Knee Strain

Injury to the muscles or tendons that attach to bones in the knee. Muscles,tendons and bone comprise units. These units stabilize the knee joint and allow its motion. A strain occurs at a unit's weakest part. Strains are of 3 types:

• Mild (Grade I)-Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
• Moderate (Grade II)- Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
• Severe (Grade III)-Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.

BODY PARTS INVOLVED

• Tendons and muscles in the knee region,especially the quadriceps and the hamstrings.
• Bones in the knee area, including the femur,patella, tibia and fibula.
• Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.

Causes

• Prolonged overuse of muscle-tendon units in the knee.
• Single violent blow or force applied to the knee.

Signs & Symptoms

• Pain when moving or stretching the knee.
• Muscle spasm in the knee area.
• Swelling over the injury.
• Loss of strength (moderate or severe strain).
• Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers,
• Calcification of the muscle or tendon (visible with X-rays).
• Inflammation of the tendon sheath.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large styrofoam cup with water and freeze.Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
• After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
• Take whirlpool treatments, if available.
• Wrap the injured knee with an elasticized bandage between treatments.
• Massage gently and often to provide comfort and decrease swelling.

Home Diet

Eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Participate in a stretching, strengthening and conditioning program appropriate for your sport.
• Warm up before practice or competition.
• Tape the knee area before practice or competition.

Knee Sprain

Violent overstretching of one or more ligaments in the knee. Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. If the ligament pulls loose a fragment of bone, it is called a sprain-fracture. There are 3 types of sprains:

• Mild (Grade I)- Tearing of some ligament fibers. There is no loss of function.
• Moderate (Grade II)-Rupture of a portion of the ligament, resulting in some loss of function.
• Severe (Grade III)-Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair.

BODY PARTS INVOLVED

• Any of the many ligaments in the knee.
• Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles.

Causes

Stress on a ligament that temporarily forces or pries the knee out of its normal location. Sprains occur frequently in runners, walkers, and those who jump in such sports as basketball, soccer, volleyball, skiing,and distance- or high-jumping. These athletes often accidentally land on the side of the foot.

Signs & Symptoms

• Severe pain at the time of injury.
• A feeling of popping or tearing inside the knee.
• Tenderness at the injury site.
• Swelling in the knee.
• Bruising that appears soon after injury.

How is a knee sprain diagnosed?

A caregiver will examine your knee and ask you questions about your activities. You may need x-rays or magnetic resonance (REZ-oh-nans) imaging (MRI). These tests will show a picture of the bones and tissues inside your knee. Caregivers can do these tests to learn if you have a fractured (FRAK-churd) (cracked or broken) bone or soft tissue damage.

Treatment

The immediate treatment for a sprained knee is the standard RICE formula. This is an acronym for Rest, Ice, Compression, and Elevation. These steps will help reduce swelling and pain, and speed the healing process. Rest the knee while it aches and ice it intermittently several times a day. Wrap it in an elastic bandage in between icings, and keep it elevated as much as possible.

Follow your doctor's instructions. Instructions are supplemental

The doctor usually applies a splint from the ankle to the groin to immobilize the sprained knee. If the doctor does not apply a cast ,tape or elastic bandage:

• Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured knee. Use for 20 minutes at a time.
• Wrap the injured knee with an elasticcized bandage.
• After 72 hours , apply heat instead of ice, if it feels better.Use heat lamps, hot soaks, hot showers, heating pads or heat liniments and ointments.
• Take whirlpool treatments, if available
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

Ask your doctor if you have any questions about using medications. Drugs that are commonly used to reduce pain and inflammation include:

• Ibuprofen (Motrin, Advil)
• Naproxen (Aleve, Naprosyn)
• Acetaminophen (Tylenol)
• Aspirin

Home Diet

During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Build your strength with a conditioning program appropriate for your sport.
• Warm up before practice or competition.
• Take a break from sports or exercise when you feel tired.
• Tape vulnerable joints before practice or competition.
• Do exercises that strengthen the leg muscles.
• Wear proper protective shoes. A twist or injury to the foot can affect the knee.
• Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, ligaments and tendons, including those around your knee.

Knee Dislocation, Tibia Fibula

Injury and displacement of the bones of the lower leg so they no longer touch each other. This is less common than dislocation of the kneecap. It often occurs with fracture of the tibia.

BODY PARTS INVOLVED

• Knee joint.
• Lower leg bones (tibia and fibula) where they join the knee joint.
• Soft tissue surrounding the dislocation, including nerves, periosteum (covering of bone), tendons, ligaments, muscles and blood vessels.

Causes

• Direct blow to the knee.
• End result of a severe sprain caused by a twisting injury.
• Powerful muscle contractions related to quick changes of direction while running.

Signs & Symptoms

• A feeling of the knee "giving way."
• Excruciating pain at the time of injury.
• Locking of the dislocated bones in the abnormal position or spontaneous reposition, leaving no apparent deformity.
• Tenderness over the dislocation.
• Swelling and discoloration of the knee.
• Numbness or paralysis in the lower leg and foot from pressure, pinching or cutting of blood vessels or nerves.

Treatment

Follow your doctor's instructions. Instructions are supplemental

After removal of the cast :

• Use an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
• You may try heat instead of ice, if it feels better.Use heat lamps,hot soaks,hot showers, heating pads or heat liniments and ointments.
• Take whirlpool treatments ,if available
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

Your doctor may prescribe:

• General anesthesia or muscle relaxants to make joint manipulation possible.
• Acetaminophen or aspirin to relieve moderate pain.
• Narcotic pain relievers for severe pain.
• Stool softeners to prevent constipation due to decreased activity.
• Antibiotics to fight infection following surgery.

Home Diet

• Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
• During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Develop your muscle strength and overall conditioning
• Warm up adequately before physical activity.
• After recovery, protect the knee during contact or running sports by wearing wrapped elastic bandages, tape wraps, knee pads or special support stockings.

Knee Dislocation, Tibia Femur

Injury to the knee joint in which the upper and lower leg bones are displaced and no longer touch each other. Knee dislocations often include torn or ruptured ligaments in the knee.

BODY PARTS INVOLVED

• Tibia (large lower leg bone), femur (thigh bone) and patella (kneecap).
• Ligaments of the knee joint.
• Meniscus (cartilage) of the knee joint.
• Soft tissue surrounding the dislocated knee, including periosteum (covering to bone), nerves, tendons, blood vessels and connective tissue.

Causes

• Overextension of the knee.
• Direct blow to the tibia.
• Direct blow to the thigh, driving the knee to either side.
• End result of a severe knee sprain.
• Congenital knee abnormality, such as shallow or malformed joint surfaces.

Signs & Symptoms

• Severe knee pain at the time of injury.
• Loss of function of the knee, and severe pain when attempting to move it.
• Visible deformity if the dislocated bones have locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
• Tenderness over the dislocation.
• Swelling and bruising around the knee.
• Numbness or paralysis below the dislocation.

Exams and Tests

Depending on how the knee looks, you can expect the doctor to check the injury in the following ways:

• X-rays: X-rays will be taken to make sure there are no breaks in the bone.
• Examination of pulses: Injury to the arteries in the knee is common with this injury. The doctor will make sure there are pulses in your foot (the place the artery in your knee runs to).
• Medical history.

