Lower Extremity ppt

Meniscus:

• fibrocartilage

• thicker on the outside than inside

• Overloaded with compression

Knee Injury Illness Script:

• Medial Meniscus Tear:

  • Foot plant with a sudden twist

  • Popping sound

  • Trauma or degenerative

  • Male>females 20-30 y/o

  • athletes

  • +McMurray

  • + Apley

  • + Thessaly

  • Medial knee pain

  • Feels better flexed

  • Lock, catch, give way

• MCL Sprain:

  • Trauma only

  • Often injured with medial meniscus

  • Athletes

  • + valgus stress

  • Medial knee pain

  • Stiffness, instability

• ITB Syndrome:

  • Overuse

  • Popping sound possible

  • Most common cause of lateral knee pain

  • Athletes

  • + Ober’s

  • Lateral thigh and lateral knee pain

  • Can’t lay on that side

Tendinitis:

• caused by overuse, improper footwear, lint fixations, sudden increase in exercise/training

Plantar Fasciitis:

• Inflammation of plantar fascia and flexor Digitorum brevis muscle near calcaneus

• Repetitive overuse, associated with walking, running

• Very common, 15% of foot injuries 30-50 y/o

• Females 2:1

• Most pain following activity or after being at rest

• Risk - obesity, reduced ankle ROM, pronation, sudden increase in distance, poor shoes

• Stabbing pain, first steps in the morning, especially big toe, middle age, tight gastrocnemius muscle

• Other risks - prolonged standing, flat feet ad high arched feet, poor biomechanics

• Dancers, runners, stand long periods

Morton’s Neuroma:

• Thickening of nerve sheath/tumor

• Associated with high heeled shoes, shoes with a tight toe box, women, foot deformities, sports, between 3rd and 4th toes, feels like standing on a pebble

• Numbness, tingling, burning and shooting pain

Foot pain - Metatarsal Stress Fractures:

• hairline fracture resulting from repetitive micro trauma - running, marching, aerobics

• 2nd and 3rd Metatarsals most common

  • Greatest impact form foot push off

• Female more common

• Pain with weight bearing and motion

• Localized swelling, limp

• Risks- osteoporosis, sudden increase in exercise, overpronation

Joint vs Muscle/Tendon:

• History

• Mechanism of injury - tissue damaged

• PROM vs RROM - ligament vs muscle/tendon

• Orthopedic tests- test ligaments, cartilage or muscle

• Muscle - diffuse ache or stiffness, weakness, spasm, pain with pressure

• Joint - Swelling, achy, diffuse, sharp pain with movement, warmth, all ROM cause pain, more likely to have pain at rest

Arthritis:

• primary - idiopathic

• Secondary - due to injury

• Arthritis vs Arthralgia

  • Arthritis= Bone ends rub together with thinned cartilage

  • Arthralgia= swollen inflamed synovial membrane with bone erosion

Strain

• muscle/tendon injury

• You can tear the fascia between the muscles or tear the muscle/tendon itself

• Scar tissue lays down and looks like cobwebs

  • Leaves the muscle weaker and less flexible

• The musculotendinous junction (MTJ) is the interface between muscle and tendon and where force is transmitted between the two tissues

  • Grade 1= pain

  • Grade 2= pain and weakness

  • Grade 3= Pain, weakness and loss of function

• Bruising

• Swelling

  • Edema or

  • Inflammation

Inflammation:

• a response to injury in which an affected area becomes red and painful, and usually swelling.

• Damage to muscle, ligament, cartilage, skin, bursa, etc.

• Effusion - swelling inside joint capsule, synovial inflammation

• Hemarthrosis - blood in the effusion inside the joint

• Ligament tears cause much more swelling than tendinitis

• Associated with joint infection

Edema:

• swelling cause by excess fluid trapped in your body’s tissues

• Not in a joint

• Edema can affect any part of your body, most commonly in hands, arms, feet, ankles and legs due to the effect of gravity

• Can be the results of medication, pregnancy or an underlying disease

  • Often congestive heart failure, kidney or liver disease

• Cause: Systemic

  • Increased hydrostatic pressure:

  • Causes more water to be driven outwards in the interstitial spaces.

• Most commonly Bilateral, but can be unilateral