Knee Presentations Sports Medicine Notes
Knee Presentations Sports Med Notes
Patellar Malalignment
The patella (kneecap) can move laterally (to the outside) or medially (to the inside) when the knee is bent.
The lateral or medial movement of the patella may be caused by pressure from the quadriceps muscle pulling unevenly.
Causes can be both genetic (though often they are not) and functional.
Symptoms may include a sensation of movement or visible swelling in the knee.
Knee Plica
Characterized by symptoms of pain, swelling, and instability in the knee joint.
A knee plica is a fold in the synovial membrane that envelops the knee joint.
This condition can arise from trauma or injury.
Patients may experience tightness in the knee along with audible clicking, snapping, or popping sounds.
Recommended interventions include strengthening the quadriceps to stabilize the knee and improve flexibility.
Initial range of motion exercises should avoid squats, lunges, and similar activities that stress the joint.
Patellar Tendonitis (Jumper's Knee)
This overuse injury leads to pain, swelling, and tenderness in the patellar tendon.
Continuous stress on the patellar tendon can create small tears, resulting in pain.
Patients may experience sharp pain below the patella, potentially worsening over time, along with limited range of motion in the knee.
Diagnosis is typically confirmed through physical examination techniques, which may include X-ray, MRI, and palpation.
Strengthening surrounding muscle groups in the knee helps resist further injuries.
Patellofemoral Stress Syndrome (Runner’s Knee)
Defined as pain around the front of the kneecap, specifically during running and jumping activities.
Stemming from alignment problems of the knee and overuse, it affects a significant number of athletes.
Approximately 29% of individuals experience this condition annually, with females being twice as likely to be affected.
Treatment should focus on strengthening the knees and hips, gradual intensity building, and body awareness.
Osteochondritis Dissecans
Breakdown of the term: "Osteo" refers to bone reactions; "Chondritis" denotes inflammation of cartilage.
This joint condition occurs when bone beneath the cartilage dies due to lack of blood flow.
Symptoms include joint pain, weakness, swelling, stiffness, and reduced range of motion, worsening with activities such as running and jumping.
Mild joint swelling may also present, requiring protective gear and stress avoidance.
Treatment options include over-the-counter anti-inflammatory medications and bracing, or surgical procedures to enhance blood flow by creating a hole in the cartilage if the condition advances.
Medial Collateral Ligament Sprain (MCL)
An MCL sprain occurs when the knee is forced inward, stretching or tearing the ligament on the inner side of the knee.
Common causes include direct blows to the outer knee or forceful twisting or hyperextension of the knee.
MCL injuries have varying degrees of severity; for instance, a Grade 3 sprain indicates a complete tear with involvement of both superior and inferior ligament sections.
Recommended treatments include strengthening surrounding muscles, improving balance and form, wearing suitable shoes, and utilizing over-the-counter pain relief methods.
Meniscus Lesions (Tears)
A meniscus lesion refers to injury of the C-shaped cartilage discs situated between the femur and tibia.
Such tears often arise during activities that require twisting or rotation of the knee, categorized as non-contact injuries.
Initial symptoms may include delayed or intermittent swelling and pain during knee flexion, coupled with increasing stiffness and discomfort over time.
Types of meniscus tears:
Bucket Handle Tear: occurs from accidental twisting, causing a section of cartilaginous tissue to move in a way that resembles a handle.
Flap Tear: damage to both inferior and superior surfaces of the meniscus.
Radial Tear: a tear that extends centrally from the inner edge of the meniscus, leading to a gap in the cartilage.
Recommendations include strengthening the muscles supporting the knee, wearing a brace if instability is a concern, and ensuring proper footwear.
Non-steroidal anti-inflammatory drugs (such as ibuprofen or aspirin) may be prescribed.
Rest is crucial for recovery, particularly if surgery is not indicated; following the RICE method (Rest, Ice, Compression, Elevation) is encouraged post-injury.
Patellar Dislocation
Defined as the patella being dislocated from the trochlear groove on the femur, typically occurring laterally.
There are two primary types of dislocation:
Acute Dislocation: results from sudden force applied to the knee, usually from the medial side.
Congenital Dislocation: a rare developmental condition where the patella is positioned outside the trochlear groove.
Symptoms include visible swelling on the lateral side of the knee.
Typical instances of patellar dislocations occur laterally.
Treatment should involve stretching and strengthening various muscle groups that stabilize the knee, ensuring balanced stress distribution.
Proper athletic form is essential to minimize risks, while reconstruction surgery may be indicated in severe cases.
RICE and physical therapy are critical for muscle strengthening post-injury.
Injury to Infrapatellar Fat Pad
The infrapatellar fat pad is a fatty structure located beneath the patella and in front of the femur, serving as a shock absorber and providing joint protection.
It contributes to knee movement and stability.
Symptoms include sharp, aching pain in the knee area and visible swelling.
