ATEP test 3
Legg Calve'-Perthes Disease (Coxa Plana)
-Cause of Condition •Avascular necrosis (cell death) of the femoral head in child ages 4-10 •Articular cartilage becomes necrotic and flattens -Signs of Condition •Pain in groin that can be referred to the abdomen or knee •Limping is also typical •Varying onsets and may exhibit limited ROM -Care •Bed rest to reduce chance of chronic condition •Brace to avoid direct weight bearing •Early treatment and head may reossify and revascularize -Complication •If not treated early, will result in ill-shaping and osteoarthritis in later life
Piriformis Syndrome
-Cause of Condition •Compression of sciatic nerve; irritation due to tightness or spasm of muscle •May mimic sciatica (irritation of sciatic nerve) -Signs of Injury •Pain, numbness and tingling in butt - may extend below knee and into foot •Pain may increase following periods of sitting, climbing stairs, walking or running -Care: •Stretching and massage •NSAID's may be prescribed •Cessation of aggravating activities will be prescribed •Corticosteroid injection may also be suggested •Surgery is sometimes an option as well
Slipped Capital Femoral Epiphysis
-Cause of Condition •May be growth hormone related •25% of cases are seen in both hips •Epiphysis slips from femoral head in backwards direction due to weakness in growth plate •May occur during periods of elevated growth -Signs of Condition •Pain in groin that comes on over weeks or months •Hip and knee pain during passive and active motion; limitations of abduction, flexion, medial rotation and a limp -Management •W/ minor slippage, rest and non-weight bearing may prevent further slippage •Major displacement requires surgery •If undetected or surgery fails severe problems will result
Hip Labral Tears
-Cause of Condition •Result of repetitive overuse (i.e. running or pivoting) •May occur due to acute trauma (i.e. dislocation) -Signs of Injury •Often present as asymptomatic •Causes clicking, locking, or catching •Pain in the groin; stiffness; limited motion -Care •Exercises to maintain ROM, strength & stability •Avoid aggravating activities •NSAID's, corticosteroids •Surgical repair
Iliac Crest Contusion (hip pointer)
-Cause of Injury •Contusion of iliac crest or abdominal musculature •Result of direct blow -Signs of Injury •Pain, spasm, and transitory paralysis of soft structures •Decreased rotation of trunk or thigh/hip flexion due to pain -Care •RICE for at least 48 hours, NSAID's, •Bed rest 1-2 days in severe cases •Referral must be made, X-ray •Padding should be used upon return to minimize chance of added injury
Acute Femoral Fractures
-Cause of Injury •Generally involving shaft and requiring great force •Occurs in middle third due to structure and point of contact -Signs of Injury •Shock, pain, swelling, deformity •Must be aware of bone displacement and gross deformity •Loss of function -Care •Treat for shock, verify neurovascular status, splint before moving, reduce following X-ray •Secure immediate emergency assistance and medical referral
Femoral Stress Fractures
-Cause of Injury •Overuse •Uncommon injury - tends to occur in endurance athletes (Females>Males) -Signs of Injury •Pain occurs weeks after increasing workout intensity •Persistent pain in thigh, groin, especially after activity •Referred pain to knee •X-ray or bone scan will reveal fracture •Commonly seen in femoral neck -Management •Initial treatment involves rest •While most head with conservative management, fracture may result (May require surgical repair)
Acute Fracture of Pelvis
-Cause of Injury •Result of direct blow or blunt trauma -Signs of Injury •Severe pain, loss of function, shock -Care •Immediately treat for shock •Refer to physician •Seriousness of injury dependent on extent of shock and possibility of internal injury
Sprains of the Hip Joint
-Cause of Injury •Result of violent twist due to forceful contact •Force from opponent/object or trunk forced over planted foot in opposite direction -Signs of Injury •Signs of acute injury and inability to circumduct hip •Pain in hip region, w/ hip rotation increasing pain -Care •X-rays or MRI should be performed to rule out fracture •RICE, NSAID's and analgesics •Depending on severity, crutches may be required •ROM and PRE are delayed until hip is pain free
Quadriceps Muscle Strain
