common sports injuries of the knee & shoulder james m. farmer m.d. sports medicine &...

Common Sports Injuriesof the Knee & ShoulderCommon Sports Injuriesof the Knee & Shoulder

James M. Farmer M.D.Sports Medicine &

Orthopaedic SurgeryLewis-Gale Physicians

James M. Farmer M.D.Sports Medicine &

Orthopaedic SurgeryLewis-Gale Physicians

James M. Farmer M.D.540-772-3530


OverviewOverview

Knee InjuriesMeniscal TearArticular Cartilage TearACL TearPatellofemoral PainIliotibial Band Syndrome

Knee InjuriesMeniscal TearArticular Cartilage TearACL TearPatellofemoral PainIliotibial Band Syndrome



OverviewOverview

Shoulder InjuriesDislocationA-C SeparationSLAP LesionRotator Cuff Tear

Shoulder InjuriesDislocationA-C SeparationSLAP LesionRotator Cuff Tear



Knee AnatomyKnee Anatomy

Femur and TibiaArticular CartilageMeniscusLigaments

Femur and TibiaArticular CartilageMeniscusLigaments



Meniscal TearMeniscal Tear

Mechanism Young: twisting or pivotingOlder: minor trauma

Signs and SxSwellingCatchingGiving wayLocking

Mechanism Young: twisting or pivotingOlder: minor trauma

Signs and SxSwellingCatchingGiving wayLocking



Meniscal TearMeniscal Tear



Preferred TreatmentPreferred Treatment

Acute: Rest, Ice, Activity Modification, SurgeryMeniscal tears will not normally heal without help unless very young

Chronic: Surgical excision

Acute: Rest, Ice, Activity Modification, SurgeryMeniscal tears will not normally heal without help unless very young

Chronic: Surgical excision



Articular Cartilage Tear

Articular Cartilage Tear

MechanismAcute traumaWear and tear

Signs and SxPainSwelling

MechanismAcute traumaWear and tear

Signs and SxPainSwelling




Non Surgical: Activity Modification, Pain Medications, Injections

Surgical:Arthroscopic debridement and removal of lose fragments

Procedures to restore weight bearing surfaceResurfacing, Cartilage Transplant, Joint Replacement

Non Surgical: Activity Modification, Pain Medications, Injections

Surgical:Arthroscopic debridement and removal of lose fragments

Procedures to restore weight bearing surfaceResurfacing, Cartilage Transplant, Joint Replacement



ACL TearACL Tear

MechanismTwistingPivotingSudden stop

Signs and SxAcute: swelling, pain, instabilityChronic: frequent giving way, pain

MechanismTwistingPivotingSudden stop

Signs and SxAcute: swelling, pain, instabilityChronic: frequent giving way, pain



ACL TearACL Tear




Non Surgical: Activity Modification, Rehabilitation, Bracing

Surgical: Reconstruction of LigamentGoals of Surgery: Restore normal knee stability and function. Delay onset of degenerative arthritis

Non Surgical: Activity Modification, Rehabilitation, Bracing

Surgical: Reconstruction of LigamentGoals of Surgery: Restore normal knee stability and function. Delay onset of degenerative arthritis



Patellofemoral PainPatellofemoral Pain

Pain originating from behind the knee cap

Very common conditionExact cause unknown (likely many)Signs and Sx

Aching pain along front of kneeWorse with sitting, stairs and squatting

Giving way and buckling

Pain originating from behind the knee cap

Very common conditionExact cause unknown (likely many)Signs and Sx

Aching pain along front of kneeWorse with sitting, stairs and squatting

Giving way and buckling



Patellofemoral PainPatellofemoral Pain




Non Surgical!!!Non Surgical!!!Non Surgical!!!

Activity modificationPhysical TherapyTaping, Bracing, OrthoticsInjections

SurgeryNot many “Good” optionsArthroscopy, Osteotomy, Resurfacing, Arthroplasty

Non Surgical!!!Non Surgical!!!Non Surgical!!!

Activity modificationPhysical TherapyTaping, Bracing, OrthoticsInjections

SurgeryNot many “Good” optionsArthroscopy, Osteotomy, Resurfacing, Arthroplasty



Iliotibial Band Syndrome


Caused by tight ITB rubbing over lateral epicondyle of femur when running.

