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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
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
