Chapter 07 MSK and Sports Flashcards
AC Sprains/Tears – AC injuries may be seen with falls on the ___________ shoulder. A type I (___________ classification) injury is a nondisplaced ___________ of the AC ligament, manifested by local tenderness w/o anatomic deformity. A type II injury (see Fig. 7-1) involves an AC ___________ and ___________ ligament sprain, but the ___________ interspace is intact. Treatment for type I or II injuries includes an arm sling, ice, analgesics, and progressive ROM exercises. An ___________ type II injury may require arm sling use for 2 to 4 weeks. Sports activities can be resumed when full painless ROM is achieved and deltoid strength is near-baseline. Type III to VI lesions involve rupture of the ___________ and ___________ ligaments with varying displacements of the clavicle. These require orthopedic consultation for potential ___________, although many separations may be followed conservatively with several weeks of sling-and-swathe immobilization, followed by long-term therapy.
AC Sprains/Tears – AC injuries may be seen with falls on the adducted shoulder. A type I (Rockwood classification) injury is a nondisplaced sprain of the AC ligament, manifested by local tenderness w/o anatomic deformity. A type II injury (see Fig. 7-1) involves an AC tear and CC ligament sprain, but the CC interspace is intact. Treatment for type I or II injuries includes an arm sling, ice, analgesics, and progressive ROM exercises. An unstable type II injury may require arm sling use for 2 to 4 weeks. Sports activities can be resumed when full painless ROM is achieved and deltoid strength is near-baseline. Type III to VI lesions involve rupture of the AC and CC ligaments with varying displacements of the clavicle. These require orthopedic consultation for potential ORIF, although many separations may be followed conservatively with several weeks of sling-and-swathe immobilization, followed by long-term therapy.
ACJ OA – OA is a very common cause of ACJ pain, especially in the ___________. The presence of ACJ tenderness and pain with cross body abduction suggests ACJ OA. Radiologic studies such as ___________-___________ and ___________ evaluation can help confirm the diagnosis. Treatment includes topical or oral analgesics, PT, injections, and surgery if refractory to conservative care. Traditional injection techniques have proven to be inaccurate; therefore, fluoroscopic or US-guided injections are preferred.
ACJ OA – OA is a very common cause of ACJ pain, especially in the elderly. The presence of ACJ tenderness and pain with cross body abduction suggests ACJ OA. Radiologic studies such as x-rays and US evaluation can help confirm the diagnosis. Treatment includes topical or oral analgesics, PT, injections, and surgery if refractory to conservative care. Traditional injection techniques have proven to be inaccurate; therefore, fluoroscopic or US-guided injections are preferred.
ACJ OA (Rotator Cuff Tendinitis/Shoulder Impingement Syndrome) – Predisposing and causative factors include acromion ___________ and repetitive ___________ activities (i.e., throwing, racquet sports, and swimming). Pain and aches are often worse at night and can be aggravated by overhead activities. Shoulder flexion and abduction may be limited.
ACJ OA (Rotator Cuff Tendinitis/Shoulder Impingement Syndrome) – Predisposing and causative factors include acromion shape and repetitive overhead activities (i.e., throwing, racquet sports, and swimming). Pain and aches are often worse at night and can be aggravated by overhead activities. Shoulder flexion and abduction may be limited.
A painful arc (Fig. 7-2) may be present at about ___________° to ___________° on passive arm abduction. Neer’s test (Fig. 7-3) and Hawkins test evaluate for shoulder impingement. In Neer’s test, the examiner fixes the scapula with one hand and elevates the subject’s arm with the other hand. Pain indicates a positive test. Hawkins test is performed by ___________ the subject’s arm to 90° with the elbow flexed, then ___________ rotating the shoulder. Hawkins test can also be performed in the scapular plane. In the ___________ arm test, the arm is passively elevated to 90° in abduction and the patient is asked to hold the arm in position and then slowly lower the arm to the side. The inability to slowly lower the arm or having severe pain when attempting to do so may be indicative of a severe or complete tear of the rotator cuff pathology.
