Sports injuries occur during participation in sports or exercise in general. Globally, around 40% of individuals engage in some form of regular exercise or organized sports, with upwards of 60% of US high school students participating in one or more sports. Sports injuries account for 15 - 20% of annual acute care visits with an incidence of 1.79 - 6.36 injuries per 1,000 hours of participation. Sports injuries can be broken down into the types of injuries, risk factors and prevention and the overall impact that injuries have on athletes.
Types of sport injury The type of sports injury suffered varies greatly based on gender, age and sport. Nonetheless, those with the highest prevalence remain contusions, fractures and sprains, followed closely by wounds and overuse injuries. Also common, the possible severity of head and neck injuries are important to consider. It is also paramount to place emphasis on the specific injuries that are most commonly encountered by sports medicine specialists.
Soft tissue injuries
Soft tissue injuries can be divided into those that affect the connective tissue (such as the skin), ligaments, tendons, or muscles. Injuries affecting the integument or the skin, can be classified as contusions, abrasions, and lacerations. Contusions or bruises are the simplest and most common injuries and are usually a result of blunt force trauma. Severe contusions may involve deeper structures and can include nerve or vascular injury. Abrasions are superficial injuries to the skin that result from a shearing force and are no deeper than the most superficial tissue layer, the epidermis. Bleeding, when present, is minimal. Minor abrasions generally do not scar, but deeper abrasions generally bleed and may scar. Lacerations occur from blunt trauma and result in a puncture through the skin, leaving an open wound. Facial lacerations are the most variable of the soft tissue injuries that athletes can sustain. They can occur intraoral or extraoral, and vary from a superficial skin nick to a lip laceration, or involve significant vascular disruption or injury to collateral vital structures. Another major set of soft tissue injuries are those that affect the tendons and ligaments involved in the function of weight bearing joints. Of the various ligament and tendon injuries sustained during sports, those that hold particular importance for sports medicine providers due to their high prevalence are described in the following table:
Table: Prevalence and Implications of Common Soft Tissue Sports Injuries
Bony injuries Types of hard tissue injuries can include dental and bone injuries and are less frequent than soft tissue injuries in sport, but are often more serious. Hard tissue injuries to teeth and bones can occur with contusions, such as Battle sign, which indicates basilar skull fracture, and so-called raccoon eyes, which indicate midface fractures. However, tooth fractures are the most common type of tooth injury, and can be categorized as crown infractions, enamel-only fracture, enamel-dentin fractures, and fractures that extend through the enamel and dentin into the pulp which is defined below.
Crown infractions are characterized by a disruption of the enamel prisms from a traumatic force, these injuries typically present as small cracks that affect only the enamel. Enamel-only fractures are mild and often appear as roughness along the edge of the tooth crown. These injuries typically can go unnoticed by the athlete as they are usually not sensitive to the touch or temperature changes. Enamel-only fractures are not considered dental emergencies and immediate care is not needed. Enamel-Dentin crown fractures typically present as a tooth fracture confined to enamel and dentin with loss of tooth structure, but not exposing the pulp. The athlete often will report sensitivity to air, cold or touch, but the athlete can return to play as tolerated and referral can be delayed up to 24 hours. Enamel-Dentin-Pulp fractures extend through the enamel and dentin and into the pulp. If the pulp is vital, a focal spot of hemorrhage will be noticeable within the yellow dentin layer and the athlete may report acute pain. Referral to a trauma-ready dentist should occur as soon as possible. In addition to tooth fractures, there are several types of bone fractures as well. These types being closed or simple, open or compound, greenstick, hairline, complicated, comminuted, avulsion, and compression. A complicated fracture is when the structures surrounding the fracture are injured, such as blood vessels, organs, nerves, etc.
Overuse injuries Overuse injuries can be defined as injuries that result from a mechanism of repetitive and cumulative micro-trauma, that exceeds tissue repair capacity. Overuse injuries can be divided into three primary categories, tendinopathy, stress reaction and stress fractures, and Juvenile Osteochondritis Dissecans. Tendinopathy is the result of accumulative micro-trauma and degenerative changes to the tissue that can predispose to pain and even rupture with activity. Tendinopathy progresses in stages from tendinitis which is inflammatory driven, to later tendinosis which is primarily degenerative. The lack of inflammation in this later stage is in fact what hinders the body's ability to heal the injury. Stress reaction and stress fractures occur due to accumulative trauma to bone that leads to an imbalance between bone cleavage and replacement leaving the bone prone to micro-damage (stress reactions) and stress fractures. A common cause for both these types of injuries are increase in training frequency and can be associated with poor technique, or other external factors like training on hard surfaces or long distance sports. Finally, the rapid changes in physical growth in children leave them prone to overuse injuries, especially Juvenile Osteochondritis Dissecans, in which the bone-cartilage interface is affected. This disease is driven primarily by repetitive micro-trauma sustained while training and can lead to pain in the affected joints. The disease predominately affects athletes undergoing rapid periods of growth, therefore as the athlete's bodies continue to mature, the disease tends to self-resolve.
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