-Cause of Injury •Sudden stretch when athlete falls on bent knee or experiences sudden contraction •Associated with weakened or over constricted muscle -Signs of Injury •Peripheral tear causes fewer symptoms than deeper tear •Pain, point tenderness, spasm, loss of function and little discoloration •Complete tear may leave athlete w/ little disability and discomfort but with some deformity -Care •Rest, ice and compression to control internal bleeding •Determine extent of injury early •Neoprene sleeve may provide some added support
Avulsion Fractures
-Cause of Injury •Avulsions seen in sports w/ sudden accelerations and decelerations •Pulling of tendon away and off of bony insertion •Common sites include ASIS (sartorius), AIIS (rectus femoris attachment), ischial tuberosity (hamstring -Signs of Injury •Sudden localized pain w/ limited movement •Pain, swelling, point tenderness -Care •Rest, limited activity and graduated exercise
Groin Strain
-Cause of Injury •One of the more difficult problems to diagnose •Often seen in early part of season due to poor strength and flexibility •Occurs from running , jumping, twisting w/ hip external rotation or severe stretch -Signs of Injury •Sudden twinge or tearing during active movement •Produce pain, weakness, and internal hemorrhaging -Care •RICE, NSAID's and analgesics for 48-72 hours •Determine exact muscle or muscles involved •Rest is critical •Restore normal ROM and strength -- provide support w/ wrap •Refer to physician if severe groin pain is experienced
Dislocated Hip
-Cause of Injury •Rarely occurs in sport •Result of traumatic force directed along the long axis of the femur -Signs of Injury •Flexed, adducted and internally rotated hip •Palpation reveals displaced femoral head, posteriorly •Serious pathology •Soft tissue, neurological damage and possible fracture -Care •Immediate medical care (blood and nerve supply may be compromised) •Contractures may further complicate reduction •2 weeks immobilization and crutch use for at least one month
Osteitis Pubis
-Cause of Injury •Seen in distance runners •Repetitive stress on pubic symphysis and adjacent muscles -Signs of Injury •Chronic pain and inflammation of groin •Point tenderness on pubic tubercle •Pain w/ running, sit-ups and squats -Management •Rest, NSAID's and gradual return to activity
Myositis Ossificans
-Cause of Injury: •Formation of ectopic (on top of) bone following repeated blunt trauma -Signs of Injury: •X-ray shows calcium deposit 2-6 weeks following injury •Pain, weakness, swelling, decreased ROM •Tissue tension and point tenderness -Care: •Treatment must be conservative •May require surgical removal if too painful and restricts motion (after one year - remove too early and it may come back) •If condition is recurrent it may indicate problem with blood clotting
Knee Plica
-Etiology •Irritation of the plica (generally, mediopatellar plica and often associated w/ chondromalacia) -Signs and Symptoms •Possible history of knee pain/injury •Recurrent episodes of painful pseudo-locking •Possible snapping and popping •Pain w/ stairs and squatting •Little or no swelling, and no ligamentous laxity -Management •Treat conservatively w/ RICE and NSAID's if the result of trauma •Recurrent conditions may require surgery
Patellar Tendinitis (Jumper's or Kicker's Knee)
-Etiology •Jumping or kicking - placing tremendous stress and strain on patellar or quadriceps tendon •Sudden or repetitive extension -Signs and Symptoms •Pain and tenderness at inferior pole of patella •3 phases - 1)pain after activity, 2)pain during and after, 3)pain during and after (possibly prolonged) and may become constant -Management •Ice, phonophoresis, iontophoresis, ultrasound, heat •Exercise •Patellar tendon bracing •Transverse friction massage
Injury to the infrapatellar fat pad
A hockey goalie notes pain, swelling and even mild discoloration below the patellar ligament especially during knee extension. Some mild weakness is noted in the knee extensors as well as stiffness with movement.
Osteochondral Knee Fractures
A lacrosse midfielder twists his knee while cutting and hears a snap and feels his knee give way. There is immediate swelling and considerable pain along the joint line.
Patellar Tendinitis (Jumper's or Kicker's Knee)
A middle blocker on your volleyball team has been c/o anterior knee pain for the past several weeks. She began c/o pain just after activity which progressed to pain during and after activity and now the pain is occurring during and stays with her for several hours after activity and into the next morning until she gets loosened up. Pain is worst during jumping activities and lately she tells you that the tendon in front of her knee feels "creaky" when she flexes and extends her knee.