Treatment

Follow your doctor's instructions. Instructions are supplemental

After removal of the cast or splint:

• Use an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
• Apply heat instead of ice, if it feels better.Use heat lamps,hot soaks,hot showers, heating pads or whirlpool treatments.
• Wrap the injured knee with an elasticized bandage between treatments.
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

Your doctor may prescribe:

• General anesthesia, spinal anesthesia or muscle relaxants prior to joint manipulation.
• Acetaminophen to relieve moderate pain.
• Narcotic pain relievers for severe pain.
• Stool softeners to prevent constipation due to decreased activity.
• Antibiotics to fight infection if surgery is necessary.

Home Diet

• Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
• During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Build your strength with a conditioning program appropriate for your sport.
• Warm up adequately before physical activity .
• After healing, wear protective equipment such as special knee pads and knee braces during participation in contact sports.

Knee Dislocation, Tibia Femur

Injury to the knee joint in which the upper and lower leg bones are displaced and no longer touch each other. Knee dislocations often include torn or ruptured ligaments in the knee.

BODY PARTS INVOLVED

• Tibia (large lower leg bone), femur (thigh bone) and patella (kneecap).
• Ligaments of the knee joint.
• Meniscus (cartilage) of the knee joint.
• Soft tissue surrounding the dislocated knee, including periosteum (covering to bone), nerves, tendons, blood vessels and connective tissue.

Causes

• Overextension of the knee.
• Direct blow to the tibia.
• Direct blow to the thigh, driving the knee to either side.
• End result of a severe knee sprain.
• Congenital knee abnormality, such as shallow or malformed joint surfaces.

Signs & Symptoms

• Severe knee pain at the time of injury.
• Loss of function of the knee, and severe pain when attempting to move it.
• Visible deformity if the dislocated bones have locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
• Tenderness over the dislocation.
• Swelling and bruising around the knee.
• Numbness or paralysis below the dislocation.

Exams and Tests

Depending on how the knee looks, you can expect the doctor to check the injury in the following ways:

• X-rays: X-rays will be taken to make sure there are no breaks in the bone.
• Examination of pulses: Injury to the arteries in the knee is common with this injury. The doctor will make sure there are pulses in your foot (the place the artery in your knee runs to).
• Medical history.

Treatment

Follow your doctor's instructions. Instructions are supplemental

After removal of the cast or splint:

• Use an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
• Apply heat instead of ice, if it feels better.Use heat lamps,hot soaks,hot showers, heating pads or whirlpool treatments.
• Wrap the injured knee with an elasticized bandage between treatments.
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

Your doctor may prescribe:

• General anesthesia, spinal anesthesia or muscle relaxants prior to joint manipulation.
• Acetaminophen to relieve moderate pain.
• Narcotic pain relievers for severe pain.
• Stool softeners to prevent constipation due to decreased activity.
• Antibiotics to fight infection if surgery is necessary.

Home Diet

• Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
• During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Build your strength with a conditioning program appropriate for your sport.
• Warm up adequately before physical activity .
• After healing, wear protective equipment such as special knee pads and knee braces during participation in contact sports.

Knee Contusion

Bruising of the skin and underlying tissues of the knee due to a direct blow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate muscles, tendons or other soft tissue. The knee is highly vulnerable to contusions.

BODY PARTS INVOLVED

Knee, including blood vessels, muscles, tendons, nerves, covering to bone (periosteum) and connective tissue.

Causes

Direct blow to the front or side of the knee.

Signs & Symptoms

• Swelling-either superficial or deep.
• Pain and tenderness over the knee.
• Feeling of firmness when pressure is exerted on the knee.
• Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise.
• Restricted knee activity proportional to the extent of injury.
• Break in skin over the contusion (frequent in knee injuries).

Treatment

Follow your doctor's instructions. Instructions are supplemental

• Wrap an elasticized bandage over a felt pad on the knee. Keep the area compressed for about 72 hours.
• Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
• After 72 hours, apply heat instead of ice if it feels better.Use heat lamps, hot soaks, hot showers, heating pads, heat liniments or ointments or whirlpool treatments.
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

• For minor discomfort, you may use:Acetaminophen or ibuprofen. Topical liniments and ointments.
• Your doctor may prescribe stronger medicine for pain.

Home Diet

During recovery ,eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.

Prevention Tips

Wear protective knee pads during competition or other athletic activity if there is risk of a knee contusion.

Knee Cartilage Injury

Damage to cartilage in the knee at the top of the lower leg bone (tibia). Knee-cartilage injuries frequently accompany dislocations of the kneecap or ligament sprains in the knee. This is sometimes a vaguely diagnosed knee injury that resists conservative treatment.

BODY PARTS INVOLVED

• Cartilage at the top of the tibia that normally cushions force to the knee.
• Knee joint.
• Ligaments that lend stability to the knee.
• Soft tissue that includes nerves, synovial membranes, periosteum (covering to bone), blood vessels, lymph vessels and bursae of the knee joint.

Causes

• Direct blow to the knee.
• Prolonged overuse of an injured knee.
• Twisting or violent muscle contraction.

Signs & Symptoms

• Pain and tenderness in the knee, especially when bearing weight.
• Locking of the knee joint.
• "Giving way" of the knee.
• "Water" on the knee (sometimes).

Treatment

Follow your doctor's instructions. Instructions are supplemental

During the postoperative phase:

• Walk on crutches until your surgeon instructs otherwise.
• After the cast is removed, use an electric heating pad , heat lamp or a warm compress to relieve incisional pain.
• Take whirlpool treatments, if available.
• Wrap the injured knee with an elasticized bandage between treatments.
• Massage gently and often to provide comfort and decrease swelling.
• On follow-up visits, your surgeon may aspirate fluid that has accumulated in the knee joint.

MEDICATION

• For minor discomfort, you may use non-prescription medicines such as aspirin, acetaminophen or ibuprofen.
• Your doctor may prescribe stronger medicine for pain, if needed.

Home Diet

During recovery ,eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Engage in vigorous presport strengthening and conditioning.
• Avoid concrete or asphalt surfaces and other rigid surfaces for continuous conditioning exercises.
• Warm up adequately before practice or competition.
• Tape the knee before practice or competition if you have had a previous knee injury.

Knee Bursitis

Inflammation of a bursa in the knee. Bursitis may vary in degree from mild irritation to an abscess formation that causes excruciating pain. There are many bursas in the knee:

• In front of and behind the kneecap.
• On both sides of the knee.
• Behind the knee (Baker's cyst).
• Just above the knee (popliteal bursa).

BODY PARTS INVOLVED

• Knee bursas-soft sacs in the knee area filled with lubricating fluid that facilitate motion in the knee.
• Soft tissue surrounding the knee, including nerves, tendons, ligaments, blood vessels (both large vessels and capillaries), periosteum (the outside lining of bone) and muscles.

Causes

• Injury to the knee, especially falling on a bent knee.
• Acute or chronic infection in the knee.
• Arthritis.
• Gout.
• Unknown (frequently).

Signs & Symptoms

• Pain, especially when moving the knee.
• Tenderness.
• Swelling.
• Redness (sometimes) over the affected bursa.
• Fever if infection is present.
• Limitation of motion in the knee.