A painful arc (Fig. 7-2) may be present at about 70° to 110° on passive arm abduction. Neer’s test (Fig. 7-3) and Hawkins test evaluate for shoulder impingement. In Neer’s test, the examiner fixes the scapula with one hand and elevates the subject’s arm with the other hand. Pain indicates a positive test. Hawkins test is performed by abducting the subject’s arm to 90° with the elbow flexed, then internally rotating the shoulder. Hawkins test can also be performed in the scapular plane. In the drop arm test, the arm is passively elevated to 90° in abduction and the patient is asked to hold the arm in position and then slowly lower the arm to the side. The inability to slowly lower the arm or having severe pain when attempting to do so may be indicative of a severe or complete tear of the rotator cuff pathology.
The painful shoulder should initially be rested until pain and swelling subside. Ice and NSAIDs may be helpful. ___________ activities should be avoided. PT can institute gentle ___________ to preserve ___________ and ___________ strengthening. A steroid injection into the ___________ space may relieve pain and improve motion if the above measures fail. A repeat injection should be avoided in patients with ___________ months of pain relief following the first injection. Unless your clinical diagnosis is unchanged, repeat subacromial injection with US guidance to ensure accurate medication placement may be considered for additional diagnostic and therapeutic purposes.2,3 Exercises should progress until strength and ROM are restored. Surgery is an option if several months of conservative treatment/steroid injections fail to resolve the symptoms (or for complete tears). An ___________, the most common procedure, involves acromial shaving to increase the space around the inflamed tendon. The tendon may also be debrided. Several months may be required to regain full strength after surgery.
The painful shoulder should initially be rested until pain and swelling subside. Ice and NSAIDs may be helpful. Overhead activities should be avoided. PT can institute gentle stretching to preserve ROM and isometric strengthening. A steroid injection into the subacromial space may relieve pain and improve motion if the above measures fail. A repeat injection should be avoided in patients with 2 months of pain relief following the first injection. Unless your clinical diagnosis is unchanged, repeat subacromial injection with US guidance to ensure accurate medication placement may be considered for additional diagnostic and therapeutic purposes.2,3 Exercises should progress until strength and ROM are restored. Surgery is an option if several months of conservative treatment/steroid injections fail to resolve the symptoms (or for complete tears). An acromioplasty, the most common procedure, involves acromial shaving to increase the space around the inflamed tendon. The tendon may also be debrided. Several months may be required to regain full strength after surgery.
Anterior Shoulder Dislocation – ___________ dislocations are more common than ___________ dislocations. Complications include ___________ nerve injury, recurrent ___________, and ___________ ___________ tears (especially in older patients). A Bankart lesion (Fig. 7-4) is an avulsion of the ___________ ___________ labrum and capsule from the glenoid rim and is felt to be a primary etiologic factor in recurrent dislocations. A Hill-Sachs lesion is a compression fracture of the ___________ head when the ___________ aspect of the humeral head compresses against the anterior glenoid rim. Age at initial dislocation is prognostic for recurrence: teens/young adults have significantly higher redislocation rates (said to approach 90%) than older patients (said to be ≈10% to 15% for patients >40 years of age).
Various techniques exist for acute reduction, including the modified ___________ technique, where the patient lies prone with a wrist weight (i.e., 5 to 10 lbs) on the affected arm as it hangs over the side of the table. Reduction is achieved over 15 to 20 minutes as the shoulder muscles relax.
Anterior Shoulder Dislocation – Anterior dislocations are more common than posterior dislocations. Complications include axillary nerve injury, recurrent dislocations, and rotator cuff tears (especially in older patients). A Bankart lesion (Fig. 7-4) is an avulsion of the anteroinferior glenoid labrum and capsule from the glenoid rim and is felt to be a primary etiologic factor in recurrent dislocations. A Hill-Sachs lesion is a compression fracture of the humeral head when the posterolateral aspect of the humeral head compresses against the anterior glenoid rim. Age at initial dislocation is prognostic for recurrence: teens/young adults have significantly higher redislocation rates (said to approach 90%) than older patients (said to be ≈10% to 15% for patients >40 years of age).
