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100
  • Popliteus tendinopathy
  • Caused by overuse, excessive pronation
  • S&S: pain in proximal portion of tendon in popliteal fossa, worsens with downhill running
  • Management: control S&S and correct biomechanics
100
  • Patella subluxation/dislocation
  • Direct trauma or change direction with planted foot
  • S&S: effusion, pain, felt it pop out, possible deformity with dislocation
  • Management: refer, stabilize, restore function/strength/ROM
100

Muscle strains and tears

  • Common at the hip:
  • Iliopsoas, quadriceps, adductors, hamstrings
  • Often occurs due to a dynamic overload during an eccentric muscle contraction or overstretching of the muscle fibers
  • S&S
  • pain with activity, possible visible or palpable divot
  • Management
  • Ice, compression, elevation, rest, protect the structure, gentle stretching, restore function
100

Avulsion fracture

  • Occur with rapid, sudden acceleration and deceleration
  • Occur at the Sartorius (ASIS), rectus femoris (AIIS), hamstring (ischial tuberosity), and iliopsoas (lesser trochanter)
  • S&S
  • Sudden, acute, localized pain that may radiate down the muscle, swelling, discoloration, possible gap, pain increased when muscle is stretched
  • Management
  • Ice, rest, modified activity, protected weight bearing, referral
100

piriformis syndrome

  • Sciatic nerve passes under or through piriformis
  • Spasm or hypertrophy of piriformis places pressure on sciatic nerve
  • More common in women
  • S&S
  • Similar to lumbar pathology, burning, pain, numbness that increases with contraction
  • Management
  • Stretching, strengthening, possible injection or surgical release
200
  • Apophysitis (Osgood-Schlatter disease and Sinding-Larsen-Johansson disease)
  • Overuse of patella tendon causing avulsion t tibial tuberosity (Osgood-Schlatter disease) or at apex of patella (Sinding-Larsen-Johansson disease)
  • Recent growth spurt, increased training volume, repetitive jumping, insidious onset
  • S&S: quad atrophy, prominent bone growth, pain with touch, swelling, pain with kneeling, pain with stretching quads
  • Management: refer, rehab to restore strength and mobility, ice, rest
200
  • Patellar tests
  • Medial and lateral patellar glide test:

  • Supine with bolster under knee for 30 degrees flexion
  • Move patella medially
  • Normal movement is 1-2 quadrants
  • Move patella laterally
  • Normal movement is 0.5-2 quadrants

  • Patellar tilt assessment:

  • Supine with knees extended
  • Grasp the patella elevate the lateral border and depress the medial border
  • Normal is 0-15 degrees
  • Abnormal is > 15 degrees or < 0 degrees

  • Patella apprehension test:

  • Supine, knee extended
  • Clinician attempts to move patella laterally
  • Apprehension or quad guarding = positive
200

Slipped capital femoral epiphysis

  • Displacement of femoral head relative to femoral neck
  • Femoral head remains in acetabulum
  • Femoral neck displaces anteriorly
  • Most common hip disorder in adolescents
  • Boys more common
  • Overweight
  • S&S
  • Limitation in internal rotation, gait pattern, with involved extremity externally rotated, inability to bear weight, permanent retroverted femur
  • Management
  • Immediate referral, possible surgery or casting; depends on stable or unstable
200

Labral tears

  • Can result from acute trauma or repeated stress
  • Anterior – produce pain and catching when hip is moved from FL/ER/ABD to EXT/IR/ADD
  • Posterior – pain during passive hip FL/IR with posterior load
  • S&S
  • “Catching” type of pain, pain in anterior hip but can be in the lateral hip/buttock, increases with WB
  • Management
  • Refer, most likely surgery
200

Snapping hip syndrome

  • Palpable and audible “snapping” within hip as joint flexes and extends
  • Internal snapping represents the iliopsoas tendon contacting the femoral head or other structure
  • External snapping caused by IT band catching on greater trochanter
  • Intra-articular snapping hip is most commonly associated with a loose body within the joint, labral tear, or synovial fluid
  • S&S
  • Snapping sensation
  • Management
  • Reduce inflammation, correct biomechanical errors, stretch, strengthen, rest, NSAIDs, possible surgery
300
  • Proximal tibiofibular syndesmosis sprain
  • Caused by a direct blow or inversion & PF ankle injury with associated knee flexion
  • S&S: pain over fibular head, increased joint play possible knee instability reported
  • Management: RICE, strengthen, rule out fracture
300

Iliac crest contusion

  • Hip pointer
  • MOI
  • Direct blow to ilium
  • S&S
  • Pain, swelling, discoloration, loss of function, muscle spasm
  • Management
  • Ice, crutches, stretching, possibly radiographs to rule out fracture
300

Legg-Calve-Perthes disease

  • Develops in first decade of life (ages 4-10)
  • More common in boys
  • A condition resulting from temporary or permanent loss of blood supply to a bone that causes the bone to collapse
  • S&S
  • Gradually increase joint pain with loss of motion, permanently decreased hip ABD and IR ca occur
  • Management
  • Limited impact, possible surgery
300