Treatment

Follow your doctor's instructions. Instructions are supplemental

• Use frequent ice massage. Fill a large styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, before workouts or competition.
• After 72 hours, apply heat instead of ice if it feels better.Use heat lamps, hot soaks, hot showers,heating pads or heat liniments or ointments.
• Take whirlpool treatments, if available.
• Use crutches to prevent weight-bearing on the knee ,if needed.
• Whenever possible, elevate the knee above the level of the heart to reduce swelling and prevent accumulation of fluid. Use pillows for propping or elevate the foot of the bed.
• Gentle massage will frequently provide comfort and decrease swelling.

MEDICATION

Your doctor may prescribe:

• Non-steroidal anti-inflammatory drugs.
• Antibiotics if the bursa is infected.
• Prescription pain relievers for severe pain. Use non-prescription aspirin, acetaminophen or ibuprofen (available under many trade names) for mild pain.
• Injection with a long-lasting local anesthetic mixed with a corticosteroid drug, such as triamcinolone.

Physical therapy: Your caregiver may want you to go to physical (FIZ-i-kal) therapy. A physical therapist (THER-ah-pist) can do treatments to help your knees. Exercises to make the muscles and tendons of your knee, thigh, and calf stronger will be started after the bursitis has healed.

• Caregivers may use ultrasound to increase blood flow to the injured area. This may help bursitis heal faster.
• Caregivers may use massage to stretch the tissue and bring heat to the injury, which increases blood flow. This can help your knee heal faster and better.
• You may slowly increase the amount of weight you put on your leg when caregivers say it is OK. You will be told to stop doing any activity or exercise if you feel any pain.

Home Diet

Eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity. Your doctor may suggest vitamin and mineral supplements to promote healing.

Prevention Tips

• Always warm up your muscles and stretch gently before exercising. Do cool-down exercises when you are finished. This will loosen the muscles and tendons in your thigh and calf which will decrease stress on your knees.
• Wear warm clothing in cold weather.
• To prevent recurrence, continue to wear extra knee pads until healing is complete.

Kidney Injury

Bruising or tearing of the kidney or ureter. Kidneys filter waste material from the bloodstream and produce urine. Ureters are the tubes that carry urine from the kidneys to the bladder. The most common injury to the kidney is contusion. In contact sports, this may result from a blow from a knee or helmet, with the shock penetrating the flank muscles and reaching the kidney.

BODY PARTS INVOLVED

• Kidney.
• Ureters (tubes that carry urine from the kidney to the bladder).
• Muscles of the abdominal wall.
• Subcutaneous tissue, nerves, blood vessels and connective tissue.
• Urethra (tube that carries urine from the bladder out of the body).

Causes

• A blow or penetrating wound to the kidney, located on the side of the body under the ribs.
• Urinary-tract infection caused by kidney damage that leads to decreased rate of flow of urine. Decreased urinary flow rates allow bacteria to grow and infect the parts of the urinary tract-kidney, ureters, bladder and urethra.

Signs & Symptoms

• Pain and tenderness in the flank or back, just below the ribs on the injured side.
• Fever to 101 F (38.3C).
• Blood in the urine. There may be enough to make urine look "smoky" or bloody. Lesser bleeding can only be determined by studying urine under the microscope.
• If infection of the injured kidney complicates the injury, sudden onset of:
  Fever and shaking chills.
  Burning, frequent urination.
  Cloudy urine or blood in the urine.
  Aching (sometimes severe) in one or both sides of the lower back.
  Abdominal pain.
  Marked fatigue.

Treatment

Follow your doctor's instructions. Instructions are supplemental

No special instructions except those under other headings. If surgery is required,your surgeon will supply postoperative instructions.

MEDICATION

Your doctor may prescribe:

• Pain relievers.
• Antibiotics to treat or protect against infection.

Home Diet

• Drink 6 to 8 glasses of fluid daily.
• Don't drink alcohol.
• During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Use adequate protective equipment for contact sports.
• Develop good muscle conditioning in the flank area. Increased muscle mass helps protect underlying organs and other tissues.
• Toxic injury often may be prevented by properly observing the directions for use of medications or other products. Follow the directions of the health care provider for use of all medications, including over-the-counter medications.
• Use cleaning products, solvents, and fuels as directed in a well-ventilated area because the fumes may also be toxic. Be aware of potential sources of lead poisoning, such as old paints, vapors from working with lead-coated metals, alcohol distilled in recycled car radiators, and similar sources.

Jaw Sprain

Violent overstretching of one or more ligaments in the temporo-mandibular joint. Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. If the ligament pulls loose a fragment of bone, it is called a sprain-fracture. There are 3 types of sprains:

• Mild (Grade I) - Tearing of some ligament fibers. There is no loss of function.
• Moderate (Grade II) - Rupture of a portion of the ligament, resulting in some loss of function.
• Severe (Grade III) - Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair.

BODY PARTS INVOLVED

• Ligaments of the temporo-mandlbular joint of the jaw.
• Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles.

Causes

Stress that forces the jaw through wider range of motion than ligaments normally permit.

Signs & Symptoms

• Severe pain at the time of injury.
• A feeling of popping or tearing inside the jaw.
• Difficulty opening and closing the mouth.
• Tenderness at the injury site.
• Swelling around the jaw.
• Bruising that appears soon after injury.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the jaw .Use for 20 minutes at a time.
• After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or , ointments.
• Massage gently and often to provide comfort decrease swelling.

MEDICATION

• For minor discomfort, you may use aspirin, acetaminophen or ibuprofen.
• Your doctor may prescribe: Stronger pain relievers. Injection of a long-acting local anesthetic to reduce pain. Injection of a corticosteroid, such as triamcinolone, to reduce inflammation. Stool softeners if constipation results from a liquid or soft diet.

Home Diet

A normal diet may be difficult, especially if the jaw is wired or bandaged. If so, eat soft or liquid foods and increase your protein intake to promote healing.

Prevention Tips

Wear protective equipment, such as a face mask and mouthpiece, when appropriate.

Jaw Fracture (Mandible)

A complete or incomplete break in the lower jaw (the mandible). The temporo-mandibular joints (TMJ) are located just in front of the ears. These joints connect the lower jaw with the skull and are used to open and close the mouth. A fracture usually occurs at the condyle, or head of the mandible.

BODY PARTS INVOLVED

• Lower jawbone (mandible).
• Temporo-mandibular joint.
• Soft tissue surrounding the fracture site,including nerves, muscles, tendons, ligaments and blood vessels.

Causes

Direct blow (usually) or indirect stress to the bone. Indirect stress may be caused by violent muscle contraction.

Signs & Symptoms

• Severe pain at the fracture site.
• Swelling of soft tissue surrounding the fracture.
• Blood at the base of the teeth near the fracture site.
• Visible deformity if the fracture is complete and bone fragments separate enough to distort normal facial contours.
• Tenderness to the touch.
• Numbness around the fracture site (sometimes).

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Immobilization will be necessary. Mandible fracture usually require wiring the jaw together.
• Use an ice pack 3 or 4 times a day .Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
• After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers or a heating pad.
• Learn how to "quick-release" your wired teeth for any emergency such as severe coughing or vomiting.

