Kines 127 - Quiz 6

Bones of knee/lower leg

Tibia, Fibula, Femur, Patella

Knee ligaments

ACL, PCL, MCL, LCL

Knee cartilage

Meniscus (medial/lateral), articular cartilage

Knee tendons

Quadriceps tendon, Patellar tendon, IT band

Varus

Inward force (bow-legged)

Valgus

Outward force (knock-kneed)

Effusion

swelling within joint

Edema

swelling outside joint

Knee joint type

Hinge joint (flexion/extension + rotation)

Patellofemoral joint

Plane (gliding)

Tibiofibular joint

Plane joint (proximal & distal)

Medial meniscus

C-shaped

Lateral meniscus

O-shaped

Meniscus blood supply

Poor → limited healing

Acute knee injuries

Sprains, dislocations, meniscus tears

Chronic knee injuries

Anterior knee pain, lateral knee pain

ACL injury mechanism

Anterior translation of tibia + rotation + valgus load

ACL MOI

Deceleration + change of direction (75% non-contact) OR valgus contact

ACL symptoms

Pop, instability, large effusion

PCL injury mechanism

Posterior translation of tibia

PCL MOI

Hyperextension or dashboard injury

PCL symptoms

Instability

MCL MOI

Valgus force to lateral knee

MCL symptoms

Instability, difficulty weight bearing

Unhappy triad

MCL, ACL, and medial meniscus

LCL MOI

Varus force to medial knee

LCL symptoms

Rolled onto, awkward landing, rarely isolated

Knee dislocation

Tibiofemoral dislocation (medical emergency)

Knee dislocation symptoms

Deformity, instability, neurovascular compromise

Knee dislocation MOI

Trauma, blow, MVA

Patellar dislocation

Usually lateral displacement

Patellar MOI

Valgus + change direction OR direct blow

Patellar dislocation symptoms

Pop, deformity

Meniscus tear MOI

Plant and twist

Meniscus symptoms

Joint line pain, effusion, locking/catching, loss of function

Anterior knee pain conditions

PFPS, quad tendonitis, jumper’s knee, Osgood-Schlatter

PFPS

Caused by muscle imbalance, anatomy, training

Quadriceps tendonitis

Pain superior to patella

Jumper’s knee

Patellar tendon pain distal to patella

Osgood-Schlatter

Inflammation at tibial tuberosity (young athletes), pain distal to patella on tibia, visible bony growth on tibia

IT Band Syndrome

Lateral knee pain from overuse

ITBS symptoms

Pain lateral knee, snapping

ITBS MOI

chronic condition, overuse

Lower leg compartments

Anterior, Lateral, Superficial posterior, Deep posterior

Fibularis tendonitis

Overuse or inversion injury

Fibularis symptoms

Lateral ankle pain, snapping

Achilles injury MOI

sudden increase in activity, tight or weak calf muscles, poor warm up, forceful jump or sudden burst (rupture)

Achilles symptoms

“Pop,” feels kicked, deformity if rupture

Anterior compartment syndrome

Medical emergency from pressure buildup and limited space for swelling

Anterior compartment symptoms

Shiny/waxy skin, pale/ashen, numbness, edema, loss of sensation

Anterior compartment syndrome MOI

direct contact to the anterior shin

Posterior compartment syndrome

Chronic exertional condition where pressure rises in deep posterior compartment (not a medical emergency)

Posterior compartment symptoms

Pain with activity, relieved with rest, numbness or loss of function

Posterior compartment syndrome MOI

exercise induced

Tibia/fibula fracture MOI

Direct blow to shin

Tibia/fibula symptoms

Deformity, no weight bearing, loss of sensation

How much weight does the tibia bear compared to the fibula?

90%

MTSS

Shin splints (inflammation tibia/muscle/tendon)

MTSS symptoms

Medial shin pain, increased training, change in footwear

MTSS MOI

Repetitive overload

Stress fractures (lower leg)

Progression of MTSS

Stress fracture symptoms

same as MTSS and there is significant pain on palpation to bone (most commonly the tibia)

Stress fracture MOI

Repetitive load

Hip bones

Pelvis (ilium, ischium, pubis), sacrum, femur

Pubic symphysis

Plane joint (gliding)

SI joint

Plane joint (gliding)

Hip joint

Ball-and-socket (flex/ext, abd/add, rotation, circumduction)

Neurovascular (hip)

Sciatic nerve, femoral artery/vein

Hip cartilage

Labrum

Hip tendons

Iliopsoas, quadriceps, hamstrings, IT band

Common hip injuries (acute)

Dislocation, labral tear, avulsion, hip pointer, pelvic fracture

Common hip injuries (chronic)

Piriformis syndrome, osteitis pubis, athletic pubalgia, ITBS, FAI, SI dysfunction, snapping hip, labral teae, avascular necrosis, apophysitis

Hip dislocation MOI

Trauma, fall, tackle, MVA, posterior more common than anterior

Hip dislocation position

Leg fixed, abnormal position

Hip dislocation symptoms

shortened leg

Avascular necrosis

Death of femoral head

Avascular necrosis cause

Loss of blood supply via ligamentum teres

Avascular necrosis symptoms

Deep hip pain

AVN MOI

insidious onset or common following hip dislocation, can also be caused by steroids, viruses, etc

Labral tear

Damage to fibrocartilage in hip

Labral symptoms

Pain, catching, stiffness

Labral MOI

Acute or chronic load change

Apophysitis

Inflammation of growth plate (young athletes)

Apophysitis symptoms

Sharp pain, worse with activity

Apophysitis MOI

Overuse or insidious onset

Avulsion injury

Bone pulled off at tendon attachment

Avulsion symptoms

Pop, click, snap, sharp pain, deformity possible, pain increased with activity

Avulsion MOI

Forceful contraction or eccentric load

Hip pointer

Contusion to iliac crest/ASIS

Hip pointer symptoms

Pain, ecchymosis, loss ROM, loss of strength

Hip pointer MOI

Direct blow with the bony markings on the hip

FAI

Impingement from abnormal bone shape

Cam lesion

Extra growth femoral head/neck

Pincer lesion

Extra growth acetabulum

FAI symptoms

Deep hip pain, stiffness, limp

FAI MOI

chronic condition or congenital

Hip fracture

Common at femoral neck/intertrochanteric, more common in older populations

Hip fracture symptoms

sharp, deep pain, no weight bearing, limited ROM

Hip fracture MOI

Trauma, fall, direct contact, MVA

SI joint dysfunction

Pain at sacrum/ilium joint, prone to getting stuck as it is a plane joint that glides