Sport-related injuries may be generally categorized as acute or chronic; the range of medical conditions potentially resulting from sport- or exercise-related injuries is wide. Contusions, strains, and sprains are the most common sport-related injuries.[1] [2] Contact sports (e.g., soccer, hockey) may increase the risk of contusion, whereas sprinting and jumping are the most common activities associated with muscle strains.[3] [4] Predisposing factors for muscle sprains and strains and other types of musculoskeletal injury include type of muscle architecture, muscular imbalance, previous injury, fatigue, chronic overload, and inadequate warm-up prior to exercise.[5] [6]
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Overview
Related Diseases & Conditions
Summary
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. TBI most frequently occurs in very young children (ages 0 to 4 years), and in adolescence and young adulthood (ages 15 to 24 years), with a subsequent peak in incidence in older adults (ages over 65 years).[9] The initial approach is rapid assessment of airway, breathing, circulation, and disability, with appropriate interventions as indicated.Summary
Also called mild TBI, this acute brain injury results from either a direct blow to the head or the transmission of an impulsive force to the head, resulting in a change to mental status.[10] A task force commissioned by the World Health Organization (WHO) estimates the incidence of mild TBI to be 600 per 100,000 people worldwide.[11] Symptoms can be divided into 3 groups: cognitive, somatic, and affective. A combination of somatic and cognitive symptoms is most common. Diagnosis of mild TBI is clinical. Selected patients may be admitted to hospital for observation.Summary
Collection of blood between the dural and arachnoid coverings of the brain. May be acute or chronic, and the primary cause of both is trauma.[12] Occurs commonly in older people (ages over 65 years), and are frequently associated with falls or anticoagulant use.[13] [14] Typically presents with headache, nausea and vomiting, and confusion, which may be due to increased intracranial pressure, and diminished eye, verbal, and motor responses.Summary
An acquired focal abnormal dilation of the wall of an artery in the brain. Usually hemodynamically induced, although trauma may contribute to formation. Autopsy studies indicate that cerebral aneurysms are fairly common in adults, with a prevalence ranging between 1% and 5%.[15] [16] Stress and exertion can trigger rupture through hemodynamic effects. Patients typically present with new, not previously experienced, headache of variable character.Summary
Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space and is an emergency. The most common cause of nontraumatic SAH is rupture of an intracranial aneurysm.[17] Worldwide, almost 500,000 individuals develop a SAH caused by an aneurysm each year, with almost two-thirds of these in low- and middle-income countries.[18] Sudden severe headache, (thunderclap headache), vomiting, photophobia, and nonfocal neurologic signs (which may include loss of consciousness) are characteristic of SAH.Summary
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. One study showed that approximately 18% of sports-related injuries led to an orbital fracture in children.[19] 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.Summary
Refers to any injury to the eye. A leading cause of visual loss and blindness that frequently affects young people. Injury may be due to mechanical trauma (blunt or penetrating), chemical or thermal burns, or exposure to radiation (ultraviolet or ionizing). The WHO has estimated that up to 55 million people experience eye injury each year, with 1.6 million developing blindness, 2.3 million developing bilateral low vision, and almost 19 million developing unilateral blindness or low vision.[20] Injuries range from mild, non-sight-threatening (e.g., closed globe injuries) to extremely serious with potentially blinding consequences (e.g., open globe injuries).Summary
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. Men appear to be affected more often than women, with an estimated male-to-female ratio of 1.3:1.[21] [22] Trauma is an important risk factor for retinal detachment.[23] Depending on the type of trauma, detachment may occur within days to weeks (typically after an open globe injury) or months to years (typically after contusion).Summary
Corneal epithelial defects. Typical symptoms include a foreign body sensation (even if none is present), photophobia, excessive tearing, blepharospasm, and blurry vision. Corneal abrasions are common eye injuries in both men and women across all age groups, but occur more frequently in men due to higher-rates of occupational eye injuries.[24] Strong risk factors include eye trauma, frequent use of contact lens, and lack of protective eye wear utilization in occupations that require them (such as the automobile industry).[25] [26] Exam may find no change in visual acuity with minor defects that occur outside of the visual axis, and an exposed basement membrane with corneal fluorescein stain in the affected eye.Summary
The most common causes of neck pain are cervical spondylosis (osteoarthritis of the spine) and whiplash; other causes include musculoskeletal, neurologic, neoplastic, infectious processes, and vascular. The estimated lifetime prevalence of a significant episode of neck pain is 40% to 70%, and the global point prevalence of neck pain is 4.9%.[27] [28] Whiplash is commonly seen in sport-related injuries and road traffic accidents. Approximately 20% to 40% of patients with whiplash injury will go on to have chronic neck pain.[29] Injury is a strong predictor of chronic neck pain.[30]Summary