MEDICATION

Your doctor may prescribe:

• General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation and fixation of bone fragments possible.
• Narcotic or synthetic narcotic pain relievers in liquid form for severe pain.
• Stool softeners in liquid form to prevent constipation due to a liquid diet.
• Liquid acetaminophen (available without prescription) for mild pain after initial treatment.

Home Diet

• Drink only water before manipulation or surgery to treat the fracture.Any food in your stomach makes vomiting while under anesthesia more hazardous.
• During recovery, follow a high-protein liquid diet such as malted milk and eggnog. Add soft foods as you are able. Most people can handle rich soups, ground meat, whipped potatoes and gravy.

Prevention Tips

• Use appropriate protective equipment,such as a face masks or mouthpiece,When participating in contact sports.
• Do not push on your jaw or allow anything else to push on it. Sleep on your back.
• You will be able to take nothing but liquids while your jaw is wired. Drink high-protein nutritional supplements until the jaw has healed.

Jaw Dislocation, Temporomandibular Joint

Injury and displacement of the end of the lower jaw from its normal niche in a small depression at the base of the skull.

BODY PARTS INVOLVED

• Skull.
• Lower jaw (mandible).
• Soft tissue surrounding the dislocation, including nerves, tendons, ligaments, muscles, and blood vessels.

Causes

• Direct blow to the jaw.
• Any action that forces the mandible open wider than its normal range on either side. Muscle spasm follows immediately.This can occur with yawning, yelling or taking a very large bite.
• End result of a severe Jaw sprain.

Signs & Symptoms

• Inability to close the mouth.
• Excruciating pain in the jaw at the time of injury.
• Visible deformity if dislocated bones lock in the dislocated position. If they spontaneously reposition themselves, no deformity will be apparent, but damage will be the same.
• Tenderness over the dislocation.
• Swelling and bruising around the jaw.
• Numbness or paralysis in muscles of the face, jaw and neck from pressure, pinching or cutting of blood vessels or nerves.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Continue ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
• After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use hot compresses, heat lamps, pads, or heat ointments and liniments.
• If you have recurrent jaw dislocations, you can learn to reposition the jaw. Ask your doctor or dentist for instructions.Use the following points as reminders:

1. Place your index finger on your back lower teeth (or gums in this area if you have no teeth).
2. At the same time, place both thumbs under the center of your chin.
3. Push the fingers down while simultaneously raising upward with the thumbs.The proper motion is more of a rotating movement than a straight one. It should be gentle-not fast or jerking.

Note: It is probably easier for someone else to perform the relocation than for you to do it.

MEDICATION

Your doctor may prescribe:

• General anesthesia or muscle relaxants to make jaw manipulation easier.
• Acetaminophen or aspirin to relieve moderate pain.
• Narcotic pain relievers for severe pain.

Physical therapy and mechanical devices

Patients who have difficulty with bruxism are usually treated with splints. A plastic splint called a nightguard is given to the patient to place over the teeth before going to bed. Splints can also be used to treat some cases of internal derangement by holding the jaw forward and keeping the disc in place until the ligaments tighten. The splint is adjusted over a period of two to four months.

TMJ can also be treated with ultrasound, electromyographic biofeedback , stretching exercises, transcutaneous electrical nerve stimulation , stress management techniques, or friction massage.

Home Diet

If a mouth appliance is necessary, drink a full liquid diet until the appliance can be removed. If no appliance is necessary, eat a soft diet for a few days until discomfort decreases. Avoid chewy foods that require big bites for a while. Include extra protein, such as meat, fish, poultry, cheese, milk and eggs.

Prevention Tips

For participation in contact sports, wear protective equipment, including a mouthpiece and helmet.

Hip Synovitis

Inflammation of the synovium, the smooth, lubricated lining of the hip joint.The synovium's lubricating fluid allows the hip to move freely and prevents bone surfaces from rubbing against each other. Synovitis is often a complication of an injury, such as a fracture, or of collagen diseases, such as gout or rheumatoid arthritis.

BODY PARTS INVOLVED

• Lining of the hip joint.
• Bones of the hip, including the thigh bone and pelvis

Causes

• Any direct blow to the hip or other hip injury that damages the synovium of the hip joint. Most hip synovitis can be traced back to an injury, even though the athlete cannot remember the injury.
• Bacterial infection in the hip, usually from gonorrhea or as a complication of an open hip fracture.
• Inflammatory joint disease, such as gout or rheumatoid arthritis.

Signs & Symptoms

• Pain in the hip joint with movement.
• Swelling in the hip.
• Holding the hip flexed and rotated
• Tenderness and redness in the hip area, if inflammation is caused from infection or a disease rather than from athletic injury.
• Fever

How is it diagnosed?

Your doctor will look at your child's hip to find out what kind of movement makes the pain worse. Your doctor may order blood tests and x-rays. These tests will help your doctor make sure that the cause of hip pain isn't something more serious than hip synovitis.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Follow your doctor's instructions for treatment of any underlying condition.
• Apply heat frequently. Use heat lamps, hot soaks , hot showers, heating pads, or heat liniments and ointments.
• Take whirlpool treatments,if available.
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

• Your doctor may prescribe:Antibiotics if infection is present. Non-steroidal anti-inflammatory drugs or anti-gout medicine. Injection of a long-acting local anesthetic mixed with a corticosteroid to help reduce pain and inflammation.
• You may take aspirin or ibuprofen for minor discomfort.

Home Diet

During recovery ,eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Engage in a vigorous muscle strengthening and conditioning program prior to beginning regular participation in sports. Overall strength and muscle tone makes injury less likely. Also, warm up adequately before competition or workouts.
• When appropriate, wear hip pads to protect the hip area during participation in contact sports.

Hip Strain

Injury to the muscles and tendons attached to the trochanter, the large end of the femur (thigh bone) that forms part of the hip joint. Muscles, tendons and bone comprise units. These units stabilize the hip joint and allow its motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:

• Mild (Grade I) - Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
• Moderate (Grade II) - Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
• Severe (Grade III) - Rupture of the muscle-tendon-bone, attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.

BODY PARTS INVOLVED

• Trochanter of the femur.
• Muscles or tendons that attach to the trochanter.
• Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.

Causes

• Prolonged overuse of muscle-tendon units in the buttock area or around the hip joint.
• Single violent injury or force applied to the muscle-tendon units in the region of the buttocks and hip joint.

Signs & Symptoms

• Pain when moving, stretching or twisting.
• Muscle spasm in the hip area.
• Swelling around the injury.
• Loss of strength (moderate or severe strain).
• Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
• Calcification of muscles or tendons (visible with X-rays).
• There may be a loss of strength in the muscle.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Use ice massage 3 or 4 times a day for 15 minutes at a time.Fill a large styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
• After the first 24 hours, apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
• Take whirlpool treatments, if available.
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

• For minor discomfort, you may use:Aspirin, acetaminophen or ibuprofen. Topical liniments and ointments.
• Your doctor may prescribe: Stronger pain relievers. Injection of a long-acting local anesthetic to reduce pain. Injections of corticosteroids, such as triamcinolone, to reduce inflammation.

Home Diet

Eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Participate in a strengthening and conditioning program appropriate for your sport.
• Warm up before stretching; warming up first enables you to stretch more effectively.
• Wear or use appropriate protective gear during sports.

Hip Fracture

A complete or incomplete break in the head of the femur, the major bone In the hip joint.

