conditions 3

1

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

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

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

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

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

2

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

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

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

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

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

3

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

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

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

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

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

4

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

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

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

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

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

5

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

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

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

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

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