, respiratory, musculoskeletal, and other causes. Pain in the chest may be referred (e.g., from the right shoulder).[25]
go to our full topic on Rib fractures
A break in the rib bone of the thoracic skeleton. Rib fractures can be relatively benign, but often may be a marker of concomitant injuries such as pneumothorax, hemopneumothorax, and/or pulmonary contusions. An increased number of fractured ribs correlates with increased morbidity and mortality.
go to our full topic on Groin pain
A very common injury resulting from physical activity, including sport. Most common is adductor-related, iliopsoas-related, inguinal-related, and hip-joint-related groin pain. In certain sports (e.g., soccer and ice hockey) the incidence of groin injuries may be as high as 18%.[5]
go to our full topic on Coccygodynia
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, nontraumatic, or idiopathic in origin and is more common in women.
go to our full topic on Hip fractures
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. Associated most commonly with low-energy injury in older people (e.g., fall from standing height) and osteoporosis or osteopenia. In younger patients, the primary etiology is high-energy trauma including motor vehicle accidents and falls from height.[26]
go to our full topic on Musculoskeletal sprains and strains
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.[27][28][29]
go to our full topic on Evaluation of knee injury
Among the most reported sports injuries.[30][31][32] Traumatic knee injuries are usually differentiated based on contact versus noncontact mechanism of injury. In addition, they may be defined as either high-velocity or low-velocity injuries, especially in the case of knee dislocations.
go to our full topic on Anterior cruciate ligament injury
Usually occurs as the result of an acute noncontact deceleration injury, forceful hyperextension, or excessive rotational forces about the knee.[33][34] 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.
go to our full topic on Medial collateral ligament injury
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 American football (55%), skiing (15% to 20% of all injuries and 60% of all knee injuries), and rugby (29%), where valgus (twisting outwards away from the midline) and external rotational forces on the knee are commonly experienced.[35][36][37] MCL injuries can also occur in noncontact sports.
go to our full topic on Meniscal tear
The medial and lateral menisci are shock absorbers and force distributors located between the femur and the tibia. Menisci can tear due to traumatic injury or degenerative wear (e.g., in knee joint arthritis), and can compromise force distribution across the knee joint. The athletic population is at greatest risk, especially those who participate in twisting sports (commonly football and basketball). Common complaints include catching, locking, or buckling of the knee, knee pain, or any combination of these symptoms.
go to our full topic on Patellofemoral pain syndrome
Defined as knee pain resulting from mechanical and biochemical changes to the patellofemoral joint. Patellofemoral pain syndrome is one of the most common disorders of the knee, accounting for 25% of knee injuries seen in the sports medicine clinic.[38] The causes of patellofemoral problems are multifactorial, including abnormal patellofemoral joint mechanics, lower kinetic chain alterations, and overuse.
go to our full topic on Bursitis
An acute or chronic inflammatory condition of a bursa. 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.
go to our full topic on Osgood-Schlatter disease
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 with ultimate resolution occuring when the patient reaches skeletal maturity.[39] 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.[39][40]
go to our full topic on Popliteal cyst
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.[41] 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.
go to our full topic on Osteochondritis dissecans
An acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration, with or without articular cartilage involvement and instability.[42][43][44] Increasingly seen as a cause of joint pain (knee, ankle, or elbow) in adolescent and young adult athletes possibly due to earlier and more demanding participation in competitive sport. Osteochondritis dissecans is strongly associated with baseball, gymnastics, weightlifting, and racquet sports.[45]
go to our full topic on Iliotibial band syndrome
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.[46][47][48][49] 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.
go to our full topic on Muscle cramps
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. People carrying out strenuous exercise, particularly in endurance events such as triathlons (68%), marathons (39%), and ultramarathons (100%), are predisposed to exercise-associated muscle cramps (EAMC).[50][51] People participating in team sport are also predisposed to EAMC (e.g., rugby: 52%, cycling: 60%).[50]
Compartment syndrome of the extremities
Signs & symptoms
Investigations
Differentials
Treatment algorithm
go to our full topic on Compartment syndrome of the extremities
Compartment syndrome is characterized by elevated interstitial pressure in a closed osteofascial 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.
go to our full topic on Ankle fractures
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%).[52]
go to our full topic on Plantar fasciitis
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.[53] Pain is self-limited and usually resolves after 6 to 18 months without treatment.[54] Patients may not be able to recall any preceding trauma to the foot. Occurs in approximately 10% of people who run regularly.[55][56]
go to our full topic on Chronic pain syndromes
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.
go to our full topic on Sports preparticipation physical
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.[57][58][59][60] 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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Disclosures
This overview has been compiled using the information in existing sub-topics.
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