Ch 9 Injuries

7th hour

Bursitis of the KneeBy Alecia Sahatdjian

What is it?

● A condition that occurs when the Bursae are inflamed o Bursae are small, fluid filled sacs

that provide cushion near joints● Each knee has 11 bursae

The Cause

● Frequent and sustained pressure, such as from kneeling

● A direct blow to your knee

● Bacterial infection of the bursa

● Complications from osteoarthritis, rheumatoid arthritis or

gout in your knee

Affected Athletes

● Baseball player o catcher

● Volleyball player● Football player● Wrestler● Runners

○ Inflammation in the anserine bursa located on the medial side of the knee, below the joint

Anserine Bursa

Signs and Symptoms

● Decreased movement. ● Your knee may feel stiff or unable to move as well as it usually does.● Pain or tenderness in your knee. ● You may have pain or tenderness while walking, kneeling, or when your knees

touch together. o The pain may be worse when you do an exercise that uses repeated

movements, or when climbing stairs● Redness and warmth. If the bursa is infected, the skin over the knee may be red

and warm. o You may also have a fever.

● Swelling on top of the kneecap or the inside area of your knees

● Rest to the injured area by perhaps changing the activity.● Ice and elevation to reduce swelling.● Anti-inflammatory medication if recommended or prescribed

by your doctor.

Treatment

Recovery

● Long-term injury● Therapy● Corticosteroid injection

o Reduces inflammation● Aspiration

o Needle is used to remove fluid

● Surgeryo Completely remove bursa

Patellar Subluxation/ Dislocation

By: Amanda Bennett & Ali Brackett

Etiology

Patellar Subluxation/Dislocation is the twisting and dislocation of the knee cap. It occurs when one’s leg is forced into another direction while their leg is planted onto the ground. It can also occur from direct trauma. There are also other factors leading up to subluxation/dislocation: A wide pelvis A shallow groove in the kneecap Abnormalities in gait

Patellar Subluxation/Dislocation most often occurs in women. Athletes who suffer from this most are usually football players, soccer players, basketball players, and gymnasts.

Signs and SymptomsSigns: Knee appears to be deformed. Swelling behind the kneecap. Visible that kneecap is not where it should be. Knee cannot bend or straighten. Unable to walk.

Symptoms: Feeling the kneecap moving out of it’s position. Possible pain behind kneecap. Possible pain when bending or straightening your leg. Knee tenderness.

Management

We can take care of the injury by … Physical Therapy. Bracing and Taping. Better footwear. Ice and elevate knee. Take anti-inflammatory medicine (such as ibuprofen).

It may require possible surgery. Not everyone is cured by simple treatments. There are several surgeries possible, the type of procedure depends on the severity of the condition. (Most first-time dislocations don’t need surgery.)

If no surgery is required, it will take 2 to 4 weeks of immobilization for recovery, followed by physical therapy.

LCL SprainBy: Breanna Jackson

Cause

● A lateral ligament sprain is a knee ligament injury. It takes place when a tear to the ligament on the outside of the knee.It is most likely following a direct blow to the inside of the knee.

Symptoms and Signs

● Knee swelling ● Pain and tenderness● Locking of the knee● Stiffness

● Common among athletes who participate in relatively violent activities such as hockey, wrestling, and football

● It is also common for those who participate in sports that include stopping quickly or turning suddenly (basketball or soccer)

Management● In most cases, the individual would wear a brace, take pain

relievers, and possibly participate in physical therapy.● P.R.I.C.E● If it is a Grade 1 or 2 it will take about 2-5 weeks until the

person can return to play.● It will take about 8 weeks to fully recover, depending on the

grade of the injury.

Surgery Option● Grade 3 Lateral collateral ligament tears may

require surgery.● The surgeon will reattach the ligament to the

bone using large stitches or a metal bone staple.

Medial Collateral Ligament Sprain

By Camryn and Dejah

Location

• The Medical Collateral ligament is located on the inside of the knee

• Gives the knee stability • Connects the inner surfaces of the femur and

Tibia.