Various techniques exist for acute reduction, including the modified Stimson technique, where the patient lies prone with a wrist weight (i.e., 5 to 10 lbs) on the affected arm as it hangs over the side of the table. Reduction is achieved over 15 to 20 minutes as the shoulder muscles relax.
Anterior Shoulder Dislocation
A newer technique termed ___________ has been published and appears to be superior to the Hippocratic and Kocher methods, but was not compared with the Stimson technique. This method is performed with the patient supine and longitudinal traction is applied as the shoulder is slowly abducted. ___________ status should be checked before and after attempted relocation.
There is no strong evidence to show that immobilization or the duration of immobilization has an effect on the outcome. One option includes ___________ in ER, which may reduce the rate of recurrence, though this should be initiated 24 to 48 hours following injury. Early rehabilitation may include icing and sling immobilization for 1 to 3 weeks to allow healing of the capsule. Maintenance of elbow, wrist, and hand ROM is important. Isometric exercises and gentle pendular exercises with the arm in the sling are encouraged, but passive abduction for hygiene is limited to ___________° and ___________ rotation is avoided. The duration of sling use may be shortened in older patients due to the higher risk of frozen shoulder. Once the capsule has healed, shoulder ROM and strengthening are progressed. There is some debate regarding the optimal type and timing of surgery after shoulder dislocation and in shoulder instability.
Anterior Shoulder Dislocation
A newer technique termed FARES has been published and appears to be superior to the Hippocratic and Kocher methods, but was not compared with the Stimson technique. This method is performed with the patient supine and longitudinal traction is applied as the shoulder is slowly abducted. Neurovascular status should be checked before and after attempted relocation.
There is no strong evidence to show that immobilization or the duration of immobilization has an effect on the outcome. One option includes bracing in ER, which may reduce the rate of recurrence, though this should be initiated 24 to 48 hours following injury. Early rehabilitation may include icing and sling immobilization for 1 to 3 weeks to allow healing of the capsule. Maintenance of elbow, wrist, and hand ROM is important. Isometric exercises and gentle pendular exercises with the arm in the sling are encouraged, but passive abduction for hygiene is limited to 45° and ER (external rotation) is avoided. The duration of sling use may be shortened in older patients due to the higher risk of frozen shoulder. Once the capsule has healed, shoulder ROM and strengthening are progressed. There is some debate regarding the optimal type and timing of surgery after shoulder dislocation and in shoulder instability.
Adhesive Capsulitis – A syndrome characterized by a progressive painful loss of ___________ and ___________ glenohumeral ROM that occurs more commonly in females between the ages of 40 and 60 years. ___________ and ___________ rotation are most affected; ___________ rotation is least affected. This condition may be the end result of other conditions that result in prolonged immobility (i.e., ___________ and rotator cuff tendinitis) and has also been associated with other medical conditions (i.e., ___________, ___________ dysfunction, and ___________ diseases). Treatment can consist of an aggressive ROM program, with NSAIDs and heat modalities to improve tolerance. Other techniques include intra-articular steroid injections, brisement (___________ of the capsule), manipulation under ___________, and ___________ nerve blocks. Of these additional options, intra-articular steroid injection has been well studied and appears to improve short-term outcomes. Recovery may take several months to beyond a year.
Adhesive Capsulitis – A syndrome characterized by a progressive painful loss of passive and active glenohumeral ROM that occurs more commonly in females between the ages of 40 and 60 years. Abduction and External Rotation are most affected; internal rotation (IR) is least affected. This condition may be the end result of other conditions that result in prolonged immobility (i.e., bursitis and rotator cuff tendinitis) and has also been associated with other medical conditions (i.e., DM, thyroid dysfunction, and autoimmune diseases). Treatment can consist of an aggressive ROM program, with NSAIDs and heat modalities to improve tolerance. Other techniques include intra-articular steroid injections, brisement (hydrodilation of the capsule), manipulation under anesthesia, and suprascapular nerve blocks. Of these additional options, intra-articular steroid injection has been well studied and appears to improve short-term outcomes. Recovery may take several months to beyond a year.
