Sports wounds in Knee and lower leg
Slide 2Contents Common games wounds in knee and lower leg district Differential Dx of front, average, and sidelong knee torment Differential Dx of foremost, average, parallel lower leg and heel torment Principles of Management
Slide 3ANTERIOR KNEE PAIN
Slide 5DIFFERENTIAL DIAGNOSIS OF ANTERIOR KNEE PAIN PFJ PAIN SYNDROME PLICAL AND FAT - PAD SYNDROME PATELLAR SUBLUXATION OVERUSE SYNDROME OF PATELLA TENDON SINDING-LARSEN JOHANSSEN DISEASE OSGOOD - SCHLATTER'S DISEASE TRAUMA TO PATELLA PREPATELLA BURSITIS RSD
Slide 6FUNCTIONAL STRESS
Slide 7Tight horizontal structures Back Abnormal lower biomechanics Patellar following brokenness Hip and Thigh Ankle and Foot Weak average structures
Slide 8Sports exercises Patella following brokenness Excessive weight on PF jt PF disorder
Slide 9CONTRIBUTING FACTORS TO PFJ PAIN SYNDROME Patellar articular surface-related Surface pathology fribillation Trauma single or monotonous
Slide 10PATELLAR TRACKING RELATED Patella shape Accessory ossification centre Patellar Position Patella Alta Increased Q Ass.with hyperextension Muscular VMO
Slide 11BACK Hip and Thighs Excessive lordosis/kyphosis Pelvic Tilt Femoral antersion Tight Hip flexors Tight Hamstrings Tight ITB Leg length disparity PROXIMAL SEGMENTS
Slide 12Tibia Foot and Ankle Excessive inner torsion Genu varum or valgus Tight TA Hyperpronation Rigid cavus foot DISTAL SEGMENTS
Slide 13MANAGEMENT Control of aggravation and agony assuaging Correct arrangement of patellar Improvement of engine capacity Soft tissue discharge Knee support Correction of strange biomechanics
Slide 14Correct arrangement of patellar Taping
Slide 15Correction of turn Correction of average skim Correction of horizontal tilt
Slide 16Improvement of engine capacity Muscle preparing (VMO) Biofeedback NMES Start with sitting position CKC Hip control work out
Slide 17PATELLAR TENDINOPATHY
Slide 18JUMPER'S KNEE Related to tedious extensor activity of the knee with the era of vast whimsical powers A run of the mill useful over-burdening disorder Mostly in volleyball, b-ball players, high and long jumpers
Slide 19JUMPER'S KNEE CAUSATIVE FACTORS: EXTRINSIC: TRAINING SESSIONS (DURATION, INTENSITY AND NUMBER) PLAYING SURFACE FOOTWEAR
Slide 20JUMPER'S KNEE INTRINSIC FACTORS: RESISTANCE, ELASTICITY AND EXTENSIBILITY OF THE TENDON BIOMECHANCIAL VARIATION OF THE KNEE EXTENSOR MECHANISM, MUSCLE STRENGTH AND OVERALL LIMB ALIGNMENTS HIP FLEXOR SHORTENING AND WEAKNESS OF ABDUCTOR
Slide 21EXAMINATION AND INVESTIGATION
Slide 22PRINCIPLES OF MANAGEMENT Removal of activating components; Biomechanical revision; Estimate phase of wounds; Control torment and aggravation; and Appropriate tractable stacking
Slide 23TENDON HEALING Inflammatory stage (6 days) Fibroblastic/proliferative stage (5-21 days) Remodeling/development organize (starts on day 20) * the mending procedure for endless tendinopathy may take quite a while
Slide 24CONTROL PAIN & INFLAMMATION Physical Modalities US Laser ES Ice Medication NSAIDs Steriods
Slide 25APPROPRIATE TENSILE LOADING Specificity: MTU Maximal Loading Progression of stacking
Slide 26ECCENTRIC EXERCISE PROGRAM Warm-up Flexibility Specific practice Repeat adaptability practices Ice
Slide 27Start with moderate free dynamic Pain Increase speed (direct) Pain Increase speed (Fast) Increase resistance Pain
Slide 28PREVENTION Pre-season quality preparing Proper extending and warm-up Avoid activating elements: hardware alteration method conformity natural (running surfaces)
Slide 29FAT PAD SYNDROME Fat cushion – a touchy structure in the knee; Chronic fat cushion disturbance is regular; Pain generally irritated by expansion moves; Localized delicacy and puffiness; Often connected with hyperextension of knees and expanded foremost pelvic tilt
Slide 30Principles of administration Pain easing & Fat cushion emptying by taping
Slide 31Principle of taping for Fat Pad Syndrome
Slide 32OTHER LESS COMMON CONDITIONS
Slide 33PLICAL SYNDROMES Embryologically, combination of 3 synovial compartments amid fetal month Plical - any segment of the embryonic synovial septa endure into grown-up life Infrapatellar, suprapatellar and average patella plica Medial plica - a crescentic crease, running from the quadriceps into average mass of jt. & finishing in infrapatellar fat cushion.
