Sports Medicine: Just the Facts

patellar grafting in athletes with prior patellar tendon

dysfunction. After 6–9 months of aggressive rehabili-

tation, functional bracing to protect the reconstructed

ACL is generally desirable to aid safe return to full

football activities.

THIGH/QUADRICEPCONTUSION

• The most common soft tissue injury in football,
  resulting from blunt trauma.
  •Treatment focuses on limitation of hemorrhage and
  inflammation while maintaining range of motion and
  strength. Ice and NSAIDs are appropriate initial inter-
  ventions. Some practitioners advocate immobilizing
  the knee in 120°of flexion to limit hemorrhage and
  hematoma formation.


• Massage and ultrasound should be avoided early in the
  treatment course to allow for early stabilization of the
  damaged muscle. Athletes may return to play when
  they have full range of motion and strength approxi-
  mating that of the uninjured leg. This injury may lead
  to myositis ossificans (calcific changes in areas of dam-
  aged muscle) in 9–20% of cases if treated inadequately.

TURFTOE
•A sprain of the plantar-capsular ligament complex
with associated articular cartilage damage to the
metatarsal heads or base of the proximal phalanx.

• The first metatarsophalangeal(MTP) joint is the pri-
  mary area of injury, typically resulting from forced
  hyperextension of the planted toe on the turf. Athletes
  experience significant pain, have local swelling, and
  often limp.


• Artificial turf surfaces and lighter, more flexible shoes
  have been implicated in a higher incidence of turf toe
  injuries.


• Management centers on protection of the area with a
  rigid insert in the shoe to protect against dorsiflexion,
  donut padding, taping, ice, and NSAIDs. Activity
  status is as dictated by pain.

HIPPOINTER

• Contusion or separation of attached muscle fibers at
  the superior aspect of the iliac crest as a result of blunt
  trauma, generally resulting in a significant degree of
  pain and dysfunction.


• X-rays are generally unnecessary at the time of diag-
  nosis but should be strongly considered for symptoms
  that are prolonged or increasing.


• Management includes aggressive icing, stretching of
  the low back and flank muscles, and additional pro-
  tective padding at the time of return to play.


• Local modalities such as ultrasound or anesthetic/
  corticosteroid injections may speed the healing
  response as well.

UPPER EXTREMITY INJURIES

SHOULDERINSTABILITY

• Shoulder instability is a common malady in football
  athletes as a result of repetitive blows to the shoulder
  and unusual loading that may arise with blocking and
  tackling.


• Frank dislocations occur anteriorly in 95% of cases
  and result from excessive abduction, extension, and
  external rotational forces.
  •Surgery to correct shoulder instability is a frequent
  consideration as the recurrence rate for subluxations
  or dislocations is 50%.


• Open stabilization, rather than arthroscopic, is a more
  predictable means of restoring shoulder stability with
  excellent maintenance of range of motion and postop-
  erative stability (Pagnani and Dome, 2002).
  •Offensive linemen may develop posterior instability
  from blocking with outstretched arms and repetitively
  loading the posterior capsule of the glenohumeral
  joint. Except in extreme cases, aggressive rehabilita-
  tion and modification of weightlifting techniques are
  adequate for management.

JERSEYFINGER

•Forced extension of the actively flexed finger, as in

attempting to grasp an opponent for a tackle, may result

in avulsion of the flexor digitorum profundus from its

insertion on the volar side of the distal phalanx.

• The ring finger is most commonly involved, followed
  by the middle finger.


• The athlete will feel a pop and the retracted tendon
  may be palpable proximally in the finger. Examina-
  tion will demonstrate loss of independent flexion of
  the distal interphalangeal joint.


• Early surgical repair is the treatment of choice.

SPINAL AND NEUROLOGIC INJURIES

CERVICAL SPINE INJURY

MECHANISM

•Historically, head trauma had been the greatest source

of morbidity and mortality in football, generally from

subdural hematomas. Better helmet construction

decreased such head injuries but fostered technique

changes in play, which favored leading with the head

and neck for tackling and blocking, so-called “spear-

ing.” This dangerous technique led to a marked increase

in cervical spine injuries until rule changes were insti-

tuted to outlaw spearing in football.

•A review of 1300 cervical spine injuries from the

National Football Head and Neck Injury Registry has

492 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS