11

Injuries to the Thigh, Injuries to the Thigh, Leg, and KneeLeg, and Knee

PE 236PE 236Juan Cuevas, ATCJuan Cuevas, ATC

22

33

44

55

Fractures of the Femur Fractures of the Femur and/or Patellaand/or Patella

Signs and symptoms include:Signs and symptoms include:– Pain at the injury site.Pain at the injury site.– Swelling and/or Swelling and/or ________________________. Athlete’s . Athlete’s

report of having suffered a traumatic event.report of having suffered a traumatic event.– Athlete may report a _________ at time of Athlete may report a _________ at time of

injury.injury.The injury needs to be evaluated by a The injury needs to be evaluated by a

physician. _________________ is a serious physician. _________________ is a serious complication.complication.

66

77

88

Fractures of the Femur Fractures of the Femur and/or Patella (continued)and/or Patella (continued)First AidFirst Aid

– Treat for ________.Treat for ________.– Splint the injured leg, preferably with Splint the injured leg, preferably with

traction splint.traction splint.– Apply _________ dressings to any open Apply _________ dressings to any open

wounds.wounds.– Monitor vital signs and ___________ to lower Monitor vital signs and ___________ to lower

leg.leg.– Arrange for transport to a nearby medical Arrange for transport to a nearby medical

facility… facility… 911!911!

99

Patellar Patellar Dislocation/SubluxatioDislocation/Subluxatio

nnInjury may be caused by a quick _____ Injury may be caused by a quick _____ motion that generates a great deal of motion that generates a great deal of abnormal force within the knee. abnormal force within the knee.

Instead of moving normally within it’s Instead of moving normally within it’s groove, the patella moves _______ and groove, the patella moves _______ and may dislocate.may dislocate.

1010

Patellar Patellar Dislocation/Subluxation Dislocation/Subluxation

(Continued)(Continued)Signs and symptoms include:Signs and symptoms include:

– Severe pain and abnormal movement of the Severe pain and abnormal movement of the patella when injury occurred.patella when injury occurred.

– ____________.____________.– Gross Deformity.Gross Deformity.– Extreme pain along the medial aspect of the Extreme pain along the medial aspect of the

patella.patella.**_________________**_________________

1111

Patellar Patellar Dislocation/Subluxation Dislocation/Subluxation

(continued)(continued)

First AidFirst Aid– Apply ice and compression.Apply ice and compression.– Splint the __________.Splint the __________.– Transport to a medical facility.Transport to a medical facility.

1212

1313

Dislocation of the Knee Dislocation of the Knee or Tibiofemoral Jointor Tibiofemoral Joint

Dislocation of the knee or the ___________ joint Dislocation of the knee or the ___________ joint can compromise blood flow to the lower leg. can compromise blood flow to the lower leg.

****Napoleon MCcallumNapoleon MCcallum****Shaun ________________Shaun ________________

Signs and symptoms include:Signs and symptoms include:

Extreme pain.Extreme pain.Dislocation of the ________.Dislocation of the ________.GROSS DEFORMTYGROSS DEFORMTY

First AidFirst Aid– The injury must be splinted.The injury must be splinted.– Refer athlete to the nearest medical facility... _____!Refer athlete to the nearest medical facility... _____!

1414

1515

Patellofemoral Joint Patellofemoral Joint InjuriesInjuries

Acute and chronic injuries can affect Acute and chronic injuries can affect patellofemoral joint. Such injuries can be patellofemoral joint. Such injuries can be ____________ and must be treated. ____________ and must be treated.

Osteochondritis dissecansOsteochondritis dissecans ( (__________) or “joint ) or “joint mice”mice”– Condition occurs when small pieces of bone or Condition occurs when small pieces of bone or

cartilage are dislodged from joint and float within cartilage are dislodged from joint and float within capsule.capsule.

– A bone fragment can ________ a joint.A bone fragment can ________ a joint.– Damage to joint surface can occur.Damage to joint surface can occur.

1616

Patellofemoral Joint Injuries Patellofemoral Joint Injuries (continued)(continued)

Signs and symptoms of OCD Signs and symptoms of OCD include:include:– Chronic knee pain with Chronic knee pain with

exertion.exertion.– ________ swelling.________ swelling.– Knee may lock; quadriceps Knee may lock; quadriceps

may atrophy.may atrophy.– One or more femoral One or more femoral

condyles may be tender condyles may be tender when palpated.when palpated.

First AidFirst Aid– Application of ice and Application of ice and

compression.compression.– If necessary, crutches for If necessary, crutches for

walking.walking.– ______ athlete to physician.______ athlete to physician.

1717

_________________ Patella_________________ PatellaWear and tear of the under surface of the Wear and tear of the under surface of the patella as it articulates on the femoral patella as it articulates on the femoral groove due to overuse. groove due to overuse. – __________ injury__________ injury– May have swelling present on the _____ of the May have swelling present on the _____ of the

knee.knee.– Pain with standing after sitting for a prolonged Pain with standing after sitting for a prolonged

period of time. “movie-goer’s knee”period of time. “movie-goer’s knee”– Quadriceps atrophyQuadriceps atrophy– ““_____________” grinding_____________” grinding

– ““__________ Grind Test”__________ Grind Test”

1818

__________ of the Knee__________ of the KneeBursa are small fluid-Bursa are small fluid-

filled sacs located at filled sacs located at strategic points.strategic points.

Numerous bursa are in Numerous bursa are in the knee region; only the knee region; only a few are typically a few are typically injured.injured.

1919

Bursa of the Knee Bursa of the Knee (continued)(continued)

Inflammation can be caused by:Inflammation can be caused by:– ___________.___________.– Infection.Infection.– Overuse.Overuse.

The __________ bursa is susceptible The __________ bursa is susceptible to direct trauma.to direct trauma.

2020

Bursa of the Knee Bursa of the Knee (continued)(continued)

Signs and symptoms Signs and symptoms include:include:

– __________ and __________ and tenderness at site.tenderness at site.

– Pain when Pain when increased external increased external pressure is applied.pressure is applied.

– Athlete may report Athlete may report ________ trauma to ________ trauma to knee.knee.

2121

Bursa of the Knee Bursa of the Knee (continued)(continued)

First AidFirst Aid– Application of ice and compression.Application of ice and compression.– ________ activity for a short time. ________ activity for a short time. – In chronic cases, anti-inflammatory In chronic cases, anti-inflammatory

agents may be helpful.agents may be helpful.

2222

Osgood-SchlatterOsgood-Schlatter Disease Disease (_____)(_____)

OSD usually involve irritation of the OSD usually involve irritation of the patellar tendon complex. patellar tendon complex.

Signs and symptoms of OSD include:Signs and symptoms of OSD include:– Pain and tenderness on the patellar tendon Pain and tenderness on the patellar tendon

complex.complex.– Swelling in the area.Swelling in the area.– Decreased ability to use the ____________.Decreased ability to use the ____________.– If inflammation continues, area over tibial If inflammation continues, area over tibial

______________ may become solid when ______________ may become solid when palpated.palpated.

2323

Osgood-Schlatter Disease Osgood-Schlatter Disease (OSD)(OSD)

First AidFirst Aid– Apply ice and Apply ice and

compression.compression.– _____ to physician _____ to physician

for specific for specific diagnosis.diagnosis.

– Until inflammation Until inflammation subsides, _____ is subsides, _____ is important.important.

2424

Jumper’s KneeJumper’s KneeSigns and symptoms of Signs and symptoms of

Jumper’s knee (JK) include:Jumper’s knee (JK) include:– Pain and tenderness around the Pain and tenderness around the

patellar __________________ that patellar __________________ that may spread to tibial tuberosity. may spread to tibial tuberosity.

– Decreased ability to use Decreased ability to use quadriceps for running or quadriceps for running or jumping.jumping.

– Symptoms that ________ with Symptoms that ________ with activity.activity.

First AidFirst Aid– Apply ice and compression.Apply ice and compression.– Refer to physician for possible Refer to physician for possible

anti-inflammatory medicationsanti-inflammatory medications– Rest will be helpful.Rest will be helpful.

2525

Menisci InjuriesMenisci Injuries

Menisci are typically damaged by Menisci are typically damaged by quick, sharp, ______ movements.quick, sharp, ______ movements.

Injury is more likely to occur if the foot is Injury is more likely to occur if the foot is _______ firmly on the playing surface. _______ firmly on the playing surface.

There are many different types of There are many different types of tears, and they affect each athlete tears, and they affect each athlete differently.differently.

In some cases, a _________ of meniscus In some cases, a _________ of meniscus will get caught in the joint, causing it to will get caught in the joint, causing it to lock.lock.

2626

Menisci Injuries Menisci Injuries (continued)(continued)

Signs and symptoms include:Signs and symptoms include:– _____ or snap when the knee was injured._____ or snap when the knee was injured.– May not see any significant swelling.May not see any significant swelling.– May not be painful.May not be painful.– _______ of ROM._______ of ROM.– Athlete may be able to continue Athlete may be able to continue

participating.participating.– A feeling the knee is “_____________” A feeling the knee is “_____________”

periodically.periodically.**_______________**_______________

2727

Menisci Injuries (continued)Menisci Injuries (continued)First AidFirst Aid

– Apply ice and Apply ice and compression.compression.