Activity modification is vital to prevent re-injury along with careful management of footwear and use of pain medications.
Rest and adherence to the RICE regimen are crucial for recovery.
Chondromalacia Patella
This condition signifies inflammation on the underside of the kneecap, leading to softening of the cartilage.
Smooth cartilage is vital for pain-free joint movement; softening or thinning leads to increased pain during motion.
The shallow femoral trochlear groove and tilted patella contribute to this problem.
Treatment consists of rest, the use of NSAIDs (non-steroidal anti-inflammatory drugs), proper stretching, and low-impact exercises to minimize joint stress.
ACL Reconstruction
Graft: refers to tissue used for surgical repair or reconstruction of the ACL (anterior cruciate ligament).
Autograft: a graft taken from the patient’s own body (e.g., from the hamstring or patellar tendon).
Allograft: tissue sourced from a cadaver (deceased donor) or another individual.
Arthroscopy: a minimally invasive surgical procedure wherein a tiny camera is introduced into the knee joint, reducing the extent of surgery, leading to less scarring, faster recovery, and lower risk of infection.
Female-Specific ACL Injuries
Q Angle: refers to the angle created from the hip to the knee which places stress outside the center of gravity, increasing risk for ACL injuries in females.
Hormonal Differences: Estrogen influences flexibility in ligaments, contributing to an increased likelihood of injuries among women.
Higher Flexibility: Women generally possess looser ligaments compared to males, further elevating their vulnerability to ACL tears.
Other Terminologies and Concepts
MOI (Mechanism of Injury): refers to the specific conditions or actions that lead to injury.
Modalities: methods or treatments used to address injury symptoms.
Planes of Movement and Example Activities
Median/Sagittal Plane
Walking
Kicking a soccer ball
Forward lunge
Frontal/Coronal Plane
Lateral arm raises
Jumping jacks
Side lunge
Transverse Plane
Russian twist
Swinging a golf club
Swinging a baseball bat
How many vertebrae are in each of the four sections
Cervical: 7 (C1-C7 in the neck)
Thoraic: 12 (T1-T12 in the upper back)
Lumbar: 5 (L1-L5 in the lower back
Sacral: 5 (fused to form the sacrum)
Coccygeal: 4 (Fused to form the tailbone)
What lies in between each vertebrae
Intervertebral Disk: Absorbing shock and resisting compression
What’s different about the Sacral section
The Sacrum section is made of fused vertebrae
What are the 3 functions of the vertebral column?
Protecting the spinal cord, holding the body upright for walking, and serving as a site for muscular attachments
Why don't the disks of the spine heal like other tissues?
Because they do not receive any blood supply, so they do not have the same healing potential as other tissues of the body
What are the top two vertebrae called? Why?
Atlas: Because he is the god required to hold the celestial vault on his shoulders
Axis: The name comes from the Latin word axle, which means to serve as the central rod or pivot for rotation
Tendons - Connect BONES - MUSCLE (TWO different things)
Ligaments - Connect BONES - BONES (SAME things together
Describe Kyphosis, Lordosis, and Scoliosis (Specific with anatomical terminology)
Kyphosis: The thoracic spine should be somewhat curved, but excessive roundedness is undesirable
Lordosis: Too much forward curve at the lumbar spine in the median/sagittal plane
Scoliosis: The spine may be crooked rather than running straight down the median from the skull to the sacrum on the frontal/coronal plane
List 4 ways to help an athlete improve their posture
Participate in exercise and flexibility programs, use proper technique when lifting heavy objects, use a back support, and strengthen your abdominal muscles as well as those around the hip
What is it called when a football player tackles with their head down?
Spearing
Describe Spondylosis, Spondylolisthesis, and a disk bulge
Spondylosis is often described as a stress fracture or bone degeneration of the vertebrae
Spondylisthesis is the instability in the spine when a fracture fails to heal, allowing the vertebra to slip forward onto the vertebra below it
What is a disk bugle wrongly called?
A slipped disk
Which direction does a bulge occur, and why?
They often bulge posteriorly to one side or another, rather than to the anterior or posterior sides of the body
Why might a disk bulge cause numbness, tingling, and pain down the leg?
A disk bulge is putting pressure on a nerve, leading to tingling, numbness, and pain in the leg
What does stretching the BP result in?
It results in burning, tingling, numbness, and a stinging sensation of the arm and shoulder
What are the two common names for this injury?
A burner of stinger
What are two treatments for this injury?
Neck-strengthening exercises and range of motion stretching of the area
Define and describe each step of the treatment process with PRICES
PRICES: protection, rest, ice, compression, elevation, and support
Protection: It involves splinting or padding an area
Rest: The athlete should avoid being active in the injured area
Ice: Applied for no longer than 20-30 min
Compression: Pressure applied to the injury to prevent swelling, achieved with snug application of wraps
Elevation: to lift the body 10-12 inches above the heart
Suppost: Relates to providing necessary ambulatory aids such as crutches or canes