In the United States, hip fractures are the most common broken bone that requires hospitalization; about 300,000 Americans are hospitalized for a hip fracture every year. Hip fractures are generally separated into two types of fractures:

1. Femoral Neck Fractures
2. Intertrochanteric Hip Fractures

BODY PARTS INVOLVED

• Femur (the large bone extending from the knee to the hip).
• Acetabulum (hip socket in bony pelvis).
• Hip joint.
• Soft tissue around the fracture site, including muscles, nerves, tendons, ligaments, periosteum (covering to bone), blood vessels and connective tissue.

Causes

Direct blow or indirect stress to the hip joint. Indirect stress may be caused by twisting or a violent muscle contraction. In older adults, a hip fracture is most often a result of a traumatic event, such as falling, and weak bones.

Signs & Symptoms

• Severe pain in the hip.
• Inability to stand.
• Swelling and bruising around the fracture.
• Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal body contours.
• Tenderness to the touch.
• Numbness or coldness in the leg and foot if the blood supply is impaired or nerves are injured.

Treatment

Follow your doctor's instructions. Instructions are supplemental. Surgery is almost always the best way to repair a hip fracture. Doctors typically use non-surgical alternatives, such as traction, only if you have a serious illness that makes surgery too risky. The type of surgery you have generally depends on the part of the hip that fractured, the severity of the fracture and your age.

• Immobilization will be necessary. In hip fracture, the fractured bone is usually fixed and held with surgical steel pins or nails. A rigid cast is placed from pelvis to knee.
• Use frequent ice massage after the cast is removed. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day.
• Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
• Take whirlpool treatments, if available.
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

Your doctor may prescribe:

• General anesthesia to make joint manipulation possible.
• Narcotic or synthetic narcotic pain relievers for severe pain.
• Stool softeners to prevent constipation due to inactivity.
• Acetaminophen for mild pain.
• Antibiotics to fight infection following surgery.

Home Diet

• Drink only water before manipulation or surgery to treat the fracture .Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
• During recovery ,eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

You can reduce your risk of a hip fracture by taking steps to prevent osteoporosis. Women are more likely than men are to develop osteoporosis; however, both women and men can take steps to prevent osteoporosis. These steps can help you prevent a hip fracture by slowing bone loss:

• Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
• Weight-bearing exercises, such as walking, apply tension and pressure to your muscles and bones, encouraging your body to increase bone density to meet the additional stress. Exercise also increases your overall balance and strength, making you less likely to fall. High-impact exercises, such as those involving running or jumping, aren't recommended if you have weak bones, as they may increase your risk of a fracture or injury.
• Use appropriate protective equipment, such as hip pads, when competing in contact sport.
• Ensure an adequate calcium intake (1000mg to 1500mg a day) with milk and milk product or calcium supplements.
• Preserve your bone density by avoiding the excessive use of alcohol and by not smoking.
• If you're older, wear thinner, hard-soled, flat shoes. Resilient-soled athletic shoes may impair your balance and contribute to falls. Avoid wearing high heels or sandals with light straps. Avoid wearing shoes that are either too slippery or too sticky.
• Poor eyesight is a possible cause of falls. If you're having trouble seeing, have your eyes checked. Wearing proper glasses and being able to see well around your home makes it more likely that you'll see objects that you might trip over.

Hip Dislocation

A serious hip injury in which adjoining bones in the hip are displaced so they no longer touch each other. Dislocations are frequently accompanied by bone fractures, torn ligaments and torn tendons. Temporary or permanent damage to bone or to the sciatic nerve makes immediate treatment necessary.

Some children are born with a hip problem called congenital hip dislocation (dysplasia). The condition is usually diagnosed as soon as a baby is born. Most of the time, it affects the left hip in first-born children, girls, and babies born in the breech position.

BODY PARTS INVOLVED

• Femur (thigh bone) and pelvis.
• Strong ligaments that hold the hip in place.
• Sciatic nerve.
• Soft tissue surrounding the dislocated hip, including periosteum (covering to bone), other nerves, tendons, blood vessels and connective tissue.

Causes

• Direct or indirect blow to a flexed knee and hip.
• End result of a severe hip sprain.
• Congenital abnormality, such as shallow or malformed joint surfaces.

Signs & Symptoms

• Severe pain in the hip at the time of injury, and when trying to move hip.
• Loss of hip function.
• Visible deformity if the dislocated bones have locked in the dislocated position. The leg may appear shortened and turned in. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
• Tenderness over the dislocation.
• Swelling and bruising at the injury site.
• Numbness or paralysis below the dislocation from pressure, pinching or cutting of blood vessels or nerves.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

At home:

• Apply heat frequently. Use heat lamps, hot soaks,hot showers or heating pads.
• Take whirlpool treatments, if available.
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

Your doctor may prescribe:

• General anesthesia or muscle relaxants to make joint manipulation possible.
• Acetaminophen to relieve moderate pain.
• Narcotic pain relievers for severe pain.
• Stool softeners to prevent constipation due to decreased activity.
• Antibiotics to fight infection if surgery is required.

Home Diet

• Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
• Eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Build your overall strength and muscle tone with a long-term conditioning program appropriate for your sport.
• Warm up adequately before physical activity.
• After healing, protect vulnerable joints with special hip pads.
• Consider avoiding contact sports if treatment is unsuccessful in restoring a strong, stable hip.

Hip Bursitis

Inflammation of the bursa surrounding either of the big knobs of bone (trochanters) at the top of the femur (thigh bone). Bursitis may vary in degree from mild irritation to an abscess formation that causes excruciating pain.

BODY PARTS INVOLVED

• One of two bursas in the hip joint where the trochanters fit into their socket. A bursa is a soft sac filled with lubricating fluid that facilitates motion in the hip and protects it from injury.
• Soft tissue surrounding the hip joint, including nerves, tendons, ligaments, blood vessels (both large vessels and capillaries), periosteum (the outside lining of bone) and muscles.

Causes

• Injury to the hip.
• Acute or chronic Infection.
• Arthritis.
• Gout.
• Unknown (frequently).

Signs & Symptoms

• Pain in the hip.
• A "crackling" feeling when moving the hip.
• Tenderness.
• Swelling.
• Pain which radiates down the thigh at night
• Redness (sometimes) over the affected bursa.
• A "snapping" noise with stepping or other hip motion.
• Fever if infection is present.
• Limitation of motion in the hip.

How is hip bursitis diagnosed?

The diagnosis of hip bursitis is made most reliably on physical examination. The most common symptoms of hip bursitis include:

• Tenderness over the bony prominence of the upper/outer thigh
• Swelling over the bursa

An x-ray is often obtained to ensure there are no bone spurs or calcifications that could be contributing to the problem. Occasionally, your doctor may obtain an MRI if the diagnosis is unclear or if the problem does not resolve with treatment.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Use frequent ice massage. Fill a large styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area about in a circle the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition. After 72 hours, apply heat instead of ice, if it feels better.Use heat lamps, hot soaks, hot showers ,heating pads, or heat liniments or ointments.
• Take whirlpool treatments, if available.
• Use crutches to prevent weight-bearing on the hip joint,if needed.
• Elevate the hips above the level of the heart to reduce swelling and prevent accumulation of fluid. Use pillows for propping.
• Gentle massage will frequently provide comfort and decrease swelling.