Signs and SxSharp pain over lateral knee when running or cycling

Occassional swelling

Caused by tight ITB rubbing over lateral epicondyle of femur when running.

Signs and SxSharp pain over lateral knee when running or cycling

Occassional swelling




Non Surgical:StretchingPhysical Therapy: Ice, Ultrasound

OrthoticsMedicationsInjections

Surgical:ITB release

Non Surgical:StretchingPhysical Therapy: Ice, Ultrasound

OrthoticsMedicationsInjections

Surgical:ITB release



Shoulder AnatomyShoulder Anatomy

Humerus and ScapulaLabrumBiceps TendonRotator Cuff

Humerus and ScapulaLabrumBiceps TendonRotator Cuff



Shoulder DislocationShoulder Dislocation




Non Surgical:Acute: Immobilization, Rest, Ice, Rehab

Chronic: Rehab, MedsSurgical:

Arthroscopic stabilization as effective as open procedures

Repair bankart lesion, tighten capsule

Non Surgical:Acute: Immobilization, Rest, Ice, Rehab

Chronic: Rehab, MedsSurgical:

Arthroscopic stabilization as effective as open procedures

Repair bankart lesion, tighten capsule



A-C SeparationA-C Separation

Sprain of joint between collar bone and shoulder blade at tip of shoulder

Mechanism: Fall onto tip of shoulder

Signs and SxPainDeformity

Sprain of joint between collar bone and shoulder blade at tip of shoulder

Mechanism: Fall onto tip of shoulder

Signs and SxPainDeformity



AC SeparationAC Separation




Grades 1 & 2: Non SurgicalGrades 4-6: SurgicalGrade 3: Debatable

Non Surgical: Adequate for mostRest acutely then resume activities

Surgical: Primarily for overhead athletes and militaryAcute: reduce and stabilize jointChronic: Reconstruct ligaments

Grades 1 & 2: Non SurgicalGrades 4-6: SurgicalGrade 3: Debatable

Non Surgical: Adequate for mostRest acutely then resume activities

Surgical: Primarily for overhead athletes and militaryAcute: reduce and stabilize jointChronic: Reconstruct ligaments



SLAP Lesion &Biceps RuptureSLAP Lesion &Biceps Rupture

Injuries to Biceps tendon origin in the shoulder

Mechanism: Acute: sudden pull on arm. Chronic: Degenerative, overuse

Signs and SxPain reaching upward with palmWeaknessPossible deformity if ruptured

Injuries to Biceps tendon origin in the shoulder

Mechanism: Acute: sudden pull on arm. Chronic: Degenerative, overuse

Signs and SxPain reaching upward with palmWeaknessPossible deformity if ruptured




Popeye DeformityJohn Elway won 2 Super Bowls AFTER Biceps rupture!

Popeye DeformityJohn Elway won 2 Super Bowls AFTER Biceps rupture!




Non Surgical:Activity modificationPhysical Therapy

Surgical:Repair of tendon attachmentRelease tendonRelocate tendon

Non Surgical:Activity modificationPhysical Therapy

Surgical:Repair of tendon attachmentRelease tendonRelocate tendon



Rotator Cuff TearRotator Cuff Tear

Continuum from Impingement to Complete Tear

Mechanism: Acute: trauma. Chronic: degeneration with age due to poor blood supply to tendon

Signs and SxPain reaching overheadPain sleepingWeakness and dysfunction

Continuum from Impingement to Complete Tear

Mechanism: Acute: trauma. Chronic: degeneration with age due to poor blood supply to tendon

Signs and SxPain reaching overheadPain sleepingWeakness and dysfunction



Rotator Cuff TearRotator Cuff Tear




Non Surgical:Activity modificationPhysical TherapyInjections

Surgical:Arthroscopic or Open repair of tendon and removal of bone spurs

Shoulder replacement

Non Surgical:Activity modificationPhysical TherapyInjections

Surgical:Arthroscopic or Open repair of tendon and removal of bone spurs

Shoulder replacement

common sports injuries of the knee & shoulder james m. farmer m.d. sports medicine &...

Documents

pain slide

meniscal tear slide

acl tear slide

tear signs

patellofemoral pain

sx pain

pain mechanism

acl tear mechanism