Sports Related Trauma

Aka: Sports Related Trauma, Trauma in Sports, Trauma in Athletes, Sports Injury, Athletic Injury, Sideline Medical Evaluation

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II. Causes: Head and Neck Injury

  1. Head Injury in Sports (including Concussion)
  2. C-Spine Trauma or Cervical Spine Fracture
  3. Brachial Plexus Burner
  4. Auricular Hematoma
  5. Nasal Fracture
  6. Dental Trauma (e.g. Tooth Avulsion)
  7. Eye Trauma (e.g. Hyphema, Corneal Abrasion, Eye Foreign Body)
    1. See Eye Injury in Sports
  8. Facial Fracture (e.g. Maxillary Fracture, MandibleFracture, Orbital Fracture, Zygomatic Arch Fracture)
    1. Evaluate for airway compromise
    2. Evaluate Extraocular Movements and ask about Diplopia
  9. Epistaxis
    1. Start with nasal pressure and consider intranasal Decongestant (e.g. Phenylephrine, Oxymetazoline)
    2. Place nasal pack (or balloon such as Rhinorocket) if refractory

III. Causes: Chest or Thoracic Injury

  1. Rib Fracture
  2. Clavicle Fracture
  3. Sternal Fracture
  4. Pneumothorax
  5. Pneumomediastinum
  6. Cardiac Contusion
  7. Thoracic Spine Injury

IV. Causes: Abdominal or Lumbar Injury

  1. Abdominal Trauma
  2. Genitourinary Trauma
  3. Liver Laceration
  4. Splenic Rupture
  5. Pancreatic Injury
  6. Renal Injury
  7. Pelvis Fracture
  8. Lumbar Spine Injury

V. Causes: Miscellaneous

  1. See Musculoskeletal Injury
  2. Lacerations

VI. Causes: Sports Specific Injury

  1. Baseball
    1. Shoulder Injury (e.g. Rotator Cuff Tendonitis, Shoulder Labral Tear)
    2. Elbow Injury (e.g. Medial Epicondyle Apophysitis, Medial Epicondylitis)
  2. Basketball
    1. Ankle Injury (e.g. Ankle Sprain)
    2. Finger Injury (e.g. Jammed Finger)
  3. Bicycling
    1. See Bicycling
  4. Bowling
    1. Shoulder Injury (e.g. Rotator Cuff Tendinopathy)
    2. Elbow Injury (e.g. Medial Epicondylitis or Bowler's Elbow)
    3. Wrist Injury (e.g. wrist Tendonitis)
    4. Ulnar Neuropathy of the thumb (Bowler's Thumb)
    5. Low Back Pain
  5. Boxing or Mixed Martial Arts
    1. Closed Head Injury or Concussion
    2. Facial Lacerations
    3. Shoulder Injury (e.g. Shoulder Dislocation)
    4. Extensor Tendon Sagittal Band Tear (Boxer's Knuckle)
    5. Finger Fracture
    6. Knee Injury (e.g. Ligamentous Injury)
    7. Toe Fracture
  6. Cheerleading
    1. Closed Head Injury or Concussion
    2. Ankle Injury
    3. Low Back Pain (e.g. Spondylolysis)
      1. See Adolescent Back Pain
  7. Football
    1. Closed Head Injury or Concussion
    2. Knee Injury (e.g. Ligamentous Injury, Meniscal tear)
  8. Golf
    1. See Golf Injuries
  9. Hockey
    1. Closed Head Injury or Concussion
    2. Ankle Injury (e.g. Ankle Sprain)
    3. Shoulder Injury (e.g. AC Joint Separation)
    4. Hamstring Strain
    5. Knee Injury (e.g. MCL Strain)
  10. Inline Skating
    1. See Inline Skating Injury
  11. Lacrosse
    1. Closed Head Injury or Concussion
    2. Ankle Injury (e.g. Ankle Sprain)
    3. Knee Injury (e.g. Ligamentous Injury)
    4. Rib Fracture or Contusion
  12. Running
    1. See Running Injury
  13. Scuba Diving
    1. See Scuba Diving Injury
  14. Soccer
    1. Knee Injury (e.g. Ligamentous Injury)
    2. Adductor Strain
    3. Ankle Sprain
  15. Swimming
    1. Shoulder Injury (e.g. Rotator Cuff Tendinopathy)
    2. Knee Injury (MCL Strain or Swimmer's Knee)
  16. Skiing
    1. See Downhill Skiing Injury or Snowboarding Injury
    2. See Nordic Skiing
    3. See Knee Injury in Downhill Skiing
  17. Surfing
    1. See Surfing Injury
  18. Tennis
    1. Ankle Injury (e.g. Ankle Sprain)
    2. Lateral Epicondylitis (Tennis Elbow)
    3. Low Back Pain
    4. Patellar Tendonitis
  19. Wrestling
    1. Auricular Hematoma
    2. Facial Laceration
    3. Prepatellar Bursitis
    4. Knee Injury (e.g. Ligamentous Injury)