MEDICATION

Your doctor may prescribe:

• Non-steroidal anti-inflammatory drugs.
• Antibiotics if the bursa is infected.
• You may use ibuprofen (i-bew-pro-fin) and acetaminophen (uh-c-tuh-min-o-fin) for your pain. These may be bought as over-the-counter medicine. Do not take ibuprofen if you are allergic to aspirin.
• Prescription pain relievers for severe pain. Use, non-prescription aspirin, acetaminophen or ibuprofen (available under many trade names) for mild pain.
• Injections with a long-lasting local anesthetic mixed with a corticosteroid drug, such as triamcinolone.

Home Diet

Eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.Your doctor may suggest vitamin and mineral supplements to promote healing.

Prevention Tips

• Always warm up your muscles and stretch gently before exercising. Do cool-down and stretching exercises when you are finished. This will loosen your muscles and decrease stress on your hips. Rest between exercise sessions.
• Use protective gear such as hip pads for contact sports.
• Start exercising when caregivers say that it is OK. Do not run if you have pain.
• Warm up adequately before athletic practice or competition.
• Wear warm clothing in cold weather.
• To prevent recurrence, continue to wear extra protection over the hips until healing is complete.
• Do cool-down exercises after working out.
• Rest your hip, use ice treatments and take NSAIDs as directed by your caregiver.

Head Injury, Subdural Hemorrhage And Hematoma

Bleeding (hemorrhage) that causes blood to collect and clot (hematoma) beneath the membranes (meninges) that cover the brain. There are 2 types of subdural hematomas:

• An acute subdural hematoma occurs soon after a severe head injury. It is the most frequent cause of death from injury in contact sports.
• A chronic subdural hematoma may develop weeks after a head injury. The injury may have been so minor that the patient does not remember it.

BODY PARTS INVOLVED

• Brain.
• Meninges.
• Blood vessels to the brain.
• Skull.

Causes

• Acute: Severe blow to the head that bruises and tears the brain and its blood vessels.
• Chronic: Minor (even forgotten) head injury. Blood in the enclosed space in the brain forms a hematoma that gradually increases with further bleeding.

Signs & Symptoms

• Recurrent, worsening headaches.
• Fluctuating drowsiness, dizziness, mental changes or confusion.
• Weakness or numbness on one side of the body.
• Vision disturbances.
• Vomiting without nausea.
• Pupils of different size (sometimes).

Treatment

Follow your doctor's instructions. Instructions are supplemental.

Surgery is the only treatment for a subdural hemorrhage and , hematoma. Under local or light general anesthesia, small holes are bored through the skull. The blood clot (which looks like currant jelly) is removed manually or by suction. After surgery, symptoms usually improve rapidly.

MEDICATION

Your doctor may prescribe:

• Corticosteroid drugs to reduce swelling inside the skull.
• Anticonvulsant medication.
• Antibiotics to fight infection.

Home Diet

During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

Wear a protective helmet for any activity at risk for a head injury.

Head Injury, Skull Fracture

Skull fractures may be of two types:

• A closed, or simple, break in the bone without breaking the skin or bone covering (periosteum).
• An open, or compound, break that breaks the skin and periosteum.

BODY PARTS INVOLVED

• Skull.
• Periosteum (fibrous covering of bone).
• Soft tissue adjacent to the skull, including skin and underlying tissue, muscles, nerves and tendons.
• Brain (sometimes), if bone fragments are depressed into the brain.

Causes

Direct blow to the head.

Signs & Symptoms

• Pain and swelling over the skull fracture.
• Bruising over the fracture and around the eyes and nose.
• Profuse bleeding from the scalp if the skin is broken.
• Leakage of clear fluid (cerebrospinal fluid) into the ear or nose.

Additional signs, if brain damage accompanies the skull fracture:

• Drowsiness or confusion.
• Vomiting and nausea.
• Blurred vision.
• Loss of consciousness-either temporarily for long periods.
• Amnesia or memory lapses.
• Irritability.
• Headache.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

The extent of injury can be determined only with careful examination and observation. After a doctor's examination, the injured person may be sent home, but a responsible person must stay with the person and watch for serious symptoms. The first 24 hours after injury are critical, although serious aftereffects can appear later. If you are watching the patient, awaken him or her every hour for 24 hours. Report to the doctor immediately if you can't awaken or arouse the person. Report also any of the following:

• Vomiting.
• Inability to move the arms and legs equally well on both sides.
• Temperature above 100F (37.8C).
• Stiff neck.
• Pupils of unequal size or shape.
• Convulsions.
• Noticeable restlessness.
• Severe headache that persists longer than 4 hours after injury.
• Confusion.

MEDICATION

Don't give any medicine-including non-prescription acetaminophen or aspirin-until the extent of injury is certain.

Home Diet

Follow a full liquid diet for 24 to 48 hours until the danger of complications passes.

Prevention Tips

• Teach children to obey traffic rules and signals.
• Wear a protective helmet or other appropriate headgear during athletic activity in which head injury is possible.
• Provide highly visible clothing.
• DO NOT leave the victim alone, even if there are no complaints or obvious injuries.
• Use car seats or seat belts whenever in a motor vehicle.
• Do not allow children to bike or skate at night.
• DO NOT allow the victim to continue to engage in physical activities.

Head Injury, Intracerebral Hematoma

Bleeding (hemorrhage) that causes blood to collect and partially clot (hematoma) inside the brain. The use of CAT scans has shown that this condition occurs more frequently than physicians previously thought.

BODY PARTS INVOLVED

• Brain.
• Blood vessels to the brain.

Causes

Severe blow to the head.

Signs & Symptoms

The following symptoms usually develop within 1 to 96 hours after a head injury:

• Unconsciousness for a short period of time followed by a headache that steadily worsens.
• Drowsiness or unconsciousness.
• Nausea or vomiting.
• Inability to move the arms and legs.
• Change in the size of the eye pupils.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

Surgery is the only treatment for an intracerebral hemorrhage and hematoma. Under local or light general anesthesia, small holes are bored through the skull. The blood clot (which looks like currant jelly) is removed manually or by suction. After surgery, symptoms usually improve rapidly.

MEDICATION

Your doctor may prescribe:

• Corticosteroid drugs to reduce swelling inside the skull.
• Anticonvulsant medication.
• Antibiotics to fight infection.

Home Diet

During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

Wear a protective helmet for any activity at risk for a head injury.

Head Injury, Extradural Hemorrhage & Hematoma

Bleeding (hemorrhage) between the skull and the outermost of 3 membranes (meninges) that cover the brain, resulting in a pooling of blood (hematoma) that causes pressure on the brain.

BODY PARTS INVOLVE

• Brain.
• Skull.
• Blood vessels to the brain.
• Meninges.

Causes

Head injury with skull fracture that tears the middle meningeal artery.

Signs & Symptoms

The following symptoms usually develop within 1 to 96 hours after a head injury:

• Unconsciousness for a short period of time followed by a headache that steadily worsens.
• Drowsiness or unconsciousness.
• Nausea or vomiting.
• Inability to move the arms and legs.
• Change in the size of the eye pupils.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

Surgery is the only treatment for an extradural hemorrhage and hematoma. Under local or light general anesthesia, small holes are bored through the skull. The blood clot (which looks like currant jelly) is removed manually or by suction. After surgery, symptoms usually improve rapidly.