Etiology

• Can occur through falls and twist of the knee joint

• MCL may become stretched or torn• Repetitive forces can lead to MCL sprain/tear• Common in contact sports ; soccer, football. • 3 grades of the injury

Signs and Symptoms

• Grade 1: Mild tenderness on inside of knee, no swelling, Mild laxity of joints

• Grade 2: Mild laxity of the joints, significant tenderness on medial ligament, Cannot be bent sideways completely

• Grade 3: Instability when walking, complete tear, extreme pain, significant joint laxity.

Treatment

• P.R.I.C.E • Possible Knee brace for support• If torn, surgery is probably needed.

Return to play

• All depends on the level of injury• Minor sprains may result in braces or just rest. • Grade 1: 10-14 days off/knee strengthening • Grade 2: average of 3 weeks out• Grade 3 sprain: average of 5 weeks out • Recovery time is most dependent on the

person

Quad Strains

Gabby Roberts & Celest Gudino

Etiology

-What causes a quad strain is when the tension in the quad is to excessive due to too much repetition or high force, which will cause the the quadriceps muscle fibers may be torn- This is found mostly in athletes that involve

lots of kicking or running in the sport - EX: Soccer, Cross Country, Track, Football

Sign/ Symptoms

The common signs and symptoms of quad strains are pain and tenderness in front of the thigh, stiffness and swelling of the quadriceps

and/or weakness of the quadriceps. If the blood vessels are broken then there may be bruising across the quadriceps. A very rare symptom of

quad strains is the popping or snapping sensation as the muscle tears.

ManagementTalk with your doctor for the best treatment plan individualized for you and the severity of your strain. Recovery time ranges vary depending on their severity of your quad strain. Some common examples of treatment are:• Acute Care• Rest – Your muscle will need time to heal so you need to avoid any extra or unneeded stress on the muscleo Do NOT do activities that cause pain like running, jumping and weight lifting using the leg muscles.o If walking hurts normally then shorten your stride and you may need to switch your pace.o Do NOT play any sports until your doctor says its okay• Coldo Apply ice to the area for 15-20 minutes several times a day for several days after the injury has occurredo Do NOT apply the ice directly to your skin; wrap it in a towel first then put it on the area• Pain Relief Medicationso Over-the-counter medications such as aspirin or ibuprofeno Topical pain medications such as cream or patches that get applied directly to the skino Prescription pain relievers

Management Continued • • Compression• o To prevent more swelling from occurring• o May recommend an elastic compression bandage around your

thigh• o Do NOT wrap it too tight• • Elevation• o Help to keep the swelling down• o Keep your leg higher than your heart as much as possible for the

first 24 hours or so after the injury• o A couple of days of elevation may be recommended for severe

strains• • Recovery Steps• o Do strengthening exercises for your muscles as recommended

SOME MORE MANAGEMENT…• o When the acute pain is gone then start gentle stretching as recommended several times a day. Stay within your pain limits, and hold it for about 10 seconds repeating it six times.

• o Rehabilitation with a physical therapist may be required• • Heat• o Use heat ONLY when returning to physical activity• • Prevention• o Keep your quad muscles strong so they are able to absorb the

energy of physical stress• o Learn the proper technique for exercise and sports. It will help

to decrease stress on all your muscles including your quads.• o Warm up and stretch before any physical activity

Meniscus Injury

By: Emily Miranda

Definition/description of Menisci

• 2 Menisci located in each knee:1. Medial Meniscus – inside of the knee 2. Lateral Meniscus – outside of the knee • Crescent-shaped bands (Thick, rubbery

cartilage attached to the tibia) • Absorb shock • Stabilize the knee

Cause

• Forceful rotation of the knee • Applied pressure or weight while forceful

rotation is occurring • Aggressive pivoting • Sudden stops • Heavy lifting • Degeneration with age

Common Athletes

• Most common of knee injuries• Activities that involve aggressive twisting or

pivoting• Most common in athletes: contact sports such

as football, basketball and tennis etc.

