Transcript Athletic Injuries ATC 222

Athletic Injuries
ATC 222
The Knee
Chapter 16
Anatomy
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bony
muscular
cartilage
ligaments
bursa
etc
Functional Anatomy
• Motions
– flexion/extension
– rotation
Evaluation
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History
Observation
Palpation
Special Tests
MCL Sprain
• Mechanism
– lateral force
– external tibial rotation
– hyperextension
• More severe and common than LCL
– part of capsule
– attaches to medial meniscus
• Signs and Symptoms
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pain over MCL
none to moderate edema/effusion
possible instability
possible ROM and strength loss
pain with passive extension and
external tibial rotation
MCL Sprain Treatment
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RICER
Crutches?
Immobilization?
Meniscal involvement?
Rehabilitation
LCL Sprain
• Mechanism
– varus force, internal tibial rotation
• Less prevalent that MCL
– no meniscal attachment
– action of popliteus muscle
– common peroneal nerve damage?
• Signs and Symptoms
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pain over LCL
none to mild edema/effusion
possible instability
possible ROM and strength loss
pain with passive extension and
internal tibial rotation
• Treatment
ACL Sprain
• Mechanism
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external tibial rotation with valgus
internal tibial rotation
hyperextension
deceleration
• Most common knee ligament to be
seriously injured
• Signs and Symptoms
– heard/felt a “pop”
– rapid effusion/hemarthrosis (1-2
hours)
– knee “gives out”
– instability
ACL Sprain Treatment
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RICER
Crutches?
Immobilization?
Conservative vs surgical
intervention
– commonly associated with meniscal
tear
PCL Sprain
• Mechanism
– force to anterior tibia with knee flexed
– hyperflexion
– rotation
• Signs and Symptoms
– “pop”
– effusion
– instability
• Treatment
– usually non-operative
Meniscal Lesions
• Mechanism
– rotation while weight bearing
– Acute MCL or ACL sprain
– chronic knee instability or
degeneration
• Signs and Symptoms
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clicking, catching, locking
slow developing effusion
pain on joint line
chronic effusion
• Treatment
– healing rate?
– Arthroscopic surgery
• removal vs repair
Patellar
Subluxation/Dislocation
• Mechanism
– external tibial rotation
– valgus
– functional/structural deviations
• Signs and Symptoms
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deformity
positive apprehension sign
effusion
pain on medial patellar border
• Treatment
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Reduction
immobilization and crutches?
RICER
rehabilitation
Patellofemoral Syndrome
• Structural/functional deviations
• Signs and Symptoms
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medial peripatellar pain
pain with stairs
crepitus
pain with stairs/prolonged sitting
• Treatment
– symptomatic
– correct functional/structural
deviations
Apophyseal Injuries
(apophysitis)
• Apophysis = Traction Epiphysis
• Types
– Osgood-Schlatter’s Syndrome
– Sinding-Larson-Johanson Syndrome
• Signs and Symptoms
– pain at tendon attachment
– tibial tubercle enlargement
– pain with prolonged sitting or pressure
• Treatment
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symptomatic
flexibility
activity modification
straps and sleeves
Other Injuries
• Tendonitis
• Osteochondral defects
• ITB syndrome
Special Tests of the Knee
• tibial/fibular
compression/percussion
• patellar apprehension
• ballotable patella and stroke test
• patellar excursion and compression
Other Special
Considerations
• leg length discrepancy
• Mechanics of lower extremity
• Q-Angle
– 10 males, 15 females
– over 20 is abnormal