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Injuries to the Thigh, Leg, Injuries to the Thigh, Leg, and Kneeand Knee

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Anatomy ReviewAnatomy Review

• Bones of the regionBones of the region– femur -- femur --

longest/strongest longest/strongest bone in the bodybone in the body

– patella -- sesamoid patella -- sesamoid bonebone

– tibia -- largest bone tibia -- largest bone in the lower legin the lower leg

– fibula carries 2% of fibula carries 2% of body weightbody weight

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Anatomy ReviewAnatomy Review• ligamentsligaments

– medial and medial and lateral collaterals lateral collaterals • protect the knee protect the knee

from valgus/varus from valgus/varus forcesforces

– anterior and anterior and posterior posterior cruciatescruciates• protect the knee protect the knee

from anterior & from anterior & posterior forcesposterior forces

– Menisci Menisci • Medial and Medial and

LateralLateral

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Anatomy ReviewAnatomy Review

• Knee Knee articulationsarticulations– femur and femur and

meniscusmeniscus– meniscus and meniscus and

tibiatibia– patella and patella and

femurfemur

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• FracturesFractures– femoral fracturesfemoral fractures

• results from an extremely traumatic eventresults from an extremely traumatic event• may also be in the form of a stress fracture, may also be in the form of a stress fracture,

especially the femoral neck regionespecially the femoral neck region• patellar fractures almost always fractured patellar fractures almost always fractured

as a result of a traumatic eventas a result of a traumatic event– In the adolescent, femoral fractures include In the adolescent, femoral fractures include

slipped capital epiphysis type.slipped capital epiphysis type.– In the adult, fractures of the femoral neck may In the adult, fractures of the femoral neck may

result in result in avascular necrosisavascular necrosis of the femoral of the femoral head.head.• This injury results from disrupted blood supply to the This injury results from disrupted blood supply to the

articular cartilage on the femoral head.articular cartilage on the femoral head.

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• Fractures of the femur and/or patellaFractures of the femur and/or patella– Signs/symptoms:Signs/symptoms:

• pain at the injury sitepain at the injury site• difficulty in ambulation (walking)difficulty in ambulation (walking)• swelling and/or deformityswelling and/or deformity• athlete may report having suffered a traumatic athlete may report having suffered a traumatic

eventevent• athlete may report a pop or snap at time of athlete may report a pop or snap at time of

injuryinjury

– First AidFirst Aid::• treat for shocktreat for shock• Splint the injured leg - consider the use of a Splint the injured leg - consider the use of a

traction splinttraction splint• apply sterile dressings to any related woundsapply sterile dressings to any related wounds• monitor vital signsmonitor vital signs• arrange for transport -- contact EMSarrange for transport -- contact EMS

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Common Sports Common Sports InjuriesInjuries

• Dislocation of the kneeDislocation of the knee– requires extreme trauma from an requires extreme trauma from an

external forceexternal force– mechanism similar to that of sprains, mechanism similar to that of sprains,

but more severebut more severe– Severe, obvious deformitySevere, obvious deformity– Possible loss of circulation to legPossible loss of circulation to leg– Call 911 immediatelyCall 911 immediately

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Common Sports Common Sports InjuriesInjuries• Patellar dislocation/ subluxationPatellar dislocation/ subluxation

– DetailsDetails• may be caused by direct trauma, such as a may be caused by direct trauma, such as a

blow to the medial aspect of the kneeblow to the medial aspect of the knee• If uncorrected, this injury can become chronic.If uncorrected, this injury can become chronic.

– Signs and SymptomsSigns and Symptoms• pain and abnormal movement about the patellapain and abnormal movement about the patella• patella may be obviously out-of-placepatella may be obviously out-of-place• extreme pain along the medial aspect of the extreme pain along the medial aspect of the

patellapatella• athlete may report that the knee “gave out”athlete may report that the knee “gave out”

– First AidFirst Aid::• apply ice, compression and elevateapply ice, compression and elevate• splint the entire legsplint the entire leg• transport to a medical facilitytransport to a medical facility

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Common Sports Common Sports InjuriesInjuries

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Genu Valgum Genu Varus Hyperextension

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Common Sports InjuriesCommon Sports Injuries

• Osgood-Schlatter’s Osgood-Schlatter’s Disease (OSD) and Disease (OSD) and Jumper’s Knee (JK) Jumper’s Knee (JK) (Patella Tendonitis)(Patella Tendonitis)– DetailsDetails

• sometimes associated sometimes associated with athletes involved in with athletes involved in jumping activityjumping activity

• main difference between main difference between the two is location of the two is location of pathologypathology

• In OSD the involved area In OSD the involved area is the tibial tuberosity.is the tibial tuberosity.

• In JK the involved area is In JK the involved area is the patellar tendon.the patellar tendon.

