Injuries to the Injuries to the Thigh, Leg, & Thigh, Leg, &

KneeKneeCh. 15Ch. 15

Stress Fractures of FemurStress Fractures of Femur

• Very rare, but possible

• Usually seen in running sports (XC)

• When stress is put on femur it bends similar to a pencil with stretching forces on one side and compression forces on the other

Femur FracturesFemur Fractures

• Great deal of stress required to break femur• Athlete will have severe pain, inability to

move leg• Complications can include internal

bleeding, tearing of muscles, tendons, nerves and arteries

• Usually causes leg to externally rotate• Immobilize and call EMS

Perthes DiseasePerthes Disease

• Disruption of blood flow to head of femur• Causes avascular necrosis • Signs and symptoms include groin and/or

knee pain with limp• Mostly seen in children or teens who are

still growing• Refer to doc immediately, can be disabling

later in life

Patellar FracturesPatellar Fractures

• Not very common

• Very debilitating

• Typically caused by direct trauma

• Surgery is usually necessary to put pieces back together, unless it’s a stable fracture

• Recovery is fairly long depending on severity of fracture, and whether or not surgery was necessary

– Cast/splint, PT

Fractured patella

Knee DislocationKnee Dislocation

• VERY serious• Obvious deformity, athlete will be in intense pain• Can cause neurovascular problems

– Check for pedal pulse and sensation

• Must be splinted• Surgery is a definite• EMS in a hurry

Dislocated kneehttp://www.youtube.com/watch?v=3e1ZKtD25Ho&feature=player_embedded

Dislocated knee, about a week later

Lower Leg FracturesLower Leg Fractures

• Another VERY serious problem

• Usually a compound fracture– Sometimes an open one– Also called a tib-fib fracture

• Splint and check for pulse and sensation

• EMS

• More surgery

Tib-fib fracturehttp://www.youtube.com/watch?v=BGmT2jeVzFs&feature=related

Thigh ContusionsThigh Contusions

• Unlike normal contusions, deep thigh contusions can cause disability

• Causes tissue tearing and bleeding

• Can result in myositis ossificans if not treated properly– Formation of bony tissue within muscle

Treatment of Thigh ContusionsTreatment of Thigh Contusions

• PRICE• Knee must be flexed when icing or athlete will

lose ability to flex knee• If contusion is severe enough they should be put

on crutches• Ice and stretching will help to restore ROM• Can use ultrasound or Hivamat to break up any

hematoma that may form, and can break up any bony deposits that may have started to form

Acute Treatment for Acute Treatment for Thigh BruiseThigh Bruise

Muscle StrainsMuscle Strains

• Very common in rectus femoris, hamstrings, and groin– Typically HS are weaker than quads and get

over-powered

• Can tear the rectus femoris, and still compete– Visible defect– Pg. 229, picture

Osteochondritis DissecansOsteochondritis Dissecans

• Also called “joint mice”

• Loose bodies in knee joint that can damage joint surfaces

• Cause proposed to be ischemia, trauma, and degenerative changes

• Cause pain and joint locking at times

• Doc will decide on treatment, possible surgery

BursitisBursitis

• Typically occurs over prepatellar bursa– Many other possible locations

• Causes swelling and pain, sometimes disability

• Ice and compression are the best treatments

• A day or two off may be necessary to reduce swelling and restore proper function

Pre-patellar bursitis

Patellar Patellar Dislocation/SubluxationDislocation/Subluxation

• Occurs fairly often

• Typically dislocates laterally

• Usually becomes chronic problem

• Causes a lot of pain and some swelling

• Can be fixed surgically but quad/hip strengthening help tremendously

Dislocated PatellaDislocated Patella

Osgood-Schlatter DiseaseOsgood-Schlatter Disease

• Irritation of patellar tendon at insertion point, causing irritation at tibial tuberosity

• Characterized by pain, swelling, and tenderness

• Restrict activity, let pain be the guide• May need pad because of tenderness• Usually resolves by itself in mid-late teens

Osgood-Schlatter DiseaseOsgood-Schlatter Disease

Patellofemoral PainPatellofemoral Pain

• VERY common problem(s)• Almost always caused by weak muscles

– Typically VMO and/or hips

– Q angle plays a part also

• Chondromalacia– Roughening of backside of patella

– Due to patella not tracking properly in its groove

– Lots of crepitus

– Usually starts with mild, intermittent discomfort and worsens

– Can lead to other problems

Patellofemoral PainPatellofemoral Pain

• “Jumper’s Knee”– Tendonitis (tendinosis) of patellar tendon

– Can be caused by overuse, can also be caused by patella not tracking properly, causing the tendon to be pulled at awkward angle

– Both chondromalacia and “Jumper’s Knee” cause pain and swelling (sometimes random) in the knee

– Treat both w/ ice, rest, strengthening, and sometimes NSAIDs

Meniscus InjuriesMeniscus Injuries

• Half circle pieces of cartilage that attach to the tibia on medial & lateral sides

• Provide stability, absorb shock, allow smooth movement of the joint, protect joint surface

• Usually torn when athlete rotates leg with foot planted

• Can also accompany a torn ACL & MCL– Unhappy triad

Meniscii

Meniscus InjuriesMeniscus Injuries

• Signs & symptoms– “Popping” or “clicking” when walking/running

– Pain sometimes, but not always

– Swelling sometimes, but not always

– If a flap of the meniscus is torn it could cause the knee to “lock” due to the flap getting caught in the joint

• Treatment– Ice, see the doc, surgery probable

– Depending on location of tear the doc can “clean it up” or repair it• Repairs take much longer to come back from, typically on crutches for 4-6

weeks

Knee LigamentsKnee Ligaments

• 4 major ones– ACL, PCL, MCL, LCL

– All work together to stabilize knee• If one is torn, stability is greatly compromised, as are the remaining

ligaments

– ACL injured with sudden stopping or changing direction

– PCL injured by falling on knee (posterior force)

– MCL injured by valgus force

– LCL injured by varus force

Major knee ligaments

Knee LigamentsKnee Ligaments

• http://www.youtube.com/watch?v=1JQKko6C42s– ACL

• http://www.youtube.com/watch?v=lr57dyxpeZQ– MCL

Knee LigamentsKnee Ligaments

• MCL & LCL typically heal on their own (if not completely ruptured) as long as they are protected

• ACL & PCL require surgery

• You can still perform ADL’s and play sports when one of these is torn, but you put your knee at risk for further injury

Knee Injury PreventionKnee Injury Prevention

• Strong quads, HS, hips, and proper landing techniques are VERY important

• Prophylactic bracing was thought to be beneficial to preventing injuries but has since been proven ineffective

• Post surgical bracing is typically up to the athlete. Some docs require it to a certain point and then athlete can decide if they want to wear it or not. Some docs make them optional all together