Bicipital Tendinitis – This ___________ injury can be associated with ___________ activities or sports and often coexists with the shoulder impingement syndrome, rotator cuff tears, or labral pathology (i.e., ___________ lesions). Examination often reveals a tender ___________ groove. While palpating this structure, assess for instability/subluxation of the bicipital tendon by ___________ and ___________ rotating the shoulder. If unstable, the tendon may sublux medially over the lesser tuberosity and a clunk or snap may be appreciated. ___________ test (Fig. 7-5) is performed by elevating the subject’s arm to 90° with the elbow extended and palm upward, then having the patient attempt forward flexion of the arm against resistance. Pain in the bicipital ___________ is indicative of a positive test. Treatment includes NSAIDs, activity modification, and progressive exercise program, which may include the use of modalities such as heat and postactivity ___________. Local corticosteroid injection may be used in refractory cases and US guidance may help increase your accuracy of performing injections into the tendon sheath.
Bicipital Tendinitis – This overuse injury can be associated with overhead activities or sports and often coexists with the shoulder impingement syndrome, rotator cuff tears, or labral pathology (i.e., SLAP lesions). Examination often reveals a tender bicipital groove. While palpating this structure, assess for instability/subluxation of the bicipital tendon by internally and externally rotating the shoulder. If unstable, the tendon may sublux medially over the lesser tuberosity and a clunk or snap may be appreciated. Speed’s test (Fig. 7-5) is performed by elevating the subject’s arm to 90° with the elbow extended and palm upward, then having the patient attempt forward flexion of the arm against resistance. Pain in the bicipital groove is indicative of a positive test. Treatment includes NSAIDs, activity modification, and progressive exercise program, which may include the use of modalities such as heat and postactivity icing. Local corticosteroid injection may be used in refractory cases and US guidance may help increase your accuracy of performing injections into the tendon sheath.
Scapular Winging
Medial scapular winging (Fig. 7-6) is caused by weakness of the ___________ ___________ (___________ ___________ oracic nerve). It is elicited by having the patient push against a wall and using resisted forward ___________ or resisted scapular ___________.
Scapular Winging
Medial scapular winging (Fig. 7-6) is caused by weakness of the serratus anterior (long thoracic nerve). It is elicited by having the patient push against a wall and using resisted forward flexion or resisted scapular protraction.
Scapular Winging
Lateral winging is caused by weakness of the ___________ muscle (CN ___________) and is elicited by shoulder ___________.
Scapular Winging
Lateral winging is caused by weakness of the trapezius muscle (CN XI) and is elicited by shoulder abduction.
Golfer’s Elbow (medial epicondylitis) – An overuse syndrome of the tendinous origin of the ___________-pronator mass and ___________ ___________ ligament of the elbow. The initial treatment is ___________ and ___________. Stretching the elbow during the painful period is important. Once pain and inflammation subside, strengthening exercises are started (important groups include the wrist flexors/extensors, wrist radial deviators, forearm pronator/supinators, and elbow flexor/extensors). Injection of local steroids into the area of max tenderness can also be considered, with care taken not to injure the ulnar nerve. A tennis elbow counterforce strap may be helpful.
Golfer’s Elbow (medial epicondylitis) – An overuse syndrome of the tendinous origin of the flexor-pronator mass and medial collateral ligament of the elbow. The initial treatment is RICE and NSAIDs. Stretching the elbow during the painful period is important. Once pain and inflammation subside, strengthening exercises are started (important groups include the wrist flexors/extensors, wrist radial deviators, forearm pronator/supinators, and elbow flexor/extensors). Injection of local steroids into the area of max tenderness can also be considered, with care taken not to injure the ulnar nerve. A tennis elbow counterforce strap may be helpful.