Sequela
A patient develops a meniscal tear and subsequently osteoarthritis after attempting to play while he was ACL deficient. This is an example of a __________.
Prognosis
A physician tells a patient that if he keeps running with the stress fracture it is likely to continue to deteriorate and eventually fracture through the bone. However if he will go NWB for 4-6 weeks it should heal normally. She is provided the patient a _______.
LCL Sprain
A soccer forward steps forward into a stride position to reach for a ball. When his foot hits the ground with his tibia slightly internally rotated, the opposing defender makes contact with the medial aspect of his knee. Swelling is noted over the lateral aspect of the joint and some laxity is present.
Peroneal Nerve Contusion
A soccer player drops to the field after being kicked near the fibular head. She reports feeling an "electric shock" sensation radiating down the front of her leg and into the top of her foot. When you palpate the area where she was kicked it increases the tingling sensation. When she tries to walk off the field she says it feels like she can't lift her toes and it sounds like her foot is slapping the ground.
Patellofemoral Stress Syndrome
A tennis player c/o dull aching anterior knee pain with activity. She also notes pain after sitting for long periods of time like in the car, in class or at the movies. She occasionally notes a crackling sensation when she moves her knee, especially if she pushes down on her kneecap. She has been working with the weight room staff b/c she exhibits very tight lateral thigh muscles and somewhat weak medial thigh muscles. In addition to this she also pronates.
Patellar Fracture
A volleyball player dives for a ball and lands directly on her knee with it in a semi-flexed position. Significant pain and swelling are noted over the patella and it is painful for her to flex and extend her knee.
Symptoms
Fever, headache and nausea are all examples of __________ that might be reported by a patient.
O (Objective)
Findings based on AT's evaluation
Plain Film Radiographs (X-ray)
Used to determine presence of fractures bone abnormalities and dislocations Can be used to rule out disease (neoplasm) Occasionally used to assess soft tissue
Syndrome
Vague anterior knee pain associated with the positioning and tracking of the patella as well as the pull by muscle groups combined with foot biomechanics is known as a _________. Shin splints is another example of this type of condition.
Arthrography
Visual study of joint via X-ray after injection of dye, air, or a combination of both Shows disruption of soft tissue and loose bodies
PCL Sprain
Your sister calls you in tears because she and her boyfriend were in an automobile accent, and he rear-ended a car in front of them. The dashboard was pushed back striking him in the knee. He tells her that he felt a pop in the back of his knee but not a lot of pain. He is able to walk but "something just doesn't feel right"
Pathology
_________ is the structural and functional changes that result from injury. Multi-directional shoulder instability following several dislocations.
Etiology
____________ is the cause of injury of disease. For example, this athlete inverted his ankle. For our purposes, sometimes synonymous with Mechanism of Injury.
SOAP Notes
an organized method of documenting a patient's status on his or her chart that includes subjective findings, objective findings, assessments and plans for each problem experienced by the patient
Sequela
condition following and resulting from disease or injury (pneumonia resulting from flu)
Sign
objective, definitive and obvious indicatior for specific condition
Etiology
the cause of a disease
Special Tests
used to detect specific pathologies
Progress Evaluations/Notes
•Constantly monitor athlete's progress until returns to previous level of activity •More limited in scope •S/Sxs compared to previous evaluation
Hamstring Muscle Strains
-Cause of Injury: •Multiple theories of injury •Hamstring and quad contract together •Change in role from hip extender to knee flexor •Fatigue, posture, leg length discrepancy, lack of flexibility, strength imbalances, -Signs of Injury: •Muscle belly or point of attachment pain •Capillary hemorrhage, pain, loss of function and possible discoloration •Grade 1 - soreness during movement and point tenderness •Grade 2 - partial tear, identified by sharp snap or tear, severe pain, and loss of function Signs of Injury (continued) •Grade 3 - Rupturing of tendinous or muscular tissue, involving major hemorrhage and disability, edema, loss of function, ecchymosis, palpable mass or gap -Care: •RICE •Restrict activity until soreness has subsided •Ballistic stretching and explosive sprinting should be avoided initially
