conditions 2

1

100

SALTER-HARRIS CLASSIFICATION OF FRACTURES

type 1 (s) = separated growth plate

type 2 (a) = above growth plate (most common)

type 3 (l) = lower than growth plate

type 4 (t) = through growth plate

type 5 (er) = erasure of growth plate (smooshed)

200

OS TRIGONUM INJURY

OS TRIGONUM INJURY

•Background:

• Formed at birth or by a nonunion fracture or stress fracture, subtalar and midtarsal joint pronation causes the os trigonum to become compressed between the tibia and calcaneus

•Signs & Symptoms:

• Inflammation of the posterior joint, pain worsens after activity, sudden onset of pain with forced plantarflexion or dorsiflexion, point tenderness anterior to the Achilles and posterior to the talus

•Management:
 Refer for x-rays, RICE

300

ANKLE DISLOCATION

ANKLE DISLOCATION

•Background:

• Resulting from excessive rotation combined with inversion or eversion, dislocations of the talocrural joint result in major disruptions of the joint capsule and associated ligaments.

•Signs & Symptoms:
• Deformity

•Management:
• Immobilize and refer

400

ACHILLES TENDON PATHOLOGY

ACHILLES TENDON PATHOLOGY

•Background:
• Most common tendonitis. Risk factors include tight calves, foot malalignment deformities, change in shoes, increase in workload, change in exercise environment. Insidious onset or as a result of trauma

•Signs & Symptoms:

• Aching and burning pain in the posterior heel, which increases with passive dorsiflexion and resisted plantarflexion, possible nodules, pain worse after exercise, thickened tendon, possible Haglund deformity

•Management:
• Ice therapy, NSAIDs, activity modification, stretching, strengthening, heel lifts

500

ACHILLES TENDON RUPTURE

ACHILLES TENDON RUPTURE

•Background:

• Forceful sudden movement (PF with eccentric loading), chronic degenerative breakdown, most common in men over 30, injection?

•Signs & Symptoms:

• Hear “pop”, feel like they were “kicked”,
deformity possible, swelling, unable to bear
weight

•Management:
• Stabilize, refer

•Special Test:
• Thompson Test

2

100

CALCANEAL/RETROCALCANEAL BURSITIS

CALCANEAL/RETROCALCANEAL BURSITIS

•Background:
• Insidious onset, increase of training volume, change in footwear with rubbing or pressure on the heel, overuse injury

•Signs & Symptoms:
• Painful gait with pain at push off, pain elicited with pinching of the retrocalcaneal bursa

•Management:

• Ice, improve footwear, possible doughnut pad, referral for MRI if needed

200

SEVER’S DISEASE

SEVER’S DISEASE

•Background:

• Inflammation of an unfused apophysis in children, most common source of heel pain in children 5-11 years of age, tight posterior muscle of the LL increase risk

•Signs & Symptoms:
• Presents with pain in the posterior heel with activity that decreases with rest, toe-touch gait, pain with squeezing of the calcaneus

•Management:

• Ice therapy, NSAID, heel cups, improved footwear, rehab, casting possible

300

PERONEAL TENDON PATHOLOGY

PERONEAL TENDON PATHOLOGY

•Background:
• Forceful, sudden DF & EV or PL and IV may stretch or rupture the superior peroneal retinaculum
• Pes planus, rearfoot valgus, recurrent ankle sprains  onset of subluxating peroneal tendons

•Signs & Symptoms:
• Snapping tendons, pain

•Management:
• Rehab, taping, padding, possible surgery

400

MEDIAL TIBIAL STRESS SYNDROME (MTSS)

MEDIAL TIBIAL STRESS SYNDROME (MTSS)

•Background:
• Results from repetitive overuse. Make up about 15% of all running injuries

• Training on hard surface, increasing load, shoes, muscle fatigue, biomechanical abnormalities

•Signs & Symptoms:
• gradual onset, pain, tenderness

•Management:

• Control pain, NSAIDs, ice therapy, rehab to strengthen or control biomechanical abnormalities, taping or orthotics for pronation

500

compartment syndrome

COMPARTMENT SYNDROME

•Background:

• Results from increased pressure within the compartment which obstructs the neurovascular network of the compartmentlack of oxygenischemic tissue

• Traumatic, acute exertional, chronic exertional •Signs & Symptoms:

• Pain, pallor (pale), pulselessness (faint pulse), paresthesia (numbness feeling), paralysis (weakness with movements)

• Severe pain with passive stretching!!!

•Management:
• Medical emergency!!!  refer

3

100

DVT

•Background:
• Blood clot that is potentially life-threatening due to pulmonary embolism risk

•Signs & Symptoms:
• Warmth, tightness of the calf muscles and pain.

•Management:
• Refer!

•Special Tests:
• Wells DVT Criteria

200

mcl sprain

• Damage resulting from valgus stress caused by blow to lateral aspect of knee or twisting action
• S&S = pain along medial aspect of knee, laxity, possible loss of ROM, possible decreased strength
• Management: most commonly non-operatively, control S&S, rehab, knee brace
• Special tests
• Valgus stress test
• Full ext
• 25-degree flex

300

lcl

• Damage resulting from varus stress cause by blow of medial aspect of knee or twisting action
• S&S = pain along lateral aspect of knee, laxity, possible loss of ROM, possible decreased strength
• Management: poor blood supply = often surgical intervention needed, control S&S, rehab, knee brace
• Special tests
• Varus stress test
• Full ext
• 25-degree flex

400

acl

• Damage resulting from force causing anterior displacement of tibia on femur
• Non-contact rotation
• Cutting, pivoting
• Hyperext of knee
• Direct blow
• S&S = “pop” heard, immediate loss of function (not always), rapid swelling, limited ROM, laxity
• Management: control S&S, brace, refer, surgical intervention

special tests: lachmans (reg and prone), pivot, ant D, slocum D, crossover, levers

