Osteitis Pubis Repetitive overuse of hip adductors and abdominal muscles (rectus) Repetitive overuse...

Osteitis Pubis

Repetitive overuse of hip adductors and abdominal muscles (rectus)

Symptoms of progressive groin painOccasional “popping sensation”Tenderness over pubis symphysisOne leg stance with hop elicits painMay need bone scan to r/o fractureTreatment includes rest, stretching,

NSAID’s and strengthening

Osteitis Pubis

rectus

adductors

Pediatric And Adolescent Injuries Or Conditions At

The ThighIliotibial band

syndromeMyosytis

ossificans

Iliotibial band

Gerdy’s tubercle

Iliotibial Band Syndrome

Relatively common among

long distance runnersOveruse of knee in flexion/extensionProvokes swelling underneath

the ITB and ITB itselfAppears friction from repetitive

flexion/extension causes

impingement

Iliotibial Band Syndrome

PredispositionIncrease in quality and quantity of trainingImproper warm up and stretchingToo much downhill runningWorn out shoesRunning in same direction on banked trackExcessive pronation

Iliotibial Band Syndrome

Physical ExamLateral knee painLateral thigh painPain after runningTenderness at lateral

epicondyle or Gerdy’s tubercle or along entire ITB

Ober test

Iliotibial Band Syndrome

TreatmentStretchesModalitiesNSAID’sCorrection of

training errors

Myositis Ossificans

Heterotopic bone formation caused by deep muscle contusion especially after large hematoma

Most common in Quadriceps

Myositis Ossificans

Follows injury by 3-6 weeks

May remodel or reabsorb over 6 to 12 months

May need bone scan to detect activity

Myositis Ossificans

TreatmentPRICES (protection,

rest, ice, compression, elevation, support)

Early on no massage or heat ( can worsen)

Myositis Ossificans

Excision rarely -After maturation

usually > 1yr-Check bone scan

if needed to be done sooner

-If excised early can reoccur

Pediatric Injuries And Conditions Around The

KneeOsteochondritis

Dissecans Osgood-Schlatter

DiseaseSinding-Larsen-

Johansson Syndrome

Jumper’s kneeDiscoid meniscusPatellar femoral

pain syndromePlicaTorn ACLMeniscal tearsPatellar dislocation

Osteochondritis Dissicans

Can occur at the knee, ankle or elbowMost commonly seen in the knee at the

lateral aspect of medial femoral condyleEtiology ? Thought to be a result of

trauma to a flexed kneeResults in the separation of an abnormal

ossification area within the epiphysis covered by articular cartilage

Osteochondritis Dissicans

Boys more common than girls

Localized pain, effusion, locking and giving way

Younger patients have best prognosis

Treatment: usually requires surgical intervention

Osteochondritis Dissicans

Osteochondritis Dissicans

Osgood-Schlatter Disease

Usually an overuse type injury to the tibial tubercle apophyses

Activity-related pain that is aggravated by jumping, squatting, and kneeling

X-rays shows tubercle enlargement and fragmentation

Osgood-Schlatter Disease

Osgood-Schlatter Disease

Treatment– Reassurance about this benign

condition– Resolution sometimes 12-18 months– Activity modification (not elimination)

Osgood-Schlatter Disease

Treatment– Symptomatic treatment with ice

massage, knee pad, NSAID’S, quadricep & hamstring flexibility and strengthening exercises

– If separate ossicle persists surgical excision may be required

Sindig-Larsen-Johansson’s Disease

Sequela of traction on the immature distal pole by the patellar tendon

Analogous to Osgood-Schlatter DiseasePre-teen age groupRadiographs may show avulsions at

distal pole of patellaTreatment similar to Osgood-Schlatter

Disease (conservative symptomatic care)

Sindig-Larsen-Johansson’s Disease

Jumper’s Knee

Patellar tendonitisAn inflammation of the proximal patellar

tendonCause is repetitive stress from jumpingSeen in adolescentsCondition can progress to produce

intratendinous degeneration and

necrosis

Jumper’s Knee

Discoid Meniscus

A congenital abnormality in which the meniscus is discoid not semilunar

There is abnormal peripheral attachments that lead to hypermobility and hypertrophy

Clinical finding is a disc of meniscal cartilage covering the lateral tibial plateau

Most discoid menisci remain asymptomatic

Discoid Meniscus

Symptoms- include lateral knee pain , popping, swelling, giving way

Diagnosis- MRI, Arthrogram, arthroscopyTreatment of symptomatic discoid menisci

is to remove the torn portion, sculping of the meniscus by excision of the central portion, or complete meniscectomy

Discoid Meniscus

Anterior Knee Pain

Anterior Knee Pain

Many namesChondromalacia patellaPatellofemoral pain syndromePatellofemoral dysfunctionPatellalgiaPatellar compression syndrome

Anterior Knee Pain

One of the most common musculoskeletal complaints presenting to FP’s office

In one study approx 17,000 pts – 11.3% 25% of all athletesMore common in femalesEncompasses a wide variety of potential

problems, from short duration acute symptoms to chronic long standing problems

Anterior Knee Pain

Very frustrating for physician & patientFrequent lack of an easily identifiable

objective pathological causeCommonly only subjective

Anterior Knee Pain

Very frustrating for physician & patientFrequent lack of an easily identifiable

objective pathological causeCommonly only subjective

Causes Of Anterior Knee Pain

IntrinsicAbnormality of

articular cartilage Abnormality of

subchondral bonePoor healing after

trauma

ExtrinsicVMO atrophyPatellar position,

shape, or instabilityFemoral rotationTibial torsionMedial facet

overuse

Patellofemoral Weight Bearing With Activity

Walking .5 x body weight

Stairs up or down 3.3 x body weight

Squatting 6.0 x body weight

Reid, Sports Injury Assessment and Rehabilitation, 1992 Churchill

Patellofemoral Weight Bearing with ROM

5 degrees of flexion 30% body weight

30 degrees of flexion 2 x body weight

45 degrees of flexion 3 x body weight

75 degrees of flexion 6 x body weight

Reid, Sports Injury Assessment and Rehabilitation, 1992 Churchill

Anterior Knee Pain

HistorySpecific initial eventOveruse ( usually recent increase or

change in training)Vague, nonspecific, dull, aching and stiff

(B/L in 2/3 ‘s of the cases)Occasional feelings of “giving way”

Anterior Knee Pain

Physical ExamCheck gait (feet

supinated or pronated)Genu varus or genu

valgusQ angle (males 10

degrees or less; females up to 15 degrees

Q-angle

Anterior Knee Pain

Clarke sign

Apprehension test

Patellar facet test

Anterior Knee Pain

TreatmentConservative treatments is successful

80% of the timeModify activityModalities

Anterior Knee Pain

TreatmentTherapeutic exercises (stretch &

strengthen)Taping or BracingSurgical ( usually after 6 month of

conservative treatments)

PFPS Rehabilitation

Relative rest: avoid deep knee bends, stairs, etc.

Ice: 5-10 minutes before and after activity VMO strengthening (short arc quad sets

& leg presses) Increase flexibility (hamstrings, ITB,

quads) Isometric quads & adductor stretching

PFPS Rehabilitation (cont.)

Gradual increase of activity (full ROM & 80% normal strength), and pain free

Home exercise programPatellar sleeve to augment

proprioceptionCardiovascular conditioningNSAID's