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Common Sports Common Sports InjuriesInjuries

– Signs/symptoms of OSDSigns/symptoms of OSD• point tenderness of the tibial tuberositypoint tenderness of the tibial tuberosity• swelling over the tibial tuberosity -- over swelling over the tibial tuberosity -- over

time, it may become solid feelingtime, it may become solid feeling

– Signs/symptoms of JKSigns/symptoms of JK• pain/tenderness around the patellar pain/tenderness around the patellar

tendon complextendon complex• pain when running/jumpingpain when running/jumping

• First Aid:First Aid:• ice and compressionice and compression• Chronic cases of patella tendonitisChronic cases of patella tendonitis

– Heat, stretching, and strengthening programHeat, stretching, and strengthening program

• Anti Inflammatory MedsAnti Inflammatory Meds

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TendonitisTendonitis

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BursitisBursitis• BursitisBursitis

– inflamed bursa inflamed bursa – small fluid-filled small fluid-filled

sac located at sac located at strategic pointsstrategic points

– numerous bursa numerous bursa around the knee around the knee region -- only a region -- only a few are typically few are typically injuredinjured

– inflammation can inflammation can be caused by be caused by trauma, chronic trauma, chronic irritation or irritation or infectioninfection

– the prepatellar the prepatellar bursa is often bursa is often irritated by irritated by traumatrauma

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BursitisBursitisSigns/symptoms:Signs/symptoms:– swelling/ swelling/

tendernesstenderness– increased pain increased pain

caused by manual caused by manual pressurepressure

– history of trauma history of trauma or chronic injuryor chronic injury

• First Aid:First Aid:– apply ice and apply ice and

compressioncompression– reduction of activityreduction of activity– if chronic -- anti-if chronic -- anti-

inflammatory agents inflammatory agents with a physician’s with a physician’s approvalapproval

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MenisciMenisci• Menisci injuriesMenisci injuries

– typically typically damaged by damaged by quick, sharp, quick, sharp, cutting cutting movementsmovements

– in some cases, a in some cases, a torn flap of torn flap of meniscus will meniscus will get caught in get caught in the joint, the joint, causing it to causing it to locklock

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Common Sports Common Sports InjuriesInjuries

• Signs/symptoms:Signs/symptoms:– pop or snap when the knee was pop or snap when the knee was

injuredinjured– may not see any significant swellingmay not see any significant swelling– may not be painfulmay not be painful– in some cases, the knee may lockin some cases, the knee may lock– knee may “give out” periodicallyknee may “give out” periodically

• First Aid:First Aid:– ice and compressionice and compression– put athlete on crutchesput athlete on crutches– refer to a physicianrefer to a physician

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Torn MenisciTorn Menisci

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• Meniscal TestsMeniscal Tests– McMurray’s Meniscal TestMcMurray’s Meniscal Test

• Used to determine displaceable meniscal Used to determine displaceable meniscal teartear

• Leg is moved into flexion and extension Leg is moved into flexion and extension while knee is internally and externally while knee is internally and externally rotated in conjunction w/ valgus and rotated in conjunction w/ valgus and varus stressingvarus stressing

• A positive test is found when clicking and A positive test is found when clicking and popping are feltpopping are felt

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LigamentsLigaments• Ligament injuriesLigament injuries

– Medial CollateralMedial Collateral• Prevents varusPrevents varus

– Lateral CollateralLateral Collateral• Prevents valgusPrevents valgus

– Anterior CruciateAnterior Cruciate• Prevents anterior Prevents anterior

translationtranslation

– Posterior CruciatePosterior Cruciate• Prevents posterior Prevents posterior

translationtranslation

Excessive stress on the MCL

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LigamentsLigaments

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Common Sports Common Sports InjuriesInjuries

– Signs/symptoms:Signs/symptoms:• athlete reports the knee was forced beyond athlete reports the knee was forced beyond

the normal ROMthe normal ROM• pain at the site of injurypain at the site of injury• swelling around the kneeswelling around the knee• athlete will state the knee feels unstableathlete will state the knee feels unstable• athlete will report having felt and/or heard athlete will report having felt and/or heard

a snap or pop at the time of injurya snap or pop at the time of injury

– First AidFirst Aid::• ice and compressionice and compression• place the athlete on crutchesplace the athlete on crutches• refer immediately to a physician for refer immediately to a physician for

medical evaluationmedical evaluation

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– Valgus and Varus Valgus and Varus Stress TestsStress Tests• Used to assess the Used to assess the

integrity of the MCL integrity of the MCL and LCL and LCL respectivelyrespectively

• Testing at 0 degrees Testing at 0 degrees incorporates incorporates capsular testing capsular testing while testing at 30 while testing at 30 degrees of flexion degrees of flexion isolates the isolates the ligamentsligaments

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– Anterior Cruciate Ligament TestsAnterior Cruciate Ligament Tests• Drawer test at 90 degrees of flexionDrawer test at 90 degrees of flexion

– Tibia sliding forward from under the femur is Tibia sliding forward from under the femur is considered a positive sign (ACL)considered a positive sign (ACL)

– Should be performed w/ knee internally and Should be performed w/ knee internally and externally to test integrity of joint capsuleexternally to test integrity of joint capsule

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• Lachman Drawer Lachman Drawer TestTest– Will not force knee Will not force knee

into painful flexion into painful flexion immediately after immediately after injuryinjury

– Reduces hamstring Reduces hamstring involvementinvolvement

– At 30 degrees of At 30 degrees of flexion an attempt flexion an attempt is made to translate is made to translate the tibia anteriorly the tibia anteriorly on the femuron the femur

– A positive test A positive test indicates damage indicates damage to the ACLto the ACL

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• Preventing Knee InjuriesPreventing Knee Injuries– Overall strength of muscles Overall strength of muscles

surrounding kneessurrounding knees– Flexibility of muscles surrounding Flexibility of muscles surrounding

kneesknees– Proper biomechanicsProper biomechanics– Knee bracing is appropriate under Knee bracing is appropriate under

certain circumstancescertain circumstances

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