Tennis Elbow (lateral epicondylitis) – An ___________ tendinopathy, especially of the ___________. The initial treatment is relative rest, NSAIDs, and heat or cold modalities. Wrist extensor stretching and strengthening should be initiated when tolerated. Conservative measures are usually effective, but recurrences are common. A tennis elbow ___________ worn circumferentially around the forearm just distal to the elbow may be helpful and a wrist ___________ may be considered to rest the common wrist extensor tendons. Modifications to the racquet include a ___________ racquet grip and head and ___________ string tension. A corticosteroid injection into the area of max tenderness may be indicated if conservative treatment fails. Treatment with PRP or autologous whole blood has been shown to be more effective than corticosteroids in those patients who have failed conservative treatment. No more than ___________ injections should be given at intervals of 5 days to 1 week. Surgical fasciotomy or fixation of the conjoined tendon may be considered if the above measures fail.
Tennis Elbow (lateral epicondylitis) – An extensor tendinopathy, especially of the ECRB. The initial treatment is relative rest, NSAIDs, and heat or cold modalities. Wrist extensor stretching and strengthening should be initiated when tolerated. Conservative measures are usually effective, but recurrences are common. A tennis elbow strap worn circumferentially around the forearm just distal to the elbow may be helpful and a wrist splint may be considered to rest the common wrist extensor tendons. Modifications to the racquet include a larger racquet grip and head and lesser string tension. A corticosteroid injection into the area of max tenderness may be indicated if conservative treatment fails. Treatment with PRP or autologous whole blood has been shown to be more effective than corticosteroids in those patients who have failed conservative treatment. No more than three injections should be given at intervals of 5 days to 1 week. Surgical fasciotomy or fixation of the conjoined tendon may be considered if the above measures fail.
De Quervain’s Disease – A ___________ of the ___________ dorsal compartment of the hand, including the ___________ and ___________ tendons. ___________ test is positive when pain is elicited in the radial wrist while the wrist is forced into ulnar deviation with the thumb enclosed in a fist. Treatment includes activity modification and NSAIDs followed by a stretching and strengthening program (Fig. 7-7). A thumb ___________ splint with the wrist in neutral position and the first MCP immobilized (IP joint is free) is helpful in resting the tendons. Local corticosteroid injections (maximum of three) into the compartment reduce acute pain and inflammation. US-guided injections have been described and may improve accuracy while decreasing the risk of intratendinous injections. Surgical decompression may be curative in severe, refractory cases.
De Quervain’s Disease – A tenosynovitis of the first dorsal compartment of the hand, including the APL and EPB tendons. Finkelstein’s test is positive when pain is elicited in the radial wrist while the wrist is forced into ulnar deviation with the thumb enclosed in a fist. Treatment includes activity modification and NSAIDs followed by a stretching and strengthening program (Fig. 7-7). A thumb spica splint with the wrist in neutral position and the first MCP immobilized (IP joint is free) is helpful in resting the tendons. Local corticosteroid injections (maximum of three) into the compartment reduce acute pain and inflammation. US-guided injections have been described and may improve accuracy while decreasing the risk of intratendinous injections. Surgical decompression may be curative in severe, refractory cases.
\_\_\_\_\_\_\_\_\_\_\_ Fracture (most common carpal bone fracture) – Often due to a fall on an outstretched hand. \_\_\_\_\_\_\_\_\_\_\_ tenderness may be noted. If initial plain films (approximately three to four views) are negative, the wrist should be \_\_\_\_\_\_\_\_\_\_\_ (short arm cast or splint with thumb spica) and films repeated in ≈2 weeks (some fractures may not be visible until bone has resorbed around the fracture line). If repeat films are negative and clinical suspicion persists, CT or MRI can be considered. Because the main blood supply (Fig. 7-8) enters from the \_\_\_\_\_\_\_\_\_\_\_ pole, there is a high incidence of \_\_\_\_\_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_\_\_\_ in waist and proximal pole fractures. For nondisplaced fractures, a long arm thumb spica cast should be used. Isometric muscle contractions can be performed in the cast to counter atrophy. Displaced fractures or nondisplaced fractures with persistent nonunion should be referred for surgical evaluation.