VII. Management: Sideline Medical Provider

  1. Preparation
    1. Introduce yourself to the athletic trainer (typically first point of contact for injured athletes)
    2. Identify nearest hospitals and Trauma Centers
    3. Identify location of facility emergency equipment
      1. Automated External Defibrillator (AED)
      2. Spine Board
      3. Athletic trainer's bag
      4. Treatment or training room for more thorough off-the-field evaluation and management
    4. Bring emergency supplies if not available at facility or with trainer
      1. See First Aid Kit
      2. Personal Protection Equipment (gloves, Eye Protection, mouth-to-mouth mask)
      3. Cervical Collar
      4. Dressing supplies (e.g. ace wrap, gauze, Bacitracin)
      5. SAM splints
      6. Nasal pack
      7. Flash light
    5. Position yourself available to respond to injuries
      1. Clear view and quick access to the playing field
  2. Approach
    1. See ABC Management
    2. See Primary Survey
    3. See Secondary Survey
    4. Assume Cervical Spine Injury if Altered Mental Status, bilateral extremity symptoms, midline cervical tenderness, paralysis, severe Neck Pain
      1. See Cervical Spine Injury
      2. See NEXUS Cervical Spine Decision Rule
      3. Apply Cervical Collar
      4. Log Roll Patient onto Spine Board
      5. Leave helmets and pads in place for EMS tansport unless interfering with patient management
        1. Use additional assistants to ensure Cervical Spine stabilization if equipment removal needed
    5. Head or Neck Injury indications for Emergency Department transfer
      1. Cervical Spine Injury
      2. Open Fracture
      3. Facial Fracture (e.g. Mandibular Fracture, Maxillary Fracture, Orbital Fracture)
      4. Significant Eye Injury (e.g. Acute Vision Loss, Hyphema)
        1. See Eye Injury in Sports
    6. Other management
      1. Closed Head Injury
        1. See Head Injury in Sports
        2. See Closed Head Injury
        3. See Return to Play after Concussion
        4. Athletes suspected of Concussion shoule not return to play on the same day of injury
      2. Lacerations
        1. See Laceration Repair
        2. Control bleeding
        3. Evaluate for associated significant injury (e.g. open Fracture, Hemorrhage, deep space injury, neurovascular injury)
          1. Control bleeding and bandage more significant injuries and transfer to emergency department
        4. Irrigate wound
        5. Repairs using Suture (or staple of the scalp) may return to play on same day (if not otherwise contraindicated)
          1. Repairs using Tissue Adhesive should not return to play on same day (wound dehiscence risk)
          2. High risk Laceration Repairs (e.g. vermilion border, ear helix, Eyelid) are best in a clinical environment by skilled operator

VIII. Prevention

  1. See Football Helmet
  2. See Bike Helmet
  3. See Eye Protection in Sports
  4. See Preparticipation Physical Evaluation

IX. References

  1. Amores (2021) Crit Dec Emerg Med 35(11): 19-24
  2. Dreis (2020) Crit Dec Emerg Med 34(7):3-21
  3. Ursman (2022) Am Fam Physician 106(5): 543-8 [PubMed]

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