Lecture 6: Hip, Knee, Shoulder, Lumbar Pathology

Hip

Labral Tear: MOI

• What are the 2 main types of MOI for a Labral Tear?

• What is MC pop for Labral Tear?

• Acute Vs Degenerative

• Pop: Younger

Labral Tear: MOI

• What are the 3 main Degenerative MOIs?

• Repetitive Movement

  • Golf

  • Ballet

  • Football

  • Hockey

• Trauma

• OA

Labral Tear: MOI

• What does OA Correlation mean?

• Labral Tear = Degeneration

  • OR

• Degeneration = Labral Tear

Labral Tear: S/S

• What are the 4 main S/S of Labral Tear?

• What are the 3 most painful positions?

• S/S

  • Hip and Groin Pain (90%)

    • Increased w activity

  • Slicking/Popping

  • Giving Way

  • Stiffness

• Pnful Positions

  • Flexion

  • Adduction

  • IR

Labral Tear: Diagnosis

• What are the 2 main imaging techniques to diagnose a Labral Tear?

• What does an MRA acquire?

• MRI

  • Magnetic Resonance Imaging

• MRA

  • Magnetic Resonance Arthography

• MRA requires:

  • Injection of fluid to see tear of labrum

Labral Tear: Diagnosis

• An MRI is MORE sensitive than what?

• An MRA is MORE sensitive than what?

• MRI

  • Other non invasive imaging techniques (85-90%)

• MRA

  • MRI but more risks (92%)

    • Pain and Infection

Ligamentum Terres Tear: MOI

• What are the 4 main MOI?

• Fall into end range hip motion (trauma)

• Hip dislocation

  • Ballet

  • Gymnastics

• OA

  • OA » Instability » Tearing of Lig

    • OR

  • Tearing of Lig » Instability » OA

• FAI

Ligamentum Teres Tear: S/S

• 4 main S/S

• Groin pain

  • Increased w activity

• Clicking/Popping

• Giving Way

• Stiffness

Ligamentum Teres Tear: S/S

• What activities would this pt complain of having difficulty doing?

  • 3

• Stars

• Sitting in Low Chairs

• Driving

Chondral Defect: MOI

• What are the 6 main MOI for Chondral Defect?

• Trauma

• Hip Dislocation

• Repetitive Motion/Loading/Compression

• Labral Tears

• OA

• FAi

Chondral Defect: S/S

• What are the 3 main S/S of Chondral Defect?

• Dull pain

  • Increased w activity

• Decreased ROM

• Locking/Catching

Chondral Defect: S/S

• What activities would this pt complain of having difficulty doing?

  • 3

• Stairs

• Siting in Low Chairs

• Driving

Femoral Acetabular Impingement (FAI):

• Define:

  • Pincer:

  • Cam:

  • Combined:

• Pincer:

  • Extra bone on the acetabulum

• Cam

  • Extra bone on the femoral head

• Combined

  • Both cam and pincer are present

Femoral Acetabular Impingement (FAI) S/S:

• 2 main S/S:

• Pt will have pain performing what 3 actions?

• 2:

  • Stiffness

    • Limited pain free ROM

  • Dull ache to sharp stabbing pain

• 3:

  • Squatting (MC Complaint)

  • Turning

  • Flexion

Knee

Meniscus Tears: MOI

• 6 main MOI

• Shear stress

• Compression

• Rotary stress

• Degeneration

  • Esp older pts

• Changing directions

• Pivoting

Meniscus Tears:

• Which meniscus is more susceptible to injury?

  • Why?

• Medial

  • Ground reaction force (GRF) loads on medial meniscus

Meniscus Tear:

• 4 main complaints:

• 4:

  • Getting out of the car

  • Pop/Click

  • Jt Line Pn

  • WB

Meniscus: Types of Tears

• Describe:

  • Flap:

    • Progression of…

  • Radial:

    • Tear of…

  • Degenerative:

    • Pop

• Flap

  • Progression of Radial Tear

• Radial

  • Tear of inner portion to outside

• Degenerative

  • Older pts

Meniscus: Types of Tears

• Longitudinal:

  • Associated w…

• Bucket Handle:

  • Progression of…

• Horizontal:

  • Moves…

• Longitudinal

  • Associated w ACL tears

• Bucket Handle

  • Progression of Longitudinal Tear

• Horizontal

  • Moves inside to outside of meniscus

Meniscus: Blood Supply

• Red Zone =

• White Zone =

• Red:

  • Blood Supply (Outside)

• White:

  • Lack of Blood Supply (Inside)

Horizontal Tear:

• ___ with the Tibial Plateau

• ___ the Meniscus in ___

• Parallel

• Divides; Half (Top and Bottom Half)

Longitudinal Vertical Tear:

• ___ to the Tibial Plateau

• ___ to the what?