MEDICATION

Your doctor may prescribe:

• Corticosteroid drugs to reduce swelling inside the skull.
• Anticonvulsant medication.
• Antibiotics to fight infection.

Home Diet

During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

Wear a protective helmet for any activity at risk for a head injury.

Head Injury, Cerebral Contusion

Bruising of the brain following a blow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate brain tissue.

BODY PARTS INVOLVE

• Brain.
• Skin, subcutaneous tissue, blood vessels(both large vessels and capillaries), periosteum (the outside lining of the skull), muscles of the scalp and connective tissue.

Causes

Direct blow to the head, usually from a blunt object.

Signs & Symptoms

Depends on the extent of injury. The presence or absence of swelling at the injury site is not related to the seriousness of injury. Signs and symptoms include any or all of the following:

• Drowsiness or confusion.
• Vomiting and nausea.
• Blurred vision.
• Pupils of different size.
• Loss of consciousness - either temporarily or for long periods.
• Amnesia or memory lapses.
• Irritability.
• Headache.
• Bleeding of the scalp, if the skin is broken.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• The extent of injury can be determined only with careful examination and observation. After a doctor's examination, the injured person may be sent home, but a responsible person must stay with the person and watch for serious symptoms. The first 24 hours after injury are critical, although serious aftereffects can appear later. If you are watching the patient, awaken him or her every hour for 24 hours. Report to the doctor immediately if you can't awaken or arouse the person. Report also any of the following:
• Vomiting.
• Inability to move the arms and legs equally well on both sides.
• Temperature above 100F (37.8C).
• Stiff neck.
• Pupils of unequal size or shape.
• Convulsions.
• Noticeable restlessness.
• Severe headache that persists longer than 4 hours after injury.
• Confusion.

MEDICATION

Don't use any medicine-including non-prescription acetaminophen or aspirin-until the extent of injury is certain.

Home Diet

A full liquid diet should be followed until the danger passes.

Prevention Tips

Wear a protective helmet for any activity at risk for a head injury.

Head Injury, Cerebral Concussion

A violent jar or shock to the brain that causes an immediate change in brain function, including possible loss of consciousness.

BODY PARTS INVOLVE

• Head.
• Skull.
• Brain.

Causes

Blow to the head.

Signs & Symptoms

Mild concussion:

• Temporary loss of consciousness.
• Memory loss (amnesia).
• Emotional instability.

Severe concussion:

• Prolonged unconsciousness.
• Dilated pupils.
• Change in breathing.
• Disturbed vision.
• Disturbed equilibrium.
• Memory loss.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• The extent of injury can be determined only with careful examination and observation. After a doctor's examination, the injured person may be sent home, but a responsible person must stay with the person and watch for serious symptoms. The first 24 hours after injury are critical, although serious aftereffects can appear later. If you are watching the patient, awaken him or her every hour for 24 hours. Report to the doctor immediately if you can't awaken or arouse the person. Report also any of the following:
• Vomiting.
• Inability to move the arms and legs equally well on both sides.
• Temperature above 100F (37.8C).
• Stiff neck.
• Pupils of unequal size or shape.
• Convulsions.
• Noticeable restlessness.
• Severe headache that persists longer than 4 hours after injury.
• Confusion.

MEDICATION

Don't use any medicine-including non-prescription acetaminophen or aspirin-until the extent of injury is certain.

Home Diet

Follow a full liquid diet until the danger passes.

Prevention Tips

Wear a protective helmet for any activity at risk for a head injury.

Hand Tendinitis And Tenosynovitis

Inflammation of a tendon (tendinitis) or the lining of a tendon sheath (tenosynovitis) in the hand. This lining secretes a fluid that lubricates the tendon. When the lining becomes inflamed, the tendon cannot glide smoothly in its covering.

BODY PARTS INVOLVED

• Tendons in the hand.
• Lining and covering of the hand tendons.
• Soft tissue in the surrounding area, including blood vessels, nerves, ligaments, periosteum (covering to bone) and connective tissue.

Causes

• Strain from unusual use or overuse of the wrist, hand or forearm.
• Direct blow or injury to the muscles and tendons of the wrist, hand or forearm. Tenosynovitis becomes more likely with repeated injury.
• Infection introduced through broken skin at the time of injury or through a surgical incision after injury.

Signs & Symptoms

• Constant pain or pain with motion of the hand.
• Limited motion of the hand and wrist.
• Crepitation (a "crackling" sound when the tendon moves or is touched).
• Redness and tenderness over the injured tendon.

Do I need any tests?

Usually not. The diagnosis of tenosynovitis and tendonitis can usually be made by a doctor who examines you. If an infection is the suspected cause (uncommon) then blood tests and other tests may be done to find the cause of the infection.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Wrap the hand and wrist with an elasticized bandage until healing is complete.
• Apply heat frequently.Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
• Take whirlpool treatments, if available.

MEDICATION

You may use non-prescription drugs, such as acetaminophen, for minor pain. Your doctor may prescribe:

• Stronger pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need.
• Injection of the tendon covering with a combination of a long-acting local anesthetic and a non-absorbable corticosteroid such as triamcinolone.

Home Diet

During recovery eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may suggest vitamin and mineral Supplements to promote healing.

Prevention Tips

• Engage in a vigorous program of physical conditioning before beginning regular sports participation.
• Avoid repetitive motion and overuse of the affected area. This may be very difficult if your job involves repetitive movements. If it is a recurring problem then you should discuss this with your employer. A change of duties may help.
• Warm up adequately before practice or competition.
• Wear protective gear appropriate for your sport.
• Learn proper moves and techniques for your sport.
• Exercises to strengthen the muscles around the affected tendon may help.

Hand Sprain

Violent overstretching of one or more ligaments in the hand. Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. If the ligament pulls loose a fragment of bone, it is called a sprain-fracture. There are 3 types of sprains:

• Mild (Grade I) - Tearing of some ligament fibers. There is no loss of function.
• Moderate (Grade II) - Rupture of a portion of the ligament, resulting in some loss of function.
• Severe (Grade III) - Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair.

BODY PARTS INVOLVED

• Ligaments connecting joints in the hand.
• Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles.

Causes

Stress on a ligament that temporarily forces or pries joints in the hand out of their normal location. Hand sprain occur frequently in contact sports or sports in which falling on an outstretched hand is likely.

Signs & Symptoms

• Severe pain at the time of injury.
• A feeling of popping or tearing inside the hand.
• Tenderness at the injury site.
• Swelling in the hand.
• Bruising that appears soon after injury .

Treatment

Follow your doctor's instructions. Instructions are supplemental.

If the doctor does not apply a cast, tape or elastic bandage:

• Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in moist towel, and place it over the injured area.Use for 20 minutes at a time.
• Wrap the hand with an elasticized bandage between ice treatments.
• After 72 hours ,apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads,or heat liniments or ointments.
• Take whirlpool treatments, if available.
• Massage gently and often to provide comfort and decrease swelling.

MEDICATION

• For minor discomfort, you may use: Aspirin, acetaminophen or Ibuprofen. Topical liniments and ointments.
• Your doctor may prescribe: Stronger pain relievers. Injection of a long-acting local anesthetic to reduce pain.