500

pcl

• Damaged as a result of force causing posterior displacement of tibia relative to femur
• Non-contact rotational
• Hyperflexion of knee or hyperextension (if knee distracted)
• Direct blow
• Landing on bent knee (foot position)
• Car crash
• S&S:
• Possible asymptomatic after injury, may present as gastric strain, symptoms present over time
• Symptoms are weakness, pain in posterior knee, reduced ROM
• Management:
• Control S&S, restore function, most commonly treated non-operatively

special tests: post D, Godfrey, post sag, ext rot (dial), quads active

4

100

meniscus

• Medial or lateral
• Acute or degenerative
• Tear type
• Vertical longitudinal
• May progress to bucket handle tear
• Oblique
• Degenerative
• Transverse (radial)
• May progress to parrot beak tear
• Horizontal
• May progress to flap tear
• A discoid (disk shaped) meniscus is thicker than normal, often oval or disc-shaped
• More prone to injury than a normally shaped meniscus
• More common lateral
• 1-3% of population
• Acute tears result from rotation and flexion of the knee
• S&S: locking or clicking in knee, pain or fullness along joint line, knee giving way during activity, pain when squatting
• Management: control S&S, surgical intervention is often required when “locking” is present, strengthen musculature, possible surgery
• Special tests for tears: Mc Murray’s test, Thessaly, apley comp dis, Childress, med-lat grind, bounce home

200

baker's cyst

• Also known as popliteal synovial cysts, commonly found in association with intra-articular knee disorders like osteoarthritis and meniscus tears
• S&S: pain (aching) and swelling in the posterior knee, possible loss of knee flexion, pain can present into the calf, can mimic meniscus injury
• Management: conservative at 1st as long as vascular or neural compression is not present: ice, rest, knee ROM exercises, corticosteroid injection. Possible surgery.

300

• Synovial plica

• Caused by direct trauma to the knee or repetitive flexion and the knee causing impingement of plica between patella and medial femoral condyle
• Can be acute or onset
• S&S: increased pain with activity and stairs’ possible snapping or crepitus, possible knee effusion
• Special tests:
• Test for medial synovial plica
• Supine, knee flexed to 90, tibia IR
• Passively move patella medially while palpating anteromedial capsule
• Extend knee with tibial IR
• Reproduce symptoms
• Stutter test
• Seated
• Lightly cup one hand over patella
• Patient actively extends knee
• Irregular motion or stuttering between 40-60 degrees

400

• Osteochondral lesions

• Describes osteochondral defects and osteochondritis dissecans which both involve the joints articular cartilage and underlying subchondral bone
• OCD – fractures of articular cartilage and underlying bone typically caused by compressive and shear forces
• 80% involve medial femoral condyle
• Males are 3x more likely than females
• S&S: often asymptomatic, diffuse pain within the knee, locking, giving way, clunking, increase of pain with WB, decrease strength
• Management: control S&S, depends on location of lesion, possibly surgical repair, restore normal function
• Special tests:
• Wilson’s test
• Extend knee with tibia in IR until pain is felt and then patient hold’s knee there
• Ask patient to ER tibia
• Pain experienced with extension and IR that is relieved with ER is positive test

500

ITB friction

• Caused by friction between IT band and lateral femoral epicondyle, insidious onset
• Associated with genu varum and excessive pronation
• S&S: pain over lateral femoral condyle, increase pain with knee flexion, inflammation possible, burning pain
• Management: correct biomechanics, decrease inflammation, increase proprioception, increase strength, increase flexibility
• Special tests:
• Noble’s compression test: For pathology, Patient supine NWB, clinician presses IT band onto femoral condyle while flexing and extending leg
• Renne’s test: For pathology, Patient standing WB, clinician presses IT band while patient is flexing and extending leg
• Ober’s test:For tightness, Patient side lying, hips stacked. Clinician grabs top leg and pulls it back by the lower leg. If knee doesn’t drop down = positive

5

100

• Contusion of infrapatellar fat pad/Hoffa’s disease

• Contusion of infrapatellar fat pad/Hoffa’s disease
• Entrapped between femur and tibia or direct trauma
• S&S: deep pain, aching or burning, inflammation, increased pain with extension
• Management: control symptoms, correct any biomechanical abnormalities

200

• Muscle contusions/strains/tears (hams, quads, gastric)

• Contusion: direct blow
• Strain and tear: caused by an eccentric load on muscle tissue through rapid acceleration or deceleration movements
• S&S: painful gait, pain along posterior aspect of knee or thigh, possible palpable defect in muscle tissue, pain with hip flexion and knee extension
• Management: RICE, NSAID, rehab

300

• Bone contusions (tibial plateau, femoral condyle)

• Relatively common injury to bone that is less severe than bone fracture
• Results in injury to bone on microscopic level
• Without discreet or visible fracture line on Xray or advanced imaging like CT or MRI
• Can lead to future bone degeneration
• S&S: pain, possible loss of function
• Management: rest, ice, limit ROM, refer

400

• Fractures (fib head, tibial plateau, patella, distal femur)

• Caused by trauma
• If tibial plateau fracture, visual deformity at knee noted
• If distal femur, deformity noted, emergency due to nerves and arteries present
• S&S: LOF, rapid swelling, possible deformity, pain, delayed ecchymosis
• Management: stabilize, refer

500

• Muscle tendinopathy/ruptures (hams, quad tendon, patella tendon, popliteus, pes anserine)

• Repetitive jumping and kicking activities and/or recent rapid increase in activity/volume
• S&S: pain and crepitus over tendon, deformity and LOF with rupture
• Management: refer, decrease inflammation, restore function, look for biomechanical causes