Wide range of potential injuries to ligaments, muscles, bones, and the spinal cord. 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.Summary
Breakages in the vertebrae of the spinal column in the thoracic and lumbar regions. Thoracolumbar spine trauma usually occurs as a result of high-energy trauma; approximately 10% are sport-related.[31] Thoracolumbar fractures are the usual outcome of thoracolumbar trauma. If acute spinal cord injury is suspected (with or without vertebral column injury) the patient should be transferred to the nearest trauma center so that life-threatening conditions can be identified and treated before transfer to a spinal cord injury center.- Spinal cord compression
Summary
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. Summary
Brachial plexus injuries are usually caused by trauma to the roots of the plexus as they exit the cervical spine.[32] 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. One study of 4538 polytrauma patients found that about 1% presenting to a tertiary trauma facility had sustained brachial plexus injuries.[33] Subgroups of patients with motorcycle and snowmobile injuries had higher rates of brachial plexus injury (about 5%).Summary
The spectrum of rotator cuff pathology is one of the most common groups of conditions affecting the adult shoulder. Rotator cuff tears can result from an acute traumatic event, repetitive or vigorous overhead activity (such as throwing a baseball or weightlifting), or chronic age-related degeneration. One systematic review found that prevalence of rotator cuff abnormalities ranged from 9.7% in patients ages 20 years and younger to 62% in patients ages 80 years and older.[34] The most common presenting symptom is shoulder pain, which is typically aggravated by overhead activities. Other symptoms include functional shoulder weakness, loss of range of motion, night pain, and deltoid pain.Summary
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. Anterior shoulder dislocations account for more than 95% of shoulder dislocations and are the most common major joint dislocation.[35] Sports-related activities are one of the most common causes of shoulder, elbow, finger, patellar, and hip dislocations.[36] [37] [38] Symptoms and signs of joint dislocation include pain, swelling, characteristic posturing, and the inability to move.Summary
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. Adhesive capsulitis affects 2% to 5% of the population. In primary (idiopathic) adhesive capsulitis, no underlying etiology or cause can be identified. On occasion, a contributing factor may be identified, such as diabetes mellitus, trauma, previous shoulder surgery, or thyroid dysfunction.[39] [40] [41] [42] [43] This is then referred to as secondary adhesive capsulitis.[41] [44] It is generally considered to be a self-limited condition and usually resolves within 18 to 24 months.Summary
Collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel. 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. Carpal tunnel syndrome is the most common entrapment neuropathy (prevalence about 1 in 25). 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.[45] [46]Summary
Epicondylitis of the elbow is a condition associated with repetitive forearm and elbow activities.[47] [48] 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.[49] [50] Increasing age is a contributing factor in epicondylitis development.[51] [52] [53] [54]Summary
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.[55] Falls on the outstretched hand, as a result from sporting activities, are one of the most common causes of wrist fractures.[56] [55] [57] [58] [59] [60] In a small proportion of patients, concomitant fractures of the distal radius and scaphoid can occur.[61]Summary
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.[62] Trigger digits and de Quervain disease (thumb extensor tendonitis in the first dorsal compartment) are the two most common forms of stenosing tenosynovitis.Summary
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.Summary
Lower back pain 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.[63] The cause of back can be divided into mechanical, systemic, and referred. Mechanical causes are the most common for back pain with a prevalence of 97%.[63] However, most low back pain is nonspecific and the cause cannot be identified.[64] A thorough history and physical examination helps elucidate the diagnosis.Summary
Pain, stiffness, and/or soreness of the lumbosacral region (underneath the twelfth rib and above the gluteal folds). Muscular, fascial, and ligamentous sprain/injury can cause lower back pain. 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. Lower back pain has a lifetime prevalence of approximately 39% to 84%.[65] [66] [67] 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.Summary
Chest pain may be caused by either benign or life-threatening etiologies and is usually divided into cardiac and noncardiac causes. The character of chest pain can help differentiate between cardiac, respiratory, musculoskeletal, and other causes. Acute chest pain warrants rapid clinical assessment, as underlying disease can be life-threatening.[68]Summary
A break in the rib bone of the thoracic skeleton. Rib fractures may be due to blunt force injury, falls, nonaccidental injury, cardiopulmonary resuscitation, sporting activities, or metastatic lesions and primary bone tumors. Stress fractures can occur in golfers, swimmers, baseball players, and competitive rowers.[69] [70] [71] Rib stress fracture occurs in 2% to 12% of rowers as a result of cyclic loading to the rib cage.[72] 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.Summary
