MUSCULOSKELETAL INJURIES

FRACTURE = BREAK! 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 or direct hit to an area can cause a fracture or break in the bone, and the severity depends on the force that caused the break. The bone may crack, break all the way through, or shatter. Fractures where the bone goes through the skin are called compound fractures and are especially serious because of the increased risk of infection. Most acute fractures are emergencies.

• Stress fractures. Stress fractures usually occur in the weight-bearing bones of the lower extremity- femur, tibia, fibula, and foot bones. They are common in sports where there is repetitive impact, like running and jumping, which include cross country, track, and basketball. Fun fact: running creates forces on the lower limbs that are 2-3 TIMES your body weight!

• Growth plate fractures. The growth plate is an area of cartilage near the ends of long bones which allow the bones to lengthen until you reach your full height. Growth plates are especially vulnerable to injury until they are converted to bone, which usually happens by the time you turn 20. Growth plate fractures can result from an acute traumatic event or from chronic stress and overuse.

Two bones that come together form a joint and when the joint becomes separated, it's described as dislocated. Contact sports such as football, basketball, and rugby, and any sport that involves significant stretching or falling, cause most dislocations. A joint dislocation can be a very painful injury and typically requires immediate medical treatment. Sometimes the bones move back into place on their own, but often the need to be manually relocated or reduced.  Joint dislocations most commonly occur in the shoulder, elbow, fingers, and kneecap (patella); a true knee dislocation is not as common, but is a VERY serious injury.

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 degree (a complete tear). Areas of the body most vulnerable to sprains are ankles, knees, and wrists.

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. 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 muscle or tendons between two joints.

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. Tendons become less flexible as you age, so you are more likely to get tendinitis as you get older.

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.

• Rotator cuff injury. These are the most common shoulder injuries. The 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.

• 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.

• 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 whohike 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.

• 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 refers to the 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 sprain. You can sprain your ankle when you roll, twist, or turn your ankle in an awkward way, stretching or tearing 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.