Scaphoid Fracture (most common carpal bone fracture) – Often due to a fall on an outstretched hand. Snuffbox tenderness may be noted. If initial plain films (approximately three to four views) are negative, the wrist should be immobilized (short arm cast or splint with thumb spica) and films repeated in ≈2 weeks (some fractures may not be visible until bone has resorbed around the fracture line). If repeat films are negative and clinical suspicion persists, CT or MRI can be considered. Because the main blood supply (Fig. 7-8) enters from the distal pole, there is a high incidence of nonunion and AVN in waist and proximal pole fractures. For nondisplaced fractures, a long arm thumb spica cast should be used. Isometric muscle contractions can be performed in the cast to counter atrophy. Displaced fractures or nondisplaced fractures with persistent nonunion should be referred for surgical evaluation.
Trigger Finger (digital stenosing ___________) – Digital tendon sheath inflammation may result in a tendinous knot that gets stuck in the finger pulley system as the finger extends. Patients with ___________ or ___________ arthritis are particularly at risk for developing trigger finger. NSAIDs and steroid injections help to reduce inflammation and pain. Use of a ___________ static hand splint that immobilizes the MCP but allows full IP flexion rests the flexor tendons and helps break the vicious cycle of inflammation and catching. In some cases, surgery may be necessary to release tendons in fingers that are locked in flexion.
Trigger Finger (digital stenosing tenosynovitis) – Digital tendon sheath inflammation may result in a tendinous knot that gets stuck in the finger pulley system as the finger extends. Patients with DM or rheumatoid arthritis are particularly at risk for developing trigger finger. NSAIDs and steroid injections help to reduce inflammation and pain. Use of a volar static hand splint that immobilizes the MCP but allows full IP flexion rests the flexor tendons and helps break the vicious cycle of inflammation and catching. In some cases, surgery may be necessary to release tendons in fingers that are locked in flexion.
Greater Trochanteric Pain Syndrome – Classically described as trochanteric ___________, but improved visualization of the hip via MRI and arthros-copy has proven that other etiologies of lateral hip pain exist (such as gluteus medius or minimus tendinosis or tears and snapping hip syndrome). Pain is noted with walking, running, climbing stairs, sitting, and especially when side-lying on the involved hip. Physical examination often reveals ___________ tenderness over greater trochanter and pain-limited hip abductor strength, and lateral hip pain with ___________ -FAbERE test is noted. Conservative treatment includes NSAIDs, an iliotibial band stretching program, and hip abductor/ extensor strengthening. If refractory to these measures, a steroid injection into the bursa (Fig. 7-9) can relieve symptoms in many patients. Various etiologies may be responsible for greater trochanteric region pain; therefore, MSK US may become a valuable tool for both diagnostic and therapeutic reasons.
Greater Trochanteric Pain Syndrome – Classically described as trochanteric bursitis, but improved visualization of the hip via MRI and arthros-copy has proven that other etiologies of lateral hip pain exist (such as gluteus medius or minimus tendinosis or tears and snapping hip syndrome). Pain is noted with walking, running, climbing stairs, sitting, and especially when side-lying on the involved hip. Physical examination often reveals point tenderness over greater trochanter and pain-limited hip abductor strength, and lateral hip pain with Patrick-FAbERE test is noted. Conservative treatment includes NSAIDs, an iliotibial band stretching program, and hip abductor/ extensor strengthening. If refractory to these measures, a steroid injection into the bursa (Fig. 7-9) can relieve symptoms in many patients. Various etiologies may be responsible for greater trochanteric region pain; therefore, MSK US may become a valuable tool for both diagnostic and therapeutic reasons.
Iliotibial Band Syndrome – Potential causes include ___________ or running on ___________ surfaces. ___________ knee pain is noted as the ITB slides over the lateral femoral condyle, especially between 20° and 30° of ___________. Predisposing factors include genu ___________, tibial ___________, ___________ hindfoot, and foot ___________. Tenderness over the lateral knee and ___________ tubercle may be noted on examination. ___________ test may be positive. Rehabilitation should be aimed at stretching the ITB, hip flexors, and gluteus maximus. ___________ may be strengthened to counteract the tight ITB, and hip abductor strengthening may also be performed to improve dynamic hip stability (Fig. 7-10). Helpful modalities include ice, US, and ___________. Foot pronation should be corrected; running only on even surfaces may help. A steroid injection into the area of the lateral femoral condyle may relieve pain. Symptoms can generally take 2 to 6 months to improve.