Injection of a corticosteroid, such as triamcinolone, to reduce inflammation.

Home Diet

During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs.

Prevention Tips

• Build your strength with a conditioning program appropriate for your sport.
• Warm up before practice or competition.
• Tape vulnerable joints before practice of competition.

Hand Hematoma

A collection of pooled blood in a small space on the back or palm of the hand

BODY PARTS INVOLVED

• Back or palm of the hand.
• Soft tissue surrounding the hematoma, including nerves, tendons, ligaments, muscles and blood vessels.

Causes

Direct blow to the hand,usually with a blunt object. Bleeding into the tissue causes the surrounding tissue to be pushed away.

Signs & Symptoms

• Swelling over the injury site.
• Fluctuance (feeling of tenseness to the touch, like pushing on an overinflated balloon).
• Tenderness.
• Redness that progresses through several color changes-purple, green-yellow and yellow-before it completely heals.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Use ice soaks 3 or 4 times a day. Fill a bucket with ice water, and soak the injured area for 20 minutes at a time.
• After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area.Use hot baths, showers,compresses,heat lamps,heating pads,heat ointments and liniments, or whirlpools.
• Don't massage the hand. You may trigger bleeding again.

MEDICATION

• For minor discomfort, you may use: Non-prescription medicines such as acetaminophen or ibuprofen. Topical liniments and ointments.
• Your doctor may prescribe stronger medicine for pain, if needed.

Home Diet

During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs.

Prevention Tips

• Protect the hand with padding if there is a risk of hand injury during participation In athletic activity.
• If you must compete before healing,use tape, padding, splints or a cast to prevent re-injury.

Ganglion Cyst - Hand Ganglion

A small, usually hard nodule lying directly over a tendon or a joint capsule on the back or palm of the hand. Occasionally the nodule may become quite large.

In the hand, a ganglion is a particular type of lump which shows up next to a joint or a tendon. Inside, it is like a balloon filled with a thick liquid. It may be soft or hard, may or may not be painful, and may get bigger or smaller on its own. It may also be referred to as a mucous cyst, a mucinous cyst or a synovial cyst.

BODY PARTS INVOLVED

• Back or palm of the hand.
• Tendon sheath (a thin membranous covering to the tendon).
• Any of the joint spaces in the hand.

Causes

The exact cause of ganglions remains uncertain. The most popular theory is that ganglions form after trauma or degeneration of the tissue layer responsible for producing the synovial fluid which normally lubricates the joint or tendon sheath. The cyst arises from accumulation of this fluid outside the joint or tendon sheath in a sac or cyst. However some other causes are :-

• A defect in the fibrous sheath of the joint or tendon that permits a segment of underlying synovium (thin membrane that lines the tendon sheath) to herniated through it.
• Irritation accompanying the herniated synovium, causing continued secretion of fluid.The sac gradually fills, enlarges, and become hard, forming the ganglion.

Signs & Symptoms

• Hard lump over a tendon or joint capsule in the hand. The nodule "yields" to heavy pressure because it is not solid.
• No pain usually, but overuse of the hand may cause mild pain and aching.
• Tenderness if the lump is pressed hard.
• Discomfort with extremes of motion (flexing or extending) and with repetition of the exercise that produced the ganglion.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

Immediately after surgery:

• The affected area is usually immobilized in a splint for 1 to 2 weeks following surgery.
• If the wound bleeds during the first 24 hours after surgery, press a clean tissue or cloth to it for 10 minutes.
• A hard ridge should form along the incision.As it heals ,the ridge will recede gradually.
• Use an electric heating pad, a heat lamp, or a warm compress to relieve incisional pain.
• Bathe and shower as usual. You may wash the incision gently with mild unscented soap.
• Between baths, keep the wound dry with a bandage for the first 2 or 3 days after surgery. If bandage gets wet, change it promptly.
• Apply non-prescription antibiotic ointment to the wound before applying new bandages.
• Wrap the hand with an elasticized bandage until healing is complete.

After the Incision has healed:

• Use ice soaks 3 or 4 times a day.Fill a bucket with ice water ,and soak the injured area for 20 minutes at a time.
• You may apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
• Take whirlpool treatments, if available.

MEDICATION

• Your doctor may prescribe pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need.
• You may use non-prescription drugs, such as acetaminophen, for minor pain.

Home Diet

During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.

Prevention Tips

• Build your strength with a long-term conditioning program appropriate for your sport.
• Warm up before practice or competition.

Hand Fracture, Navicular

A complete or incomplete break in the navicular bone of the hand.

BODY PARTS INVOLVED

• Navicular (scaphoid) bone in the hand.
• Wrist joint.
• Soft tissue around the fracture site, including nerves, tendons, ligaments and blood vessels.

Causes

Direct blow or indirect stress to the bone. The force is usually inflicted by a fall on an outstretched hand.

Signs & Symptoms

• Severe pain at the fracture site.
• Swelling of soft tissue around the fracture.
• Tenderness to the touch.
• Numbness and coldness in the hand and fingers, if the blood supply is impaired.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Immobilization will be necessary. A Rigid cast or plaster splints is placed around the injured area to immobilize the joint above and the joint below the fracture site.
• After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heating pad or heat lamp so heat can penetrate the cast.
• After the cast is removed,use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.

MEDICATION

Your doctor may prescribe:

• General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation possible.
• Narcotic or synthetic narcotic pain relievers for severe pain.
• Acetaminophen (available without prescription) for mild pain after initial treatment.

Home Diet

• Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
• During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs.

Prevention Tips

• Use appropriate protective equipment such as boxing gloves for boxing.
• If you have had a previous injury, use tape and padding to protect your hand before participating in contact sports.

Hand Fracture, Metacarpal

A complete or incomplete break in one of the metacarpal bones-the bones that connect the hand and wrist to the fingers.

BODY PARTS INVOLVED

• Metacarpal bones of the hand.
• Metacarpo-carpal joints and metacarpo-phalangeal joints.
• Soft tissue around the fracture site, including nerves, tendons, ligaments and blood vessels.

Causes

• Direct blow, such as striking a blow with the fist.
• Indirect stress to the bone. Indirect stress may be caused by twisting or violent muscle, contraction.

Signs & Symptoms

• Severe hand pain at the time of injury.
• Swelling of soft tissue around the fracture.
• Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal body contours.
• Tenderness to the touch.
• Numbness and coldness beyond the fracture site, if the blood supply is impaired.

Treatment

Follow your doctor's instructions. Instructions are supplemental.

• Immobilization will be necessary. A Rigid cast is placed around the injured area to immobilize the fingers and wrist.
• After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heating pad or heat lamp so heat can penetrate the cast.
• After the cast is removed,use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.

MEDICATION

Your doctor may prescribe:

• General anesthesia, local anesthesia, or muscle relaxants to make bone manipulation possible.
• Narcotic or synthetic narcotic pain relievers for severe pain.
• Acetaminophen (available without prescription) for mild pain after initial treatment.

Home Diet

• Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
• During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs.

Prevention Tips

• Use appropriate protective equipment, such as padded gloves for boxing and hand pad for football.
• If you have had a previous hand fracture,use tape and padding to protect your hands before participating in contact sports.