– Have athlete use Have athlete use crutches.crutches.

– Refer athlete to a Refer athlete to a physician.physician.

2828

Knee Ligament InjuriesKnee Ligament Injuries

The most commonly The most commonly injured knee injured knee ligaments are the ___, ligaments are the ___, and the ___.and the ___.

Common mechanisms Common mechanisms include cutting include cutting maneuvers when maneuvers when _________ and direct _________ and direct blows to the joint.blows to the joint.

2929

Knee Ligament Injuries Knee Ligament Injuries (continued)(continued)

Sprain to MCL is common Sprain to MCL is common sports injury.sports injury.

Occurs as a result of Occurs as a result of valgusvalgus stress on MCL. stress on MCL. ** **(______ Stress test)(______ Stress test)

VarusVarus stress can cause a stress can cause a sprain of the LCL. sprain of the LCL. ****(_____ Stress Test)(_____ Stress Test)

Both types of sprains render Both types of sprains render knee unstable in side-to knee unstable in side-to side movements.side movements.

3030

Knee Ligament Injuries Knee Ligament Injuries (continued)(continued)

_______ Ligament Injuries_______ Ligament Injuries– ACL can be injured when the tibia moves ACL can be injured when the tibia moves

forcefully in an _______ direction or when the forcefully in an _______ direction or when the femur gets pushed backward while the tibia femur gets pushed backward while the tibia is held in place. is held in place.

– Quick _______ associated with __________ Quick _______ associated with __________ movements can also damage ACL.movements can also damage ACL.

– ____ injuries most often happen when an ____ injuries most often happen when an athlete falls on both knees, or receives a athlete falls on both knees, or receives a forceful blow to the front of the knee while forceful blow to the front of the knee while foot is planted on the ground.foot is planted on the ground.

3131

Cruciate Ligament Injuries Cruciate Ligament Injuries (continued)(continued)

Signs and symptoms include:Signs and symptoms include:

– Athlete reports the knee Athlete reports the knee was forced beyond its was forced beyond its normal ROM.normal ROM.

– Pain at the site of the injury.Pain at the site of the injury.– Swelling around the knee.Swelling around the knee.– Athlete indicates the knee Athlete indicates the knee

feels ___________.feels ___________.– Athlete reports having a Athlete reports having a

snapping or__________ snapping or__________ sensation at the time of sensation at the time of injury.injury.

**_________ Drawer Test**_________ Drawer Test**Lachman’s Test**Lachman’s Test**Sag Test**Sag Test

3232

Cruciate Ligament Injuries Cruciate Ligament Injuries (continued)(continued)

First AidFirst Aid– Immediately apply Immediately apply

ice and ice and compression.compression.

– Have athlete walk Have athlete walk on ________.on ________.

– Refer to a physician Refer to a physician for medical for medical ____________.____________.

3333

Special Tests for Knee InstabilitySpecial Tests for Knee Instability– Use endpoint feel to determine __________Use endpoint feel to determine __________– Classification of Joint InstabilityClassification of Joint Instability

Knee laxity includes both straight and rotary Knee laxity includes both straight and rotary instabilityinstability__________ (tibial translation) refers to the glide of __________ (tibial translation) refers to the glide of tibial plateau relative to the femoral condylestibial plateau relative to the femoral condylesAs the damage to stabilization structures As the damage to stabilization structures increases, _______ and translation also increaseincreases, _______ and translation also increase

– Valgus and Varus Stress TestsValgus and Varus Stress TestsUsed to assess the integrity of the _____ and LCL Used to assess the integrity of the _____ and LCL respectivelyrespectivelyTesting at 0 degrees incorporates capsular testing Testing at 0 degrees incorporates capsular testing while testing at 30 degrees of flexion isolates the while testing at 30 degrees of flexion isolates the ligamentsligaments

3434

Valgus Stress Test

Varus Stress Test

3535

Lachman Drawer Lachman Drawer TestTest– Will not force knee Will not force knee

into painful flexion into painful flexion immediately after immediately after injuryinjury

– Reduces hamstring Reduces hamstring involvementinvolvement

– At 30 degrees of At 30 degrees of flexion an attempt flexion an attempt is made to translate is made to translate the tibia ________ on the tibia ________ on the femurthe femur

– A positive test A positive test indicates damage indicates damage to the ACLto the ACL

3636

Apley’s Apley’s Compression TestCompression Test– Hard downward Hard downward

pressure is pressure is applied w/ rotationapplied w/ rotation

– Pain indicates a Pain indicates a meniscal injurymeniscal injury

– Used to detect Used to detect meniscus tearmeniscus tear