Stress Fractures
-Cause of injury •Repetitive abnormal overused forces -Signs of Injury •Groin pain, w/ aching sensation in thigh that increases w/ activity and decreases w/ rest •Discomfort increases with activity and subsides during rest -Care •Refer to physician for assessment and X-ray •Rest for 2-5 months
Quadriceps Contusions
-Cause-Constantly exposed to traumatic blows -Signs: •Pain, transitory loss of function, immediate bleeding of affected muscles •Early detection and avoidance of internal bleeding are vital - increases recovery rate and prevents muscle scarring -Care •RICE and NSAID's •Crutches for more severe cases •Isometric quadriceps contractions should begin as soon as tolerated
Bursitis
-Etiology •Acute, chronic or recurrent swelling •Prepatellar = continued kneeling •Infrapatellar = overuse of patellar tendon -Signs and Symptoms •Prepatellar bursitis may be localized swelling above knee that is ballotable •Swelling in popliteal fossa may indicate a •Baker's cyst •Associated w/ semimembranosus bursa or medial head of gastrocnemius •Commonly painless and causing little disability •May progress and should be treated accordingly -Management •Eliminate cause, RICE and NSAID's •Aspiration and steroid injection if chronic
Joint Contusions
-Etiology •Blow to the muscles crossing the joint (vastus medialis) -Signs and Symptoms •Present as knee sprain, severe pain, loss of movement and signs of acute inflammation •Swelling, discoloration •Possible capsular damage -Management •RICE initially and continue if swelling persists •Gradual progression to normal activity following return of ROM and padding for protection •If swelling does not resolve w/in a week a chronic condition (synovitis or bursitis) may exist requiring more rest
Peroneal Nerve Contusion
-Etiology •Compression of peroneal nerve due to a direct blow -Signs and Symptoms •Local pain and possible shooting nerve pain •Numbness and paresthesia in cutaneous distribution of the nerve •Added pressure may exacerbate condition •Generally resolves quickly -- in the event it does not resolve, it could result in drop foot -Management •RICE and return to play once symptoms resolve and no weakness is present •Padding for fibular head is necessary for a few weeks
Acute Patella Subluxation or Dislocation
-Etiology •Deceleration w/ simultaneous cutting in opposite direction (valgus force at knee) •Quad pulls the patella out of alignment •Some individuals may be predisposed •Repetitive subluxation will stress medial restraints -Signs and Symptoms •W/ subluxation, pain and swelling, restricted ROM, palpable tenderness over adductor tubercle •Results in total loss of function -Management •Reduction is performed by flexing hip, moving patella medially and slowly extending the knee •Following reduction, immobilization for at least 4 weeks w/ use of crutches and isometric exercises during this period •After immobilization period, horseshoe pad w/ elastic wrap should be used to support patella •Muscle rehab focusing on muscle around the knee, thigh and hip are key (STLR's are optimal for the knee) •Possible surgery to release tight structures •Improve postural and biomechanical factors
Patellar Fracture
-Etiology •Direct or indirect trauma (severe pull of tendon) •Semi-flexed position with forcible contraction (falling, jumping or running) -Signs and Symptoms •Hemorrhaging and joint effusion w/ generalized swelling •Indirect fractures may cause capsular tearing, separation of bone fragments and possible quadriceps tendon tearing •Little bone separation w/ direct injury -Management •X-ray necessary for confirmation of findings •RICE and splinting if fracture suspected •Refer and immobilize for 2-3 months
Illiotibial Band Friction Syndrome (Runner's Knee or Cyclist's Knee)
-Etiology •General expression for repetitive/overuse conditions attributed to mal-alignment and structural asymmetries -Signs and Symptoms -IT Band Friction Syndrome •Irritation at band's insertion - commonly seen in individual that have genu varum or pronated feet •Positive Ober's test -Pes Anserine Tendinitis or Bursitis •Result of excessive genu valgum and weak vastus medialis •Often occurs due to running w/ one leg higher than the other (running on a slope or crowned road) -Management •Correction of mal-alignments •Ice before and after activity •Utilize proper warm-up and stretching techniques •Avoidance of aggravating activities •NSAID's and orthotics
Anterior Cruciate Ligament Sprain
