Grading of Sports Injury

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Grading of Sports Injury

Assigning grade to injury provides a frame of reference to aid communication, assessment and management.

Traumatic soft tissue injury :
Grade Symptoms Signs Histopathology
1 Mild to moderate pain Minimal to mild swelling, tenderness. Can bear weight or tolerate loading stress Up to 50% fibre disruption with local inflammatory change. Some local haemorrhage
2 Moderate pain Moderate swelling, tenderness, perhaps bruising. Pain on weight bearing or stress testing. Evidence if ligament laxity, but ‘end point’ noted. 50-80% fibre disruption.
Inflammatory changes plus haemorrhage
3 Moderate to severe pain Severe or marked swelling and tenderness with bruising. Unable to weight bear and function severely affected. No ‘end point’ to stress testing; joint laxity Complete disruption of structure. Pronounced bleeding and inflammatory changes.

Overuse soft tissue injury :
Grade Symptoms Signs Histopathology
1 Ache after activity May be mild or local tenderness Local inflammatory or adaptive changes
2 Ache or pain at onset of activity, but disappears with warm up – reappears after activity Local tenderness. Some limitation of range of movement, weakness and painful to test Inflammation of injured tissue with involvement of contiguous structure
3 Constant ache or pain exaggerated by any activity. Eventually necessitates cessation of activity Local tenderness, loss of movement and perhaps muscle wasting Extensive inflammatory changes, scar formation, adhesions. May be calcification or degenerative change.

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