Slide 34Pain may irritate by hunching down Palpable thickened band under the average fringe of patella If preservationist administration come up short, arthroscopic evacuation of plica
Slide 35Osgood-Schlatter ailment – osteochondrosis at tibial tuberosity Excessive footing on the delicate apophysis of the tibial tuberosity Associated with elevated amounts of action in the developing stage youths
Slide 36Principles of administration Usually self-restricting and settles at the season of hard combination; Might require movement adjustment; and Symptomatic treatment (ice, EPT); Stretch tight Quadriceps; and rectification of biomechanical irregularity
Slide 37Sinding-Larsen-Johansson disorder Similar to Osgood Schlatter; Affects second rate shaft of patella; Less normal than Osgood Schlatter; Same administration standards
Slide 38LATERAL KNEE PAIN
Slide 40Lateral knee torment Iliotibial band erosion disorder (ITBFS); Lateral meniscus issues; Osteoarthritis of the sidelong compartment of the knee; Biceps femoris tendinopathy; Superior tibiofibular joint sprain; Synovitis of the knee joint; Referred torment from timber spine
Slide 41ILIOTIBIAL BAND FRICTION SYNDROME CAUSATIVE FACTORS TIGHTNESS OF ITB MALALIGNMENT & LEG LENGTH DISCREPANCY EXCESSIVE FOOT PRONATION DOWNWARD CONTRALATERAL TILT OF PELVIC
Slide 42ILIOTIBIAL BAND FRICTION SYNDROME S/S: STINGING PAIN WORSE ON RUNNING DOWNHILL REPRODUCTION OF PAIN ON COMPRESSION OVER LATERAL FEMORAL CONDYLE WITH STRETCHED CREPITUS
Slide 43Principles of administration Control of aggravation Soft tissue discharge Stretching of ITB Strengthening of the parallel stabilizers of the hip Correction of biomechanical components Corticosteroid infusion or surgery if moderate administration falls flat
Slide 44Lateral meniscus anomaly Degeneration of the horizontal meniscus Pain on separation running, more extreme on tough; Tender along the joint line McMurray's test +ve Confirmation by MRI
Slide 45POPLITEUS TENDINITIS Functions of popliteus Assists opening systems of knee Prevents impingement of the back horn of the parallel meniscus Synergically with back cruciate avoiding back float of tibia Reinforces posterlateral case
Slide 46POPLITEUS TENDINITIS LOCAL TENDERNESS ANTERIOR TO THE SUPERIOR ATTACHMENT OF LCL PAIN MAY BE REPRODUCED BY RESISTED KNEE FLEXION AND TIBIA HOLD IN EXT. Turn
Slide 47Biceps femoris tendinopathy Might bring about by inordinate increasing speed and deceleration exercises; Associated with tight hamstring and firmness of wood spine; Pain recreated with opposed flexion; Same treatment standards of tendinopathy
Slide 48Superior tibiofibular joint issues Direct injury or relationship with rotational knee or lower leg wounds; Tender on joint line; Restricted or extreme skimming of prevalent T/F jt. For solid T/F jt : activation EPT modalities for torment mitigating Biomechanical variables
Slide 49MEDIAL KNEE PAIN
Slide 51Medial knee torment Patellofemoral disorder Medial meniscus variation from the norm Pes Anserinus tendinopathy/bursitis
Slide 52MENISCAL LESIONS MECHANISM OF INJURY ASSOCIATED WITH LGT. Interruption DEGENERATIVE CHANGES WITH AGE REPETITIVE ABNORMAL STRESSES SECONDARY TO CHRONIC LGT. LAXITY ISOLATED OR REPETITIVE ROTATIONAL STRESSES ABNORMAL MENISCAL SHAPE OR ATTACHMENT
Slide 53Medial Meniscus irregularity Gradual degeneration of the average meniscus Over 35 years of age Complains of clicking and agony with curving exercises Joint line delicacy +ve McMurray's test
Slide 54MEDIAL CAPSULAR COMPLEX During flexion the subterranean insect. strands sup. med. lgt. are tense; During halfway expansion the post. lie. & adj. posteromedial case take up the strain; During full ext. the entire lt. is rigid attributable to asso. turn Quad. & Hamstring exp. loan dynamic bolster Several bursa are asso. with lt and hamstring tend. & irritation may copy meniscal or lt. pathology
Slide 55POSTEROMEDIAL CORNER OF KNEE Deep average guarantee lgt. in relationship with average meniscus; Posterior shallow filaments mix with container Expansions from semitendinosis additionally fortify case Combined structure called back diagonal lt. Torn with critical valgus or turning stresses
Slide 56Pes anserinus tendinopathy/bursitis Overuse disorder; Common in swimmers (breaststrokers), cyclists and runners; Localized delicacy and swelling Pain repeated on dynamic withdrawal or extending of hamstring Treatment standards same as tendionpathy
Slide 57ANKLE AND FOOT PROBLEMS
Slide 58HEEL PAIN MEDIAL TIB. POST. TENDINITIS FLEXOR HALLUCIS LOGNUS TENDINOPATHY TARSAL TUNNEL SYNDROME MEDIAL CALCANEAL NEURITIS LATERAL PERONEAL TENDINOPATHY SINUS TARSI SYNDROME
Slide 59PLANTAR FASCIITIS CALCANEAL SPUR FAT PAD SYNDROME CALCANEAL PERIOSTITIS POSTERIOR RETROCALCANEAL BURSITIS CALCANEAL APOPHYSITIS DIFFUSE CALCANEAL STRESS FRACTURE
Slide 61TIBIALIS POSTERIOR SYNDROME Common in center separation runner Essential for the unusual control of foot pronation in Heel hit stage Frequently connected with unreasonable subtalar pronation Pain on palpation along ligament Passive eversion and opposed reversal
Slide 62FLEXOR HALLUCIS LONGUS TENDINOPATHY Integral part of the smooth take-off period of walk
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