Knee
“The Twisted Knee”
Subjective:
A 20-year-old soccer player plants her left foot while changing direction and feels a “pop” in her knee. She reports immediate pain and difficulty continuing to play. She says her knee feels unstable.
Observation:
Mild swelling is present. Athlete has an antalgic gait.
Special Tests:
Question:
What is your most likely diagnosis?
ACL sprain/ Tear
“Rolled Ankle”
A basketball player lands on another player's foot and rolls his ankle inward.
Findings:
Lateral ankle sprain, primarily ATFL
A sprinter accelerates and suddenly feels a sharp pain in the posterior thigh.
Findings:
Hamstring strain
A football player is tackled with his arm abducted and externally rotated.
He immediately grabs his shoulder.
Findings:
Anterior shoulder dislocation
A football player experiences a high-speed collision.
He initially reports:
“My arm went numb.”
The symptoms lasted 30 seconds and resolved.
However, he now reports:
“The Locking Knee”
A basketball player reports twisting his knee while landing from a rebound. He has joint-line pain and says his knee occasionally “locks.”
Tests:
Answer:
Meniscal injury
“High Ankle”
A football player gets tackled with his foot planted and ankle externally rotated.
Findings:
Syndesmotic/high ankle sprain
A soccer player kicks the ball and experiences sudden anterior thigh pain.
Findings:
Quadriceps strain
A baseball pitcher develops gradual medial elbow pain.
Findings:
UCL injury
A collegiate gymnast develops low-back pain.
Pain is worse with:
No single traumatic event occurred.
Findings:
A wrestler reports twisting his knee during a takedown.
He states:
“It feels like something is stuck inside my knee.”
Findings:
Special tests:
Bucket handle tear of the meniscus
A football linebacker reports gradually increasing midfoot pain.
No single injury occurred.
Pain increases with running and cutting.
Findings:
Navicular stress fracture
A hockey player changes direction and feels pain in the groin.
Findings:
Adductor strain
A wrestler reports repeated episodes where his shoulder feels like it is “coming out.”
Findings:
Recurrent anterior instability.
A football player reports low-back pain that travels into the posterior leg.
Findings:
Lumbar radicular/neural involvement.
A 20-year-old football player is tackled while his foot is planted. He reports a pop but is unsure exactly where he felt pain.
15 minutes later:
Special tests:
ACL injury
A sprinter pushes off the starting block and feels like someone kicked him in the back of his ankle.
Findings:
Achilles tendon rupture
A soccer player repeatedly sprints and develops anterior hip pain.
Findings:
Hip flexor strain
A volleyball player has progressive shoulder pain.
Findings:
A 20-year-old collegiate swimmer reports gradually increasing pain and numbness in her right arm over the past 2 months.
Symptoms are worse after long practices and when her arm is held overhead.
She reports:
“My arm starts feeling heavy and sometimes my fingers go numb.”
Examination
Thoracic Outlet Syndrome (TOS)
“Double Trouble”
A football player is hit from the lateral side while his foot is planted. He feels a pop and immediately falls.
Findings:
Question:
Identify at least three structures/injuries that should be considered.
Expected differential:
Bonus: Identify the classic unhappy triad.
An athlete sustains an inversion injury.
Initial swelling is mild.
However:
Question:
What diagnosis must be considered?
5th metatarsal fracture
A collegiate athlete has deep anterior hip/groin pain.
Symptoms increase with:
Tests:
A 21-year-old collegiate quarterback has had gradually increasing right shoulder pain for one month. There was no single traumatic injury. Pain is worse during the late cocking phase of throwing.
He reports:
“Sometimes it feels like my arm is going to slip out.”
He has decreased throwing velocity.
Exam:
Anterior shoulder instability
Labral Injury
A 22-year-old collegiate football offensive lineman reports low-back pain that has progressively worsened over six weeks.
He now reports:
During evaluation, he states:
“I've had some trouble controlling my bladder the last couple of days.”
Exam:
Cauda Equina Syndrome / Serious Spinal Neurological Emergency