Notes

Outline

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Football Injuries

Epidemiology 600,000 football injuries/year NFL injury rate: 1.5 injuries/player/year

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Epidemiology Prospective study of High School players: 0.5 significant injuries/player/year 0.03 severe injuries/player/year vs. 0.015 for aged matched controls 6X incidence of knee injury vs. control DeLee, Am J. Sports, 1992

Epidemiology 50% involve lower extremity 30% upper extremity 20% head/spine/other

Epidemiology Injury rate per position: running back 43% tackle 18% guards 12% quarterback 6% center 5%

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Prevention Field resurfacing Shoe re-design smaller cleats Change in rules of play

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General Principles Pressure to return to play High demand athletes MUST TREAT USING STANDARD ORTHOPAEDIC PRINCIPLES

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Concussion college: 5.9/100 athletes/year

Concussion - Treatment Airway: If adequate, do not remove helmet If not, remove face mask Treat as cervical spine injury until proven otherwise Frequent neuro checks

Concussion - Return to Play Second impact syndrome loss of autoregulation morbidity 100% mortality 50% Risk of concussion 4X greater after initial concussion Cantu, Clinics Sport Med, 1997 CDC, JAMA, 1997

Concussion - Return to Play Grade 1 - return that day if Sx < 15 min. Grade 2 - return after asympt. X 1 wk. Grade 3 - return after fully asymptomatic for 2 weeks if abnormal MRI, out for season, discourage from future play CDC, JAMA, 1997

Cervical Spine 1976 NCAA rule change: eliminated spearing in play 50% reduction in C-spine injuries 0.62/100,000 for scholastic 1.64/100,000 for collegiate Cantu, J. Spinal Dis., 1990

Cervical Spine - Catastrophic Mechanism: Axial loading Hyper flexion or hyperextension Of players with permanent injury: 77 % burst fracture 23% facet dislocation Torg, JBJS (A), 1996

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Cervical Spine - Stenosis Transient quadriparesis/quadriplegia Hyperflexion or hyperextension All completely reversible OK to return to sport unless DJD or instability noted Bailes, Neurosurg, 1991 Torg, JBJS (A), 1986

Cervical Spine - Stenosis Torg/Pavlov ratio sensitivity = 93% positive predictive value = 0.2% ! Poor utility as a screening tool Torg, JBJS (A), 1996

Shoulder - Brachial Plexus “Stinger” or “Burner” Upper trunk plexopathy Stretch vs. compression at Erb’s point Incidence  - 49 - 65% over college career Markey, Am J. Sports, 1993 Clancy, Am J. Sports, 1977

“Stinger” - Stretch

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Shoulder - Brachial Plexus Chronic burner recurrent lasting days to weeks Cervical stenosis Levitz, Am J. Sports, 1997

Shoulder - Acromioclavicular Direct blow Manage non-operatively in most except grade 3 in quarterback grade 4 and higher

Shoulder - Contusions Tackler’s exostosis distal to edge of shoulder pads early: ice, compression late: excision of exostosis Myositis ossificans younger player cleavage plane on x-ray

Shoulder - Instability Most are traumatic, unidirectional Most require either change in sport or surgery Open Bankart repair is gold standard Arthroscopic Bankart controversial in high demand athletes

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Shoulder - Rotator Cuff Usually acute impact to shoulder Conservative management Consider arthroscopic decompression, debridement Repair for full thickness tears Blevins, Am J. Sports, 1996

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Hand Scaphoid fractures non-displaced            short arm thumb spica play in custom silicone rubber cast Ulnar collateral ligament of thumb Jersey finger - FDP avulsion Riester, Am J. Sports, 1985

Hand - Metacarpal Fx Cast + Rubber silicone “game cast” Avg. return to play = 10.6 days ORIF unstable return in 14 days vs. 36 days for perc. Pin Rettig, Am J. Sports, 1989

Lumbar Spine Linemen: Avg. impact force: 3013 N = 673 lbs. Avg. compression at L4-5 = 8679 N       = 7 X body weight Compare - fatigue fractures with 570N at 1536 cycles Gatt, Am J. Sports, 1997 Cyron, JBJS (B), 1978

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Lumbar Spine Contusion/sprain most common Disc herniation most are acute conservative treatment return when normal motion, strength

Lumbar Spine - Spondylolysis Incidence:  (vs. 6% in general population) linemen = 50% all players = 15%  (13% at start of college) Usually L5-S1 Asymptomatic                may play McCarroll, Am J. Sports, 1986

Hip “Hip pointer” - iliac crest contusion protective padding “Groin pull” - iliopsoas strain Osteonecrosis Fu ed., Sports Injuries, 1994

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Thigh - Quadriceps Contusion mild - more than 90 flexion mod - less than 90 flexion severe - less than 45 flexion cold, compression, flexion ROM myositis ossificans in 9% Ryan, Am J. Sports, 1991

Knee most commonly injured joint rate of injury: 1. MCL 2. Medial meniscus 3. ACL prophylactic braces controversial

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Knee - MCL Key is to distinguish from a combined injury to the ACL Linemen most at risk Isolated MCL          treat conservatively Return  with brace when FROM, painless Indelicato, CORR, 1990

Knee - Meniscus Arthroscopy for symptomatic tears early Partial meniscectomy vs. repair return to play vs. “season ending injury”

Knee - ACL/PCL Some players may tolerate insufficiency Wide receivers, defensive backs, linebackers usually require ACL reconstruction PCL injury usually well tolerated Shino, JBJS (B), 1995

Knee - misc. Patellar tendonitis Fat pad syndrome (Hoffa’s Disease) fibrosis of anterior fat pad NSAIDs, stretching may require arthroscopic debridement

Ankle Lateral sprains vs. Syndesmotic external rotation stress test longer disability Surgery rarely needed Boytim, Am J. Sports, 1991

Foot - “Turf Toe” 1st MTPJ plantar capsular injury 45% of pro football players 85% from hyperextension injury Results in decreased motion Rodeo, Am J. Sports, 1990

Turf Toe

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