Sports wounds in Knee and lower leg

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Sports wounds in Knee and lower leg

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Contents 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

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ANTERIOR KNEE PAIN

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DIFFERENTIAL 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

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FUNCTIONAL STRESS

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Tight horizontal structures Back Abnormal lower biomechanics Patellar following brokenness Hip and Thigh Ankle and Foot Weak average structures

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Sports exercises Patella following brokenness Excessive weight on PF jt PF disorder

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CONTRIBUTING FACTORS TO PFJ PAIN SYNDROME Patellar articular surface-related Surface pathology fribillation Trauma single or monotonous

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PATELLAR TRACKING RELATED Patella shape Accessory ossification centre Patellar Position Patella Alta Increased Q Ass.with hyperextension Muscular VMO

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BACK Hip and Thighs Excessive lordosis/kyphosis Pelvic Tilt Femoral antersion Tight Hip flexors Tight Hamstrings Tight ITB Leg length disparity PROXIMAL SEGMENTS

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Tibia Foot and Ankle Excessive inner torsion Genu varum or valgus Tight TA Hyperpronation Rigid cavus foot DISTAL SEGMENTS

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MANAGEMENT Control of aggravation and agony assuaging Correct arrangement of patellar Improvement of engine capacity Soft tissue discharge Knee support Correction of strange biomechanics

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Correct arrangement of patellar Taping

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Correction of turn Correction of average skim Correction of horizontal tilt

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Improvement of engine capacity Muscle preparing (VMO) Biofeedback NMES Start with sitting position CKC Hip control work out

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PATELLAR TENDINOPATHY

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JUMPER'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

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JUMPER'S KNEE CAUSATIVE FACTORS: EXTRINSIC: TRAINING SESSIONS (DURATION, INTENSITY AND NUMBER) PLAYING SURFACE FOOTWEAR

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JUMPER'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

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EXAMINATION AND INVESTIGATION

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PRINCIPLES OF MANAGEMENT Removal of activating components; Biomechanical revision; Estimate phase of wounds; Control torment and aggravation; and Appropriate tractable stacking

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TENDON 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

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CONTROL PAIN & INFLAMMATION Physical Modalities US Laser ES Ice Medication NSAIDs Steriods

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APPROPRIATE TENSILE LOADING Specificity: MTU Maximal Loading Progression of stacking

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ECCENTRIC EXERCISE PROGRAM Warm-up Flexibility Specific practice Repeat adaptability practices Ice

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Start with moderate free dynamic Pain Increase speed (direct) Pain Increase speed (Fast) Increase resistance Pain

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PREVENTION Pre-season quality preparing Proper extending and warm-up Avoid activating elements: hardware alteration method conformity natural (running surfaces)

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FAT 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

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Principles of administration Pain easing & Fat cushion emptying by taping

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Principle of taping for Fat Pad Syndrome

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OTHER LESS COMMON CONDITIONS

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PLICAL 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.

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Pain may irritate by hunching down Palpable thickened band under the average fringe of patella If preservationist administration come up short, arthroscopic evacuation of plica

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Osgood-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

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Principles 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

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Sinding-Larsen-Johansson disorder Similar to Osgood Schlatter; Affects second rate shaft of patella; Less normal than Osgood Schlatter; Same administration standards

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LATERAL KNEE PAIN

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Lateral 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

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ILIOTIBIAL BAND FRICTION SYNDROME CAUSATIVE FACTORS TIGHTNESS OF ITB MALALIGNMENT & LEG LENGTH DISCREPANCY EXCESSIVE FOOT PRONATION DOWNWARD CONTRALATERAL TILT OF PELVIC

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ILIOTIBIAL BAND FRICTION SYNDROME S/S: STINGING PAIN WORSE ON RUNNING DOWNHILL REPRODUCTION OF PAIN ON COMPRESSION OVER LATERAL FEMORAL CONDYLE WITH STRETCHED CREPITUS

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Principles 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

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Lateral 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

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POPLITEUS 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

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POPLITEUS TENDINITIS LOCAL TENDERNESS ANTERIOR TO THE SUPERIOR ATTACHMENT OF LCL PAIN MAY BE REPRODUCED BY RESISTED KNEE FLEXION AND TIBIA HOLD IN EXT. Turn

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Biceps 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

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Superior 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

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MEDIAL KNEE PAIN

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Medial knee torment Patellofemoral disorder Medial meniscus variation from the norm Pes Anserinus tendinopathy/bursitis

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MENISCAL 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

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Medial 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

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MEDIAL 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

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POSTEROMEDIAL 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

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Pes 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

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ANKLE AND FOOT PROBLEMS

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HEEL PAIN MEDIAL TIB. POST. TENDINITIS FLEXOR HALLUCIS LOGNUS TENDINOPATHY TARSAL TUNNEL SYNDROME MEDIAL CALCANEAL NEURITIS LATERAL PERONEAL TENDINOPATHY SINUS TARSI SYNDROME

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PLANTAR FASCIITIS CALCANEAL SPUR FAT PAD SYNDROME CALCANEAL PERIOSTITIS POSTERIOR RETROCALCANEAL BURSITIS CALCANEAL APOPHYSITIS DIFFUSE CALCANEAL STRESS FRACTURE

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TIBIALIS 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

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FLEXOR HALLUCIS LONGUS TENDINOPATHY Integral part of the smooth take-off period of walk

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