-Etiology •MOI - tibia externally rotated and valgus force at the knee (occasionally the result of hyperextension from direct blow) •May be linked to inability to decelerate valgus and rotational stresses - landing strategies •Male versus female •Research is quite extensive in regards to impact of femoral notch, ACL size and laxity, malalignments (Q-angle) & faulty biomechanics •Extrinsic factors may include, conditioning, skill acquisition, playing style, equipment, preparation time •May also involve damage to other structures including meniscus, capsule, and MCL -Signs and Symptoms •Experience pop w/ severe pain and disability •Positive anterior drawer and Lachman's •Rapid swelling at the joint line •Other ACL tests may also be positive -Management •RICE; use of crutches •Arthroscopy may be necessary to determine extent of injury •Could lead to major instability in incidence of high performance •W/out surgery joint degeneration may result •Age and activity may factor into surgical option •Surgery may involve joint reconstruction w/ grafts (tendon), transplantation of external structures •Will require brief hospital stay and 3-5 weeks of a brace •Also requires 4-6 months of rehab
Anterior Cruciate Ligament Sprain
-Etiology •MOI - tibia externally rotated and valgus force at the knee (occasionally the result of hyperextension from direct blow) •May be linked to inability to decelerate valgus and rotational stresses - landing strategies •Male versus female •Research is quite extensive in regards to impact of femoral notch, ACL size and laxity, malalignments (Q-angle) & faulty biomechanics •Extrinsic factors may include, conditioning, skill acquisition, playing style, equipment, preparation time •May also involve damage to other structures including meniscus, capsule, and MCL -Signs and Symptoms •Experience pop w/ severe pain and disability •Positive anterior drawer and Lachman's •Rapid swelling at the joint line •Other ACL tests may also be positive -Management •RICE; use of crutches •Arthroscopy may be necessary to determine extent of injury •Could lead to major instability in incidence of high performance •W/out surgery joint degeneration may result •Age and activity may factor into surgical option •Surgery may involve joint reconstruction w/ grafts (tendon), transplantation of external structures •Also requires 4-6 months of rehab
Meniscal Lesions
-Etiology •Medial meniscus is more commonly injured due to ligamentous attachments and decreased mobility •Also more prone to disruption through torsional and valgus forces •Most common MOI is rotary force w/ knee flexed or extended •Tears may be longitudinal, oblique or transverse -Signs and Symptoms •Effusion developing over 48-72 hour period •Joint line pain and loss of motion Intermittent locking and giving way •Pain w/ squatting •Portions may become detached causing locking, giving way or catching w/in the joint •If chronic, recurrent swelling or muscle atrophy may occur -Management •If the knee is not locked, but indications of a tear are present further diagnostic testing may be required •If locking occurs, anesthesia may be necessary to unlock the joint w/ possible arthroscopic surgery follow-up •W/ surgery all efforts are made to preserve the meniscus -- with full healing being dependent on location •Meniscectomy rehab allows partial weight bearing and quick return to activity •Repaired meniscus will require immobilization and a gradual return to activity over the course of 12 weeks
Posterior Cruciate Ligament Sprain
-Etiology •Most at risk during 90 degrees of flexion •Fall on bent knee is most common mechanism •Can also be damaged as a result of a rotational force •Sometimes referred to as a "dashboard injury" -May result when flexed knee of car driver or passenger hits the dashboard -Signs and Symptoms •Feel a pop in the back of the knee •Tenderness and relatively little swelling in the popliteal fossa •Laxity w/ posterior sag test -Management •RICE •Non-operative rehab of grade I and II injuries should focus on quad strength •Surgical versus non-operative •Surgery will require 6 weeks of immobilization in extension w/ full weight bearing on crutches •ROM after 6 weeks and PRE at 4 months
Osgood-Schlatter Disease and Larsen-Johansson Disease
-Etiology •Osgood Schlatter's is an apophysitis occurring at the tibial tubercle •Begins cartilaginous and develops a bony callus, enlarging the tubercle •Resolves w/ aging •Common cause = repeated avulsion of patellar tendon •Larsen Johansson is the result of excessive pulling on the inferior pole of the patella -Signs and Symptoms •Both elicit swelling, hemorrhaging and gradual degeneration of the apophysis due to impaired circulation •Pain w/ kneeling, jumping and running •Point tenderness -Management •Conservative •Reduce stressful activity until union occurs (6-12 months) •Possible casting, ice before and after activity •Isometrics for quadriceps and hamstrings
