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INTRODUCTION

The intent of this chapter is to provide a brief overview of common musculoskeletal injuries encountered during sports. For an in-depth review please refer to Chapters 29, 30, and 31.

The Centers for Disease Control and Prevention estimated that 7 million people in the United States received care for sports-related injuries. Based on a national database, the incidence was 25.9 per 1,000 persons.1 The age group with the highest injury rate was children ages 5 to 14 (59.3 per 1,000 persons). Males had twice the rate as females, and basketball was the most commonly reported activity during which an injury occurred. Strains and sprains were the most common type of injury, with fractures being second most common.

One of the key diagnostic tools for musculoskeletal complaints is the patient history. The mechanism of injury should be obtained in detail. Bystander history can be a useful surrogate if the athlete does not specifically recall the incident. Demographic information such as sex, age, and patient characteristics (e.g. handedness, occupation, past injuries, and baseline activity levels) are additional clues that may guide the differential.

Physical exam tests have variable sensitivity and specificity for diagnosis. Recognizing the underlying anatomy of the pain or injury location is important, as it will guide the exam. In many instances, examination of the contralateral body part can provide a “normal” version for comparison of the patient's injured side. The theory of the kinetic chain needs to be considered: pain or injury in one area could actually be caused by pathology in another location (i.e., scapular dyskinesia leads to elbow pain in baseball pitchers).2

Imaging and laboratory testing can aid in diagnosis. Advanced imaging such as magnetic resonance imaging (MRI) is not always necessary, nor may it pinpoint the cause of pain in all cases since many asymptomatic individuals may have abnormal imaging findings.3

Physical therapy is a common management option for the majority of sports-related injuries. The goal of therapy is to directly strengthen the injured area or to affect areas that indirectly influence the region of injury or pain and eventually restore athletic function. Intraarticular, bursal, or tendon sheath injections are another therapeutic route. Surgical options should be reserved for patients who have failed conservative treatment modalities.

HEAD/NECK

Concussion

Clinical Signs and Symptoms

An estimated 1.6 to 3.8 million people experience a sports-related traumatic brain injury every year.4 The most commonly reported symptoms of concussion are headache, dizziness, and confusion.5 Loss of consciousness, which historically has been identified as pathognomonic for this injury, does not occur in all cases.

Diagnostic Studies

Concussion is a clinical diagnosis, based on history and mechanism of injury. Imaging has been found to be overused and without red flag ...

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