Figure 7-11 illustrates the Ober test for ITB/TFL contraction. The patient lies on the side with the involved side uppermost. The hip is flexed and then abducted as far as possible while stabilizing the pelvis. Next, the hip is brought into extension and the limb is released. The limb will remain abducted if there is tightness at the ITB or TFL.
Iliotibial Band Syndrome – Potential causes include overtraining or running on uneven surfaces. Lateral knee pain is noted as the ITB slides over the lateral femoral condyle, especially between 20° and 30° of flexion. Predisposing factors include genu varum, tibial varum, varus hindfoot, and foot pronation. Tenderness over the lateral knee and Gerdy’s tubercle may be noted on examination. Ober’s test may be positive. Rehabilitation should be aimed at stretching the ITB, hip flexors, and gluteus maximus. Adductors may be strengthened to counteract the tight ITB, and hip abductor strengthening may also be performed to improve dynamic hip stability (Fig. 7-10). Helpful modalities include ice, US, and phonophoresis. Foot pronation should be corrected; running only on even surfaces may help. A steroid injection into the area of the lateral femoral condyle may relieve pain. Symptoms can generally take 2 to 6 months to improve.
Figure 7-11 illustrates the Ober test for ITB/TFL contraction. The patient lies on the side with the involved side uppermost. The hip is flexed and then abducted as far as possible while stabilizing the pelvis. Next, the hip is brought into extension and the limb is released. The limb will remain abducted if there is tightness at the ITB or TFL.
Pes Anserine Bursitis (bursa under ___________, ___________, ___________; mnemonic: “Say Grace before Tea”) – Pain and tenderness at the insertion of the medial hamstrings at the medial proximal tibia may be noted. The treatment should emphasize stretching of the medial hamstrings and improving knee biomechanics. Athletes may wear protective knee padding. Steroid injections may be very effective, but US guidance should be considered since unguided injections rarely infiltrate the pes anserine bursa.
Pes Anserine Bursitis (bursa under Sartorius, Gracilis, semiTendinosis; mnemonic: “Say Grace before Tea”) – Pain and tenderness at the insertion of the medial hamstrings at the medial proximal tibia may be noted. The treatment should emphasize stretching of the medial hamstrings and improving knee biomechanics. Athletes may wear protective knee padding. Steroid injections may be very effective, but US guidance should be considered since unguided injections rarely infiltrate the pes anserine bursa.
Anterior Cruciate Ligament – The ACL proceeds superiorly and posteriorly from its anterior medial tibial attachment to attach to the ___________ aspect of the lateral femoral condyle (Fig. 7-12). It prevents excessive anterior translation of the tibia and abnormal ___________ ___________ of the tibia on the femur and knee hyperex-tension. A primary function in the athlete is maintaining joint stability during deceleration.
The most common mechanism of injury is ___________ ___________ of the femur on fixed tibia with a ___________ load. Injuries may be due to excessive pivoting or cutting, as well as hyperextension, hyperflexion, or lateral trauma to the knee. A “pop” is often heard or felt at the time of injury. Immediate swelling due to hemarthrosis and a sense of instability usually follow.
Anterior Cruciate Ligament – The ACL proceeds superiorly and posteriorly from its anterior medial tibial attachment to attach to the medial aspect of the lateral femoral condyle (Fig. 7-12). It prevents excessive anterior translation of the tibia and abnormal external rotation of the tibia on the femur and knee hyperex-tension. A primary function in the athlete is maintaining joint stability during deceleration.
The most common mechanism of injury is external rotation of the femur on fixed tibia with a valgus load. Injuries may be due to excessive pivoting or cutting, as well as hyperextension, hyperflexion, or lateral trauma to the knee. A “pop” is often heard or felt at the time of injury. Immediate swelling due to hemarthrosis and a sense of instability usually follow.
