Knee and HipConditions and Injuries

Meniscus Tear• Etiology: force to the knee

causing translation of the tibia (any direction), twist or hyperextension

• S&S: popping, locking or giving out of the knee, joint inflammation

• Continued play on a meniscus tear can lead to shredding of the cartilage-typically requires surgery

Plica• Etiology: 20% of the population

fails to create 1 synovial capsule in the knee from the 3 original-this left over fold of synovial tissue can become inflamed during repetitive knee motions

• S&S pain, clicking, inflammation, palpable fold or ridge

Patellar tendonitis (Jumper’s knee)

• Etiology: repetitive resisted knee extension (jumping, kicking or running). More common in adolescents because they are still growing causing pull on the tendon.

• S&S: pain, inflammation, thickening of the tendon

• Can lead to rupture but very rare

Osgood Schlaters (tibial apophysitis)• Etiology: excessive

pull on a tendon insertion, in response the bone overgrows

• S&S: pain, swelling over insertion site, possible bony growth over insertion site

• *if not treated can cause an avulsion fx

Iliotibial (IT)band friction syndrome (runners knee)

• Etiology: tightness in the IT band causes it to rub over the lateral tibial and/or femoral condyle. More common in women with wider hips.– Can also cause “snapping hip” or runner’s hip when it

rubs or snaps over the greater trochanter of the femur• S&S: pain, popping on lateral knee and or greater

trochanter, inflammation

“True” Knee Dislocation

• Etiology: blow to the distal leg with foot planted (blow from any direction more likely to see lateral or anterior tibial translation)

• S&S: obvious deformity, pain and inability to move joint

• *Medical emergency because of arteries and nerves

Anterior Cruciate Ligament (ACL) Sprain

• Etiology: Severe hyperextension, blow to the lateral knee with knee slightly bent (30 degrees)

• S&S pop pain inside the knee, swelling, laxity with anterior stress to the tibia

• 3rd degree sprains require surgery

Posterior Cruciate Ligament (PCL) Sprain• Etiology: Fall with full weight on the

anterior tibia, hyperextension or hard blow to the anterior tibia Not as common as ACL

• S&S: Feel a “pop,” posterior translation of the tibia on the femur, pain and joint inflammation

• 3rd degree sprain require surgery

Lateral Collateral Ligament (LCL) Sprain• Etiology: blow to the medial

knee or extreme internal rotation of the tibia. Rare

• S&S: pain and inflammation over the lateral joint line, varus laxity

Medial Collateral Ligament (MCL) Sprain

• Etiology: blow to the lateral knee, or severe external twisting

• S&S: inflammation, pain on medial joint line, medial joint line laxity with valgus stress

• Typically does not require surgery because of good vascular supply to the area

Patellar Dislocation• Etiology: deceleration with

planting and cutting or blow to the knee causing the quadriceps to pull the patella laterally

• S&S: deformity, inability to flex knee, pain and muscle spasm

• Often relocates on its own

Patellar Fracture• Etiology: direct or indirect trauma (severe pull on

patellar tendon when knee is semi-flexed)• Signs and Symptoms: extreme inflammation, pain

with movement of the knee• Complication: 2-3% of the population has bipartite

patella and can mimic patellar fracture

Chondromalacia (patelofemoral syndrome)

Etiology: softening and deterioration of the articular cartilage on the deep portion of the patella usually due to repeated stress, leg posture or strength deficiencies

• Signs and symptoms: pain on anterior knee with activity especially stairs, deep squats or jumping as well as inflammation and edema

Valgus Vs Varus

Hip Anatomy

Hip Dislocation• Etiology: Rare in sports,

more common in car accidents. Most common when the femur is pushed posterior to the accetabulum

• S&S: stuck in flexed abducted position, pain and deformity

• *medical emergency because of neurovascular compromise

Hip Labral Tear

• Etiology: extreme rotation, planting on a straight leg

• S&S pain with extreme ROM, popping or clicking

• *only treatment is to tack down or remove the torn portion

Acute Femoral FractureEtiology: more common in the elderly, direct blow, or severe twistingSigns and Symptoms: significant pain, inability to stand or walk, possible shortening of the limbManagement: medical emergency due to the vascularization of the area, often require surgery to stabilize the areaSpecial Considerations: femoral head fractures may shift (slip) mimicking a hip dislocation.

Femoral Stress Fracture

• Etiology: more common in the femoral neck, more common in females, due to repetitive stress and hip angle

• Signs and Symptoms: pain during or after activity that increases over time, x-rays may not catch this type of fracture

• Management: bone scan or MRI

Ischial Avulsion

• Etiology: sudden strong contraction of the hamstrings (hamstring tendon pulls a portion of the ischial tuberosity off)

• Signs and Symptoms: pain with active hip extension/knee flexion, pain when sitting on hard surfaces

• Management: X-ray to confirm fracture

Sacroiliac sprain• Etiology: repetitive

hyperextension of the hip, torsion, prolonged hip and lumbar flexion

• S&S: pain or SI joint, pain with hyperextension or terminal flexion of the hip. May be associated with a true or false leg length descrepancy

• Over time may cause inflammation of the sciatic nerve causing radiating pain down the leg and possible muscle weakness

Broken Tail Bone AKA Coccyx Fracture

• Etiology: Fracture of the coccyx due to fall in a seated position, direct blow, or in child birth

• S&S: pain especially when sitting or with direct pressure

Ricketts• Softening of the bones due

to decreased Vitamin D, Calcium, and/or Phosphorus

• Usually the result of malnutrition or famine

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