Hip sublux/dislocation

  • Often occurs as a result of a fall onto flexed knee with hip adducted or a jump stop or pivot that forces the femoral head posteriorly
  • S&S
  • Pain, deformity with dislocation
  • Management
  • Refer, NWB for up to 6 weeks
300

Bursitis

  • (Trochanteric, ischial, iliopsoas)
  • Caused by increased friction between a muscle or tendon
  • S&S
  • Pain
  • Management
  • Reduce inflammation, correct biomechanical errors, stretch, strengthen, rest, NSAIDs
400
  • Patella bursitis
  • Commonly occurs at prepatellar, suprapatellar, pes anserine, or infrapatellar bursa
  • Overuse or direct trauma
  • S&S: pain, loss of ROM, point tenderness, inflammation, redness, warmth
  • Management: compression, ice, OTCs, refer, rule out pseudo gout or bacterial infection
400

Quadriceps contusion

  • Results in death of muscle fibers and decreased force during knee extension
  • S&S
  • Pain, spasm, discoloration, swelling, hematoma
  • Hematoma makes area hard
  • Management
  • Restrict weight bearing until quad control and pain-free ROM is regained, ice (with knee flexed), padding, restore ROM
  • Ice with knee flexed to lengthen muscle to stop long-term muscle contractures or muscle guarding
400

Femoral neck stress fracture

  • Most prevalent in endurance athletes, especially females
  • Due to microfractures on the superior surface of neck of femur
  • S&S
  • Deep aching in groin, antalgic gait, tenderness over anterior hip, limited ROM (end-ranges), increased pain by standing, axial load, and hopping
  • Management
  • Refer for bone scan or CT scan, rest, non-weightbearing
400

Hip osteitis pubis

  • Gradual ossification and widening of pubic symphysis
  • Caused by rotational, tension, or shear forces placed on symphysis
  • Acute chronic
  • S&S
  • Pain over PS, lower abs, adductors.
  • Walking raising from seated position may increase pain
  • Management
  • Treat symptoms, ice, rest (extended), NSAIDs
400

Femoral acetabular impingement (FAI)

  • Abnormal contact between femur and acetabulum
  • Presents with “c sign” on showing where pain is
  • Cam deformity
  • Femoral neck/head is too broad
  • Most apparent in young athlete males
  • Looks like pistol
  • Pincer deformity
  • Acetabular over-coverage
  • Most apparent in middle aged woman
  • Combined type
  • Accounts for about 80% of cases
  • Radiographic findings of FAI are found in up to 47% of the general population
  • Probably closer to 30%
500
  • Patellofemoral joint dysfunction
  • General pain around anterior knee
  • Often presents after increased activity intensity and/or volume, multifactorial causes
  • S&S: pain with running, pain increases after squatting or sitting for a while (“movie goer’s knee”), hypermobile patella often present
  • Pain structure function for pain after sitting, patella rubbing on femur for substantial amount of time and having patella in that position creates pain
  • Management: biomechanical evaluation, control inflammation/pain, increase strength and mobility, brace
500

Heterotopic ossificans

  • Formation of bone within the muscle belly’s fascia and other soft tissues
  • Occurs secondary to a traumatic injury suck as a severe contusion, multiple contusions, or even a muscle strain
  • S&S
  • Pain, palpable mass, decreased ROM (can sometimes be painless)
  • Management
  • Control inflammation, treat initial injury, possible referral for surgery if fully matured
500

Femoral fracture

  • Caused by shearing, torsion, or direct compression forces
  • S&S
  • Depends on type of fracture
  • Limb deformity
  • Swelling, severe pain, LOF, muscle weakness, muscle spasm
  • Management
  • Stabilize and refer
500

Athletic pubalgia

  • Commonly called “sports hernia”
  • Not actually a hernia
  • Results from an increased muscular load placed on pubic bone and/or pubic symphysis
  • Shear force is placed on PS when lower extremity is in a CKC position and the adductor perform and isometric or eccentric contraction
  • Hip ABD, ADD, FLX, and EXT
  • S&S
  • Pain on resisted contraction of the adductor group or with resisted sit-up
  • Management
  • Conservative restore function or surgical repair
500

special tests (what are they for?)

Thomas, obers, ely, 90-90 SLR, piriformis test, FABER, FADDIR, hip scouring, trendelenburg, resisted external de-rotation, single/bilateral adduction, squeeze

Thomas: hip flex tight (rec fem and iliiopsoas)

obers:ITB tight

ely: rec fem tight

90-90 SLR: ham tight

piriformis test: prfrm tight 

FABER: hip path

FADDIR: FAI

hip scouring: labral

trendelenburg & resisted external de-rotation: glute med weak

 single/bilateral adduction & squeeze: pubic pelvis dysfunction

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