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]Summary
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.Summary
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.[73] Patients typically present with hip pain following a fall or trauma, with substantially reduced movement around the joint and inability to bear weight.Summary
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.[74] [75] [76] History and physical exam are key in diagnosis and grading of the injury as grade 1 (mild), 2 (moderate), or 3 (severe with complete rupture).Summary
Among the most reported sports injuries.[77] [78] [79] 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. The majority of symptomatic knee injuries in young patients are traumatic, while in older patients they are more commonly nontraumatic.Summary
Usually occurs as the result of an acute noncontact deceleration injury, forceful hyperextension, or excessive rotational forces about the knee.[80] [81] 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 American football, soccer, basketball, and skiing.Summary
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.[82] [83] [84] MCL injuries can also occur in noncontact sports.Summary
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.Summary
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.[85] The causes of patellofemoral problems are multifactorial, including abnormal patellofemoral joint mechanics, lower kinetic chain alterations, and overuse.Summary
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. People with bursitis who participate in sport or have an occupation entailing repetitive activity that is likely to have precipitated the bursitis will benefit from advice on modifying their activity and using protection to prevent recurrence.Summary
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.[86] High-risk sports are those that demand repeated forceful knee extension (e.g., running, jumping, squatting, and deep knee bending), including track, American football, rugby, basketball, baseball, and soccer.[86] [87]Summary
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.[88] There is no sex preference in the prevalence of cysts, but development of cysts increases with age (26% in patients ages 31 to 50 years, and 53% in patients ages 51 to 90 years).[89] 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.Summary
An acquired, potentially reversible, idiopathic lesion of subchondral bone resulting in delamination and sequestration, with or without articular cartilage involvement and instability.[90] [91] [92] 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. Vague joint pain may be present. The pain may be exacerbated by increased activity (i.e., sport participation). Osteochondritis dissecans is strongly associated with baseball, gymnastics, weightlifting, and racquet sports.[93]Summary
Results from repetitive friction of the iliotibial band sliding over the lateral femoral epicondyle, moving anterior to the epicondyle as the knee extends and posterior as the knee flexes, and remaining tense in both positions. 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.[94] [95] [96] [97] 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.Summary
A sudden, involuntary, painful muscle contraction or spasm, associated with an increase in frequency of motor action potentials.[98] [99] 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).[100] [101] [102] People participating in team sport are also predisposed to EAMC (e.g., rugby: 52%, cycling: 60%).[100] [102]Summary
Compartment syndrome is a pathologic condition characterized by elevated interstitial pressure in a closed osteofascial compartment, resulting in restriction of capillary blood flow.[103] The anterior and deep posterior compartments of the leg and the volar compartment of the forearm are most commonly affected. The most common causes of acute compartment syndrome are fractures, soft-tissue injury, vascular compromise as a result of trauma, extremity compression, reperfusion of chronically ischemic extremities, and burn injuries to extremities. Chronic exertional compartment syndrome is most frequently encountered among long-distance runners.Summary
Ankle fracture generally refers to a fracture of one or more of the medial, lateral, or posterior malleolus. A "pop" is commonly heard on falling. People with an ankle fracture may have immediate pain over either the medial or lateral malleolus or both. 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%).[104]Summary
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.[105] Pain is self-limited and usually resolves after 6 to 18 months without treatment.[106] Patients may not be able to recall any preceding trauma to the foot. Plantar fasciitis is the most common cause of infracalcaneal pain and accounts for 11% to 15% of all foot complaints that require professional treatment.[107] Occurs in approximately 10% of people who run regularly.[107] [108]Summary
Classification may be based on major pain features or by body region: myofascial, musculoskeletal (mechanical), neuropathic, fibromyalgia, and chronic headache syndromes. Chronic pain is common and has a significant impact on quality of life. Prevalence increases with increasing age (especially for pain due to musculoskeletal causes), so the number of people living with chronic pain worldwide will increase as life expectancy increases.[109] Chronic pain may occur after some acute injuries, as part of degenerative diseases, or as a result of a primary condition (e.g., migraine and fibromyalgia)..Summary
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.[110] [111] [112] [113] 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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