Signs and Symptoms

• Pain /popping sensation• Swelling • Stiffness• Weakened stability• May restrict extension of the knee (feel as if

your knee is stuck or blocked)

Treatment and Recovery Process

• Conservative treatment is sometimes effective on a torn or injured meniscus – rest, ice, bracing and over the counter medication

• More severe cases will sometimes require surgery

• PRICE/Physical Therapy

Unhappy TriadBy: Karla and Esmeralda

Etiology● Name given to 3 ligament injuries in the knee:

o ACLo MCLo Meniscus partially or

completely torn

Etiology● Occurs when the foot is planted and the knee is hit and moved in the opposite

direction ○ Common when foot is planted and knee is hit from the side○ Causes ligaments and cartilage to tear

● Common in contact sports:■ Mostly Football

● tackling■ Basketball ■ Soccer■ Rugby■ Snowboard■ Skiing

Signs and Symptoms● Popping or tearing sound ● Difficulty and pain moving the knee

o Inability to straighten or bend knee● Stiffness and swelling in knee

o Swelling happens very fast● Popping or tearing sound ● Bruising

o Appear within 2-3 days

Management● Treatment:

o P.R.I.C.E: Protection Rest Ice Elevation

o Medical Help ASAP X-Ray or MRI to confirm injury Surgery

● ACL Reconstruction and Meniscus Tear Repair or Removalo Recovery can be 4-7 monthso Performed at the same timeo MCL left to heal naturally

o Physical Therapy

Management● Recovery:

o 6-9 Monthso First couple of days:

Goal: reduce swelling and pain● ice knee, elevate knee, little movement● wear crutches or maybe knee brace

o First and Second Week: Goal: straighten knee and begin exercising

● exercise with physical therapist ● remain on crutches

Management● Recovery:

o Third through Sixth week: Goal: build strength in and around knee

● working with physical therapisto help support muscles around kneeo help knee grow strongero may begin workouts alone

o Seventh through Twelfth week:● more physical activity is added alone● can't do sports

o Four through Seven months:● Increase exercises and activity

OCD (Osteochondritis Dissecans)

Cause ● Blood Deprivation in the subchondral bone

● Microtrauma to the knee

Most common Athletes..

FootballBasketballGymnasticsSoccer Lacrosse

Signs & SymptomsSigns:● Knee pain, swelling, difficulty walking, and possibly arthritis

at a young age.

Symptoms:● Joint pain, Stiffness, Locking of Joint, Limited range of

motion( Cartilage and Bone literally being pinched)

Stages

Management● How will we take care of this injury?- In most cases OCD lesions in children and teens will cure on their own, but resting

will relieve the pain from this injury. - If the injury does not go away within due time then a doctor may recommend to

use crutches or splints.● A doctor may recommend surgery if:- If nonsurgical treatment fails to relieve pain or swelling- If the lesion is larger than one centimeter in diameter.- If the lesion is separated from the surrounding bone and cartilage and moving

around within the joint.

Management cont.● Rest and immobilization.

● Without surgery usually you will be able to get back in the sport within the first 2-4 months and for it to properly heal it could take up to a year.

● Surgery such as Drilling, Pinning, and Screws may be needed.

● 2 to 4 months of physical therapy after surgery.

● Surgery recovery time is usually about 5 to 6 months

PCL Sprain

Jessica Eberly

• Grade 1 Sprains: ligament is mildly damaged, has been slightly stretched, but is still able to help keep the knee joint stable

• Grade 2 Sprains: stretches the ligament to the point where it becomes loose, often

referred to as a partial tear of the ligament• Grade 3 Sprains: a complete tear of the ligament, ligament

has been split into two pieces, and the knee joint is unstable

• Most common in contact sports

Posterior Cruciate Ligament Sprain

sportsinjuryclinic.net

• A direct blow to the front of the knee -a fall onto a bent knee

• Pulling or stretching the ligament-a twisting or hyperextension

• Simple misstep

Etiology

sportsinjuryclinic.net

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• Mild to moderate pain in the knee that can cause a limp or difficulty walking

• Knee swelling occurs rapidly a few hours after the injury• knee feels loose, as if it's going to give out• May be so mild that you might not even notice anything

wrong• Over time pain may worsen and knee may feel more

unstable• If other parts of the knee have also been injured, your

signs and symptoms will be more severe.

