Knee Cases
A 12 year old female basketball player explains she is having knee pain. She is only playing basketball, has tight quads, and is having tenderness mainly on the inferior pole of her patella. Can you name this possible problem?
Sinding Larsen-Johansson Syndrome
*if her pain changed to being on the tibial tubercle what would this be called instead?
This injury has an MOI of axial loads and dashboard injuries. Majority of the time this happens when there is a depression of the lateral tibial plateau. What could be the injury?
- tibial plateau fracture
Stacy's mom was in a car accident where the steering wheel knocked into her bent knees. Her hip is partially flexed, internally rotated and adducted. She is really guarding the hip and any movement causes a lot of pain. What happened to her hip?
- hip dislocation
An 82 year old Hailey fell. However she is really happy because her x-ray shows that there is only a problem between the greater and lesser trochanter along the intertrochanteric line. What is the diagnosis?
Extracapsular Hip Fracture
Carson loves to run, but recently she has been having pain in the mornings in her foot. She has flat feet and notices pain when she pushes off. What could she have?
Plantar Fascitis
A football player suffered from a varus stress MOI when playing in his game. What knee ligament could be injured?
LCL
This overuse / tight LE musculature condition is felt at the superior pole of the patella for people over 40. Name the issue?
Where are the other 2 sites of this problem and at what ages would you see them?
- patellar tendonitis
- inferior pole of patella between 20-40 yrs old
- tibial tuberosity in adolescents aka OSGD
A 24 year old James comes into the clinic explaining that he is having hip pain. He has been practicing karate and this has been making it worse. Name the problem and be specific as to what type it could be?
- FAI but more likely a Cam lesion
Intra-articular snapping hip syndrome
Brandon was recently playing football and landed on the back heel of another player. He tore his metatarsal head and is using taping to try and treat the injury. What do you suspect it is?
Turf Toe
Patient explains she was playing soccer and as she slowed down her knee bent too much. She heard a pop, there was swelling immediately. What could this injury be and what MAIN special test is +
- ACL tear; Lachman test
- not necessarily anterior drawer because just ACL involved
Patient explains how they got in a fight with their sister and she kicked the inside of her knee. Her knee cap went flying to the outside of her leg and the medial retinaculum was stretched. She has pain with quad contraction. What happened to her knee?
Follow up: what special test would be positive?
- patella dislocation
- patella apprehension test
A 6 year old Aidan is presenting with a limp, pain in the groin area, trendelenburg gait and limited ROM in abduction and IR. You are worried he may have ______ and tell his parents to go get _______ because it is the gold-standard
- Legg-Calve Perthes Disease
-x-ray
An 76 year old Kait says she is limited in hip extension, ABD, and IR. She is having pain in her groin that is extending to her knee. She also has pain in terminal stance and one hip keeps dropping. What is this?
- scouring = +
- Trendelenburg = +
Degenerative Joint Disease
A 35 year old Vero has a right ankle sprain. She was turning and pivoting as she was dancing at the club last night. She had immediate pain, with minimal swelling. In class we test and saw that the external rotation test was + and the Talar tilt test for the deltoid ligament was -. What type does she have?
Tibiofibular Joint Sprain aka High Ankle Sprain
- and Grade 1 or 2
A 27 year old patient was in a car accident and suffered a dashboard injury to the knee. The patient has pain in the back of his knee that gets worse with flexion. The patient also explains like it feels like his knee is giving away. What could be the problem and if it is severe enough what else could be hurt?
- PCL Tear
- Possible tear of posterior capsule too
A 23 year old rugby player was in a game Thursday night and hurt himself. He explains that his foot got stuck which caused his tibia to rotate and pivot. He has pain during full extension. There was no immediate swelling though after the injury. He feels like his knee is giving way. Can you name what the problem is?
- meniscal tear (posterior horn)
*due to not enough blood supply for immediate swelling*
A 57 year old Eric now has osteoporosis and he tripped and fell. He is in pain and asking you what type of hip fracture he might have. You relay the news that he sadly has a _______ hip fracture and needs _______
- intracapsular
- THA asap!!
Liza explains she is having pain on her left side when she leans down to pick up her cat and when she lifts the trash. She is an active dancer, gets into a lot of external rotation, and sits for a long time in class. She is also having a hard time sitting on her left side. What could be the problem?
Piriformis Syndrome
Joey from the bachelor is complaining of medial sided pain on the plantar aspect of his foot. His foot is overly pronated and he has started to have some gait abnormalities. He is walking with a limp, has atrophy of his intrinsic muscles, and explains that he feels burning and tingling sensations in the area of his foot described already. What could be the diagnosis?
tarsal tunnel syndrome
A 45 year old female was at a zumba class when all of a sudden her tibia rotated and an injury occurred. Her pain is in the knee. Upon assessment, you see that her pain is in the proximal segment of the tibial plateau. What is injured?
coronary ligaments
*note: if pain was in the joint line = meniscal injury*
*note: can have ruptured MCL/LCL tears here too
Tom suffered a direct blow to the knee and has tight quads. When palpating he has tenderness on the outside edges of the patellar tendon at the insertion point. He also has pain with full knee flexion and hip extension. What bursa are involved?
- subcutaneous and deep infrapatellar bursa
A 12 year old boy explains he has knee pain. He is walking with his foot turned out, but has strong and painless resisted movements. You think he could have ______ because he just went through a growth spurt and due to his presentation.
- Slipped Capital Femoral Epiphysis
Name the pathologies that labral tears are associated with (5)
slipped cap epiphyses, legg-calve perthes disease, high-velocity trauma, capsular laxity/hip hypermobility, femoral acetabular impingement
Macy was playing basketball, when she dropped the ball, picked it up and as she went to push off to run, her knee was extended and she heard a loud pop. She could not walk. What is it?
Clue:
Thompson Test +
Achilles Tendon Rupture