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Classification of Injuries

Sign: a finding that is observed or that can be objectively measured (swelling, discoloration, deformity, crepitus)

Sign Versus SymptomSign Versus Symptom

Symptom: subjective complaint or an abnormal sensation that the patient describes but cannot be directly observed (pain, nausea, fatigue, altered sensation)

Acute: sudden onset and of short duration (one-time traumatic event or mechanism)

Acute Versus ChronicAcute Versus Chronic

Chronic: gradual onset and of prolonged duration (accumulation of minor insults or repetitive stress)

Soft tissue injuries: contusion, sprain, strain

Closed WoundsClosed Wounds

Bone and joint articulations: closed fractures, epiphyseal injury, dislocation, subluxationNerve injuries

Characteristic signs and symptoms include

First Degree ContusionsFirst Degree Contusions

superficial damage,

minimal swelling, and

localized tenderness.

Characteristic signs and symptoms include

Second Degree Second Degree ContusionsContusions

increased area and depth of tissue damage, and

mild to moderate limitations in ROM, muscle function.

Characteristic signs and symptoms include

Third Degree ContusionsThird Degree Contusions

severe pain,

significant hemorrhage,

severe limitations in ROM and muscle damage, and

possible damage to deeper structures.

Characterized by

First Degree SprainsFirst Degree Sprains

mild overstretching and

no tissue disruption.

mild pain, tenderness over ligament;

little or no disability;

Signs and symptoms include

minor inflammation, discloration.pain at end ROM; and

Characterized by

Second Degree SprainsSecond Degree Sprains

further stretching and

partial disruption of ligament.

moderate to severe pain,

rapid swelling,

Signs and symptoms include

ecchymosis, and

limited ROM, function.

Characterized by complete disruption.

Third Degree SprainsThird Degree Sprains

“pop,”

immediate pain,

Signs and symptoms include

rapid swelling,

loss of function, and

less painful ROM, stress test.

Characterized by

First Degree StrainsFirst Degree Strains

overstretching and

microtearing.

mild pain and tenderness,

full AROM and PROM, and

Signs and symptoms include

pain with resisted contraction.

Characterized by

Second Degree StrainsSecond Degree Strains

further stretching and

partial tearing.

pain and localized tenderness,

disability,

Signs and symptoms include

ecchymosis, and

decreased ROM and strength.

Characterized by complete rupture.

Third Degree StrainsThird Degree Strains

“pop,”

pain,

Signs and symptoms include

loss of function,

palpable defect,

hemorrhage, and

diffuse swelling.

Severe stretching or complete disruption of one or more supporting ligaments resulting in

Joint DislocationJoint Dislocation

immediate pain,

swelling,

loss of function.

deformity, and

The joint may spontaneously reduce.

Chronic instability often follows acute dislocation.

An incomplete disassociation of two joint surfaces. Athlete may complain of a feeling of “giving out.” History is important because these injuries

SubluxationSubluxation

often reduce spontaneously,

have minimal deformity, and

vary in signs and symptoms (pain, swelling, joint instability), depending on degree of injury.

Common mechanisms include

Nerve InjuriesNerve Injuries

compression or tensioning of neural structure,

direct blow, andacute swelling in space occupied by lesion/pathology.

anesthesia (no sensation),

paresthesia (tingling, burning, numbness), and

Ranges of sensory impairment include

hyperesthesia (hypersensitivity).

Transient and reversible loss in nerve function secondary to trauma or irritation. It is characterized by

NeuropraxiaNeuropraxia

mechanical deformation of a nerve,

no disruption of nerve fibers, andshort-lived sensory and motor deficits (ranging from seconds to two weeks).

Partial disruption of a nerve with eventual regeneration

AxonotmesisAxonotmesis

Prolonged sensory and motor deficits (two weeks to one year)

Considerable atrophy and weakness

Complete severance of a nerve

NeurotmesisNeurotmesis

Permanent loss of function of innervated structures distal to the point of injury

No regeneration evident after one year