Sign/Symptoms

Mayoclinic.org

• Nonsurgical (Grade 1 and 2):

– PRICE– Physical Therapy

• Surgical (Grade 3):– Replacement of ligament with a tissue graft hat is taken from

another part of your body, or from another human donor– Surgery is done with small incisions– It can take several months for the graft to heal into the bone– Follow-up at 2, 6, 12, 24, 36, 48, and 52 weeks following surgery

is recommended– Athlete may return to play once

Management

orthoinfo.aaos.org

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https://www.rcmclinic.com/rosenberg-info/images/pcl-sparing.jpg

Hamstring Strain

Katelynn Kuehl

• Muscle overload- When a muscle is being stretched to far or is challenged with a sudden load.

• This occurs when you extend a muscle while it is weighted or loaded.

Cause

• Sprinters often strain their hamstrings• During sprints the muscle lengthens as it

shortens, as the back leg is stretched and the toes are being used to push off the ground. At this point the hamstring is lengthened and loaded.

Common Athletes

• For pain– Over the counter medicine

• For a few days or weeks after the injury athletes must:– Rest– Ice – Compress(compression bandage) – Elevate

Managment

• When pain has decreased significantly you can do light stretching activity with the knowledge of your doctor

• Slowly increase your physical activity, such as walking and follow exercises given by your doctor. As your hamstring heals and strengthens you can add stretching and exercises

• Do not return before it feels significantly, better because it can recur or your hamstring may tear.

Returning to play

• Grade 1– Mild muscle strain– 2-5 days of healing

• Grade 2– Partial muscle tear– A few weeks to months

• Grade 3– Complete muscle tear– Could need surgery

Grades of a hamstring strain

• Swelling • Tenderness • Bruising/ discoloration

Signs

• Sudden sharp pain in back of thigh• Might have popping or tearing sensation

Symptoms

Osgood-Schlatter Disorder

By: Libby Roeder

Causes

• Happens when the thigh muscles pull on the tendon that connects the knee cap to the shin bone. This causes the tendon to pull away from the shin bone.

• Irritation of the bone growth plate• Overuse of the knee• Usually occurs in one knee but can

occur in both

Common Athletes

• Mostly occurs in children who participate in sports that involve running, jumping, and quick direction changes

• Ex: Soccer, Basketball, Figure Skating• More common in boys• Usually occurs during a growth spurt

Signs and Symptoms

• Pain during activities (ranges from mild to constant pain)

• Pain, swelling, and tenderness below knee• Limping after physical activity• Locking or instability of the joint• Swollen or red knee

Management

• Doctor will examine injury and take an X-ray• You are able to continue playing sports unless if the

pain is severe then you will need to take a break• Physical Therapy or stretching and strengthening

exercises will keep the muscle strong • P.R.I.C.E• Some severe cases may require a

cast or brace• Will go away on its own once your growth

spurt has ended usually around the ages of 14-18

Iliotibial (IT) Band Friction Syndrome

By:Mariah Brown

● Common cause of lateral knee pain (IT band rubbing against knee or hip).

● The iliotibial band is a thick band of fascia on the lateral aspect of the knee, extending from the

outside of the pelvis, over the hip and knee, and inserting just below the knee.

● Can occur from a change in shoe or even happen by treating another injury.

● Common athletes are: runners, military personnel, and cyclists.

Etiology

● Pain on the outside of the knee or hip.

● Hip pain as the iliotibial band snaps back and forth over the point of the hip (greater trochanter).

● The pain generally disappears as the band is stretched out and then it becomes more flexible.