Osteochondritis Dissecans
-Etiology •Partial or complete separation of articular cartilage and subchondral bone •Cause is unknown but may include blunt trauma, possible skeletal or endocrine abnormalities, prominent tibial spine impinging on medial femoral condyle, or impingement due to patellar facet -Signs and Symptoms •Aching pain with recurrent swelling and possible locking •Possible quadriceps atrophy and point tenderness -Management •Rest and immobilization for children •Surgery may be necessary in teenagers and adults (drilling to stimulate healing, pinning or bone grafts)
Lateral Collateral Ligament Sprain
-Etiology •Result of a varus force, generally w/ the tibia internally rotated •If severe enough damage can also occur to the cruciate ligaments, ITB, and meniscus, producing bony fragments as well -Signs and Symptoms •Pain and tenderness over LCL •Swelling and effusion around the LCL •Joint laxity w/ varus testing •May cause irritation of the peroneal nerve -Management •Follows management of MCL injuries depending on severity
Patellofemoral Stress Syndrome
-Etiology •Result of lateral deviation of patella while tracking in femoral groove •Tight structures, pronation, increased Q angle, insufficient medial musculature -Signs and Symptoms •Tenderness of lateral facet of patella and swelling associated w/ irritation of synovium •Dull ache in center of knee •Patellar compression will elicit pain and crepitus •Apprehension when patella is forced laterally -Management •Correct imbalances (strength and flexibility) •McConnell taping •Lateral retinacular release if conservative measures fail
Osteochondral Knee Fractures
-Etiology •Same MOI as collateral/cruciate ligaments or meniscal injuries •Twisting, sudden cutting or direct blow •Fractures of cartilage and underlying bone varying in size and depth -Signs and Symptoms •Hear a snap and feeling of giving way •Immediate swelling and considerable pain •Diffuse, pain along joint line -Management •Diagnosed through use of CT and MRI •Treatment dependent on stability of fracture •If stable the patient will be casted •If fragment is loose surgical reattachment will occur or removal via arthroscopic •Microfracture procedures used to repair defects in underlying bone •Generates small amounts of bleeding to stimulate bone growth and healing •Rehabilitation is dependent on location of fracture •ROM is typically initiated early after surgery with active strengthening beginning after 6 weeks •Return to activity at 3-6 months
Chondromalacia patella
-Etiology •Softening and deterioration of the articular cartilage •Undergoes three stages •Swelling and softening of cartilage •Fissure of softened cartilage •Deformation of cartilage surface •Often associated with abnormal tracking •Abnormal patellar tracking may be due to genu valgum, external tibial torsion, foot pronation, femoral anteversion, patella alta, shallow femoral groove, increased Q angle, laxity of quad tendon -Signs and Symptoms •Pain w/ walking, running, stairs and squatting •Possible recurrent swelling, grating sensation w/ flexion and extension •Pain at inferior border during palpation -Management •Conservative measures •RICE, NSAID's, isometrics, orthotics to correct dysfunction •Surgical possibilities •Altering muscle attachments •Shaping and smoothing of surfaces •Drilling •Elevating tibial tubercle
Patellar Tendon Rupture
-Etiology •Sudden, powerful quad contraction •Generally does not occur unless a chronic inflammatory condition persists resulting in tissue degeneration •Occur primarily at point of attachment -Signs and Symptoms •Palpable defect, lack of knee extension •Considerable swelling and pain (initially) -Management •Surgical repair is needed •Proper conservative care of jumper's knee can minimize chances of occurring •If steroids are being used, intense knee exercise should be avoided due to weakening of collagen
Osgood-Schlatter Disease and Larsen-Johansson Disease
A 12 year old basketball player c/o pain in the anterior knee with pain w/ kneeling, jumping and running. Swelling and point tenderness is noted at the attachment of the patellar tendon to the tibial tuberosity.
Patellar Tendon Rupture
A 40 year old recreational softball player with a history of patellar tendinosis sprints to close on a fly ball and notes a pop f/b an inability to extend his knee. There is a palpable defect and swelling just superior to the tibial tuberosity.