• Perpendicular

• Parallel; Long Axis of the Meniscus

LCL Pathology:

• What are the 3 Grades?

• Grade 1: Mild

  • Microscopic tears from stretching

• Grade 2: Moderate

  • Over stretching w partial tear w mild to moderate instability

• Grade 3: Severe

  • Full Tear of the Ligament

LCL Pathology: MOI

• 2 main MOI

• Twist or Rotation

• Strong VARUS Stress

LCL Pathology: S/S

• 4 main S/S

• Swelling in LAT Knee

• Loss of Knee Motion

• Lateral Jt Line Pain

• Difficulty w Cutting or Changing Directions

MCL Pathology:

• What are 3 Grades?

• Grade 1: Mild

  • Microscopic tears from stretching

• Grade 2: Moderate

  • Over stretching w partial tear w mild to moderate instability

• Grade 3: Severe

  • Full Tear of the Ligament

MCL Pathology: MOI

• 2 main MOI

• Twisting or Rotation

• Strong VALGUS Stress

MCL Pathology: S/S

• 4 main S/S

• Swelling in MED Knee

• Loss of Knee Motion

• Medial Jt Line Pain

• Difficulty w Cutting or Changing Directions

ACL Pathology: MOI

• 4 main MOI

• Femoral IR, Valgus, Tibial Abd Non-Contact Injury

• Knee Hyper Extension Non Contact

• Blow on side of Knee

• Jump Landing

ACL Pathology: S/S

• 4 main S/S

• Swelling in Knee Jt Capsule

• Loss of Knee Motion

• Hearing a “Pop”

• Knee Giving Out

PCL: MOI

• 3 Main MOI:

• Car Accident (Dashboard Injury)

• Fall

• Blow at Ant Knee

Patella Tendon Pathology: MOI

• 4 main MOI

• Repetitive Jumping

• Quad Dominance

• Too Much Too Soon (overuse)

• Running

Patella Tendon Pathology: S/S

• 4 main S/S

• Anterior Knee Pain

• Anterior Knee Swelling

• TTP

• Pn During or After Activity

Osgood Shlatter’s:

• Main Pop:

• 4 MOI

• Pop: Young People (14-18)

• MOI:

  • Overactivity of Quad

  • Quad Tightness

  • Limited ROM

  • Pn w Walking/Stairs

Shoulder

Rotator Cuff Tears: MOI

• Acute MOI (3)

• FOOSH

• Throwing

• Heavy Lifting

Rotator Cuff Tears: MOI

• Degeneration MOI (4)

• Impingement

• Bone Spur

• Repetitive Injury

• Poor Blood Supply

  • Esp w Supraspinatus

Rotator Cuff Tears: S/S

• 4 main S/S:

• Lateral Shoulder Pain

• Upper Trap Pain

• Weakness

• Pain w Overhead Activity

Shoulder Labral Tears: MOI

• 4 main MOI:

• FOOSH

• Repetitive Overhead Activity

  • Thrower

• Dislocation

• Degeneration

Shoulder Labral Tears: S/S

• 4 main S/S

• Popping or Clicking

• Feeling of Instability

• Deep Ache in Shoulder Region

• Stiff Shoulder in the Morning

What are the 2 main types of Shoulder Labral Tears?

• Superior Labrum Anterior to Posterior Lesion (SLAP)

• Bankart Lesion

Lumbar

Degenerative Changes:

• 5 main Degenerative Changes of the L/S:

• Loss of Disc Height

• Loss of Disc Fluid

• Bone Edema

• Schmorl’s Node

• Disc Bulge

L/S Degeneration:

• 3 main Movement Faults

• Poor shock absorption during gait

• Excessive lumbar flexion during fed flexion (sitting)

• Excessive lumbar rotation during functional activities

L/S Degeneration:

• 3 main Impairments

• LE weakness

• Limited hip mobility

  • Jt of Hamstring Tightness

• Coordination deficit