Injuries to the Thigh, Leg, and Knee

1. Injuries to the Thigh, Leg, and Knee

2. Anatomy Review • Bones of the region • femur -- longest/strongest bone in the body • patella -- sesamoid bone • tibia -- largest bone in the lower leg • fibula carries 2% of body weight

4. Anatomy Review • ligaments • medial and lateral collaterals • protect the knee from valgus/varus forces • anterior and posterior cruciates • protect the knee from anterior & posterior forces • Menisci • Medial and Lateral

5. Knee articulations femur and meniscus meniscus and tibia patella and femur Anatomy Review

6. Fractures femoral fractures results from an extremely traumatic event may also be in the form of a stress fracture, especially the femoral neck region patellar fractures almost always fractured as a result of a traumatic event In the adolescent, femoral fractures include slipped capital epiphysis type. In the adult, fractures of the femoral neck may result in avascular necrosis of the femoral head. This injury results from disrupted blood supply to the articular cartilage on the femoral head.

7. Fractures of the femur and/or patella Signs/symptoms: pain at the injury site difficulty in ambulation (walking) swelling and/or deformity athlete may report having suffered a traumatic event athlete may report a pop or snap at time of injury First Aid: treat for shock Splint the injured leg - consider the use of a traction splint apply sterile dressings to any related wounds monitor vital signs arrange for transport -- contact EMS

8. Dislocation of the knee requires extreme trauma from an external force mechanism similar to that of sprains, but more severe Severe, obvious deformity Possible loss of circulation to leg Call 911 immediately Common Sports Injuries

9. Patellar dislocation/ subluxation Details may be caused by direct trauma, such as a blow to the medial aspect of the knee If uncorrected, this injury can become chronic. Signs and Symptoms pain and abnormal movement about the patella patella may be obviously out-of-place extreme pain along the medial aspect of the patella athlete may report that the knee “gave out” First Aid: apply ice, compression and elevate splint the entire leg transport to a medical facility Common Sports Injuries

12. Common Sports Injuries

13. Genu Valgum Genu Varus Hyperextension

14. Common Sports Injuries • Osgood-Schlatter’s Disease (OSD) and Jumper’s Knee (JK) (Patella Tendonitis) • Details • sometimes associated with athletes involved in jumping activity • main difference between the two is location of pathology • In OSD the involved area is the tibial tuberosity. • In JK the involved area is the patellar tendon.

15. Common Sports Injuries • Signs/symptoms of OSD • point tenderness of the tibial tuberosity • swelling over the tibial tuberosity -- over time, it may become solid feeling • Signs/symptoms of JK • pain/tenderness around the patellar tendon complex • pain when running/jumping • First Aid: • ice and compression • Chronic cases of patella tendonitis • Heat, stretching, and strengthening program • Anti Inflammatory Meds

16. Tendonitis

17. Bursitis • Bursitis • inflamed bursa • small fluid-filled sac located at strategic points • numerous bursa around the knee region -- only a few are typically injured • inflammation can be caused by trauma, chronic irritation or infection • the prepatellar bursa is often irritated by trauma

18. Bursitis Signs/symptoms: • swelling/ tenderness • increased pain caused by manual pressure • history of trauma or chronic injury • First Aid: • apply ice and compression • reduction of activity • if chronic -- anti-inflammatory agents with a physician’s approval

19. Menisci injuries typically damaged by quick, sharp, cutting movements in some cases, a torn flap of meniscus will get caught in the joint, causing it to lock Menisci

20. Common Sports Injuries • Signs/symptoms: • pop or snap when the knee was injured • may not see any significant swelling • may not be painful • in some cases, the knee may lock • knee may “give out” periodically • First Aid: • ice and compression • put athlete on crutches • refer to a physician

21. Torn Menisci

22. Meniscal Tests • McMurray’s Meniscal Test • Used to determine displaceable meniscal tear • Leg is moved into flexion and extension while knee is internally and externally rotated in conjunction w/ valgus and varus stressing • A positive test is found when clicking and popping are felt

24. Ligaments • Ligament injuries • Medial Collateral • Prevents varus • Lateral Collateral • Prevents valgus • Anterior Cruciate • Prevents anterior translation • Posterior Cruciate • Prevents posterior translation Excessive stress on the MCL

25. Ligaments

26. Signs/symptoms: athlete reports the knee was forced beyond the normal ROM pain at the site of injury swelling around the knee athlete will state the knee feels unstable athlete will report having felt and/or heard a snap or pop at the time of injury First Aid: ice and compression place the athlete on crutches refer immediately to a physician for medical evaluation Common Sports Injuries

27. Valgus and Varus Stress Tests • Used to assess the integrity of the MCL and LCL respectively • Testing at 0 degrees incorporates capsular testing while testing at 30 degrees of flexion isolates the ligaments

28. Anterior Cruciate Ligament Tests • Drawer test at 90 degrees of flexion • Tibia sliding forward from under the femur is considered a positive sign (ACL) • Should be performed w/ knee internally and externally to test integrity of joint capsule

29. Lachman Drawer Test • Will not force knee into painful flexion immediately after injury • Reduces hamstring involvement • At 30 degrees of flexion an attempt is made to translate the tibia anteriorly on the femur • A positive test indicates damage to the ACL

30. Preventing Knee Injuries • Overall strength of muscles surrounding knees • Flexibility of muscles surrounding knees • Proper biomechanics • Knee bracing is appropriate under certain circumstances