● Pain will improve with rest.

● Doesn’t have pain when you initially start running.

Signs/ Symptoms

• Rest ( You can continue to participate in the activity that injured you as long as you can take the pain)

• Ice• Stretching of iliotibial band ( may use foam roller)• Instruct a person to avoid hills, shorten stride, and run on alternate sides of road• Anti-inflammatory medicine• Orthotics • Ultrasound• Contrast baths• Steroid injection

Treatment

Anterior Cruciate Ligament (ACL) Sprain

By: Natalie O’Hora and Samantha Kuk

ACL Sprain

• Causes:

-Changing direction rapidly

-Stopping suddenly

-Slowing down while running

-Landing from a jump incorrectly

-Direct contact or collision, such as a football tackle• Most Common Athlete:

-Females have a higher risk, it is due to physical conditioning and muscular strength. • Common Sports are:

-Soccer, Basketball, Football, and Tennis.

ACL SprainSigns: Symptoms:

• Popping noise• Swelling• Limping

• Pain with swelling. Within 24 hours, your knee will swell.

• Loss of full range of motion

• Tenderness along the joint line

• Discomfort while walking

ACL SprainSurgical Non-Surgical

• Rebuilding the ligament-The ligament must

be reconstructed. • Replace the torn

ligament with a tissue graft.

• Regrowth takes about 6 months until the athlete may return.

• This is only effective for patients who are elderly or not active. – By using a brace– Physical Therapy

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Jumper’s Knee/ Patellar Tendonitis

Nicole Bennett & Robert Effrein

Definition What is Patellar Tendonitis?

● Patellar Tendonitis is an injury caused by inflammation in an overused and damaged Patellar Tendon.

● If the repeated trauma persists long enough without proper treatment it is known as tendinopathy.

Etiology What causes Patellar Tendonitis?

● Overuse injury caused by repetitive strain ● Damage is sustained most often during

running, knee bending, and jumping activities and or sports.

● Weak and or tight Quadricep muscles can cause or worsen this.

● Common among children and adults alike.

Signs/Symptoms What is it like?

Symptoms● Pain at the bottom front of knee cap● Athlete will be stiff and aching after exercises● Patellar tendon will be tender when pressed on

Signs● Swelling of the patellar tendon and adjacent area

will occur.

Management How is it treated?

● Requires plenty of rest and rehab● Stretching and strengthening the

quadriceps muscles ● Icing, taping, wearing knee strap

helps reduce pain● Surgery required in extreme cases● Few weeks to several months of recovery

Chondromalacia Patella

By:Tasneem Jibawi

Definiton

Chondromalacia patella is a damage to the cartilage at the back of the kneecap.

What Happens to the Knee?

What usually happens is the knee cap is pulled over the end of the femur in a straight line by the thigh muscle aka the quadriceps muscle.

Etiology❖ Does this happen to a certain type of athlete?

➢ This can happen to any athlete whose young in age.➢ Athletes that are usually injury free.➢ It most often occurs in women because of their higher Q angle.➢ People who have had other knee injuries:

■ dislocations■ fractures

Signs/Symptoms❖ You don't really see anything because it happens to your

muscles.❖ Symptoms:

➢ Discomfort of the inner front of the knee when you run,jump,climb, or go down stairs.

➢ Sitting with your knee bent.➢ Some people feel “tightness” or “fullness” in the

knee area.

Diagnostic

❖According to Patient.co.uk some tests taken to diagnos chondromalacia patella are:➢ Blood Tests/Knee X-Ray➢ MRI scan➢ Arthroscopy: a tiny flexible camera that goes into

your knee see exactly what the cartilage looks like.

Managment❖ Treatment:

➢ First avoid activities until the pain eases.➢ Take painkillers (Ibuprofen).➢ Taping the patella➢ Physiotherapy to improve the strength of the muscles.

❖ Return to play process:➢ This injury isn't like a broken bone. If you ice it and dont push yourself too

hard you should be able to return when you feel ready. The healing process is different for everyone.