Meniscal Lesions
A baseball catcher noted pain in his back knee while rotating during batting practice. He then went to catch and told you that being down in the crouch position really bothered him as well. He localizes the pain to the medial joint line and complains of intermittent locking and giving way. The swelling arises 48-72 hours after injury.
ACL Sprain
A basketball player goes up for a rebound and comes down and lands awkwardly hyperextending his knee. He tell you that he felt a "pop" and a sudden severe pain that is diminished to a dull ache. He notes that his knee feels unstable when he tries to walk. The knee swells rapidly and looks like a water balloon.
Joint Contusions
A basketball player takes an opponents knee to the medial aspect of his leg, just proximal to this knee. He c/o severe pain, loss of movement and signs of acute inflammation. Muscular inhibition and feelings that his knee might give way are noted.
Knee Plica
A cheerleader with a history of knee pain c/o recurrent episodes of painful pseudo-locking. However, she has no specific MOI. She states that it snaps and pops a lot, especially on the medial side of her knee. She notes that the pain is the worst w/stairs and squatting. There is little to no swelling, and no ligamentous laxity is noted.
Iliotibial Band Friction Syndrome (Runner's Knee or Cyclist's Knee)
A cross country runner with genu varum and pronation c/o pain over the lateral aspect of the knee jt. He notes pain is worse going downstairs or when running downhill. He even notes a snapping sensation with every step. He tells you that since he has moved here and mostly runs on the road for training the pain has gotten worse.
Condromalacia patella
A female breaststroker who has genu valgum c/o pain w/ walking, running, stairs and squatting. She also notes recurrent swelling, and a grating sensation w/ flexion and extension. During palpation she notes pain at the inferior border of the patella.
Acute Patella Subluxation or Dislocation
A field hockey player is running down the field when she decelerated and cuts to move in the opposite direction (resulting in a valgus force at the knee. She notes immediate pain and inability to move her knee joint. There is a boney abnormality on the lateral aspect of the joint.
MCL Sprain
A football player comes out of the game limping. He states that an opposing player ran into the outside of his knee and forced it in. He c/o tenderness and stiffness over the inside of the joint and some point tenderness on the outside of the joint where he got hit. He reports a subjective feeling of mild instability and the joint is starting to swell.
Observations
Asymmetries, postural mal-alignments or deformities? How does the athlete move? Is there a limp? Are movements abnormal? What is the body position? Facial expressions? Abnormal sounds? Swelling, heat, redness, inflammation, swelling or discoloration?
A (Assessment)
Athletic trainer's professional opinion regarding impression of injury May include suspected site of injury and structures involved along with rating of severity
Palpation
Bony and soft tissue
Off-the-field Injury Evaluation
HOPS- History, Observation, palpation, special tests
P (Plan)
Includes first aid treatment, referral information, goals (short and long term) and examiner's plan for treatment
Arthroscopy
Invasive technique, using fiber-optic arthroscope, used to assess joint integrity and damage Can also be used to perform surgical procedures
What is the difference b/t the diagnosis made by a physician and the diagnosis made by an athletic trainer?
Medical Diagnosis: ultimate determination Can be assigned an ICD-10 code Clinical Diagnosis: identifies the pathology, limitations and any impairments
History
Obtain subjective information relative to how injury occurred, extent of injury, MOI Ask the following questions What is the problem? How and when did it occur? Did you hear or feel something? Which direction did the joint move? Characterize the pain
Thomas test (Special test for Thigh)
Test for hip contractures
Straight Leg Raise
Test for hip extensor tightness can also be used to assess low back or SI joint dysfunction
S (subjective)
Statements made by patient - primarily history information and patient's perceptions including severity, pain, MOI
Mechanism
mechanical description of cause
Diagnosis
denotes name of specific condition
Medial Collateral Ligament Sprain
etiology: outside force to knee three grades of sprain management: RICE anti inflam rehab progressive resistive exercise. surgery possible on grade 3
Degree
grading for injury/condition
Syndrome
group of symptoms and signs that together indicate a particular injury or disease
Symptoms
perceptible changes in body function that indicate injury or illness (subjective)
Prognosis
prediction of the course of the condition
Pathology
structural and functional changes associated with injury process
Differential diagnosis
systematic method of diagnosing a disorder-list of possible causes
