Conditions of the Knee, Thigh, Hip and Pelvis

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Conditions of the Knee, Thigh, Hip and Pelvis

• HHP 495

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• Etiology
• Result of severe blow or outward twist
• Signs and Symptoms - Grade I
• Little fiber tearing or stretching
• Stable valgus test
• Little or no joint effusion
• Some joint stiffness and point tenderness on
  medial aspect of knee
  
• Relatively normal ROM

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• Etiology
• Constantly exposed to traumatic blunt blow
• Contusions usually develop as a result of severe
  impact
  
• Extent of force and degree of thigh relaxation
  determine depth and functional disruption that
  occurs
  
• Signs and Symptoms
• Pain, transitory loss of function, immediate
  effusion with palpable swollen area
  
• Graded 1-4 superficial to deep with increasing
  loss of function (decreased ROM, strength)

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• Etiology
• Result of a varus force, generally w/ the tibia
  internally rotated
  
• Direct blow is rare
• If severe enough damage can also occur to the
  cruciate ligaments, ITB, and meniscus, producing
  bony fragments as well
  
• Signs and Symptoms
• Pain and tenderness over lateral knee
• Swelling and effusion possible
• Joint laxity w/ varus testing
• May cause irritation of the peroneal nerve

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• Etiology
• MOI - tibia externally rotated and valgus force
  at the knee (occasionally the result of
  hyperextension from direct blow)
  
• May be linked to inability to decelerate valgus
  and rotational stresses - landing strategies
  
• Male versus female
• Research is quite extensive in regards to impact
  of femoral notch, ligament size and laxity,
  malalignments (Q-angle) faulty biomechanics
  
• Extrinsic factors may include, conditioning,
  skill acquisition, playing style, equipment,
  preparation time
  
• Also involves damage to other structures
  including meniscus, capsule, MCL

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• Signs and Symptoms
• Experience pop w/ severe pain and disability
• Rapid swelling at the joint line
• Positive anterior drawer and Lachmans
• Other tests may also be positive

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• Etiology
• Formation of ectopic bone following repeated
  blunt trauma (disruption of muscle fibers,
  capillaries, fibrous connective tissue, and
  periosteum)
• Gradual deposit of calcium and bone formation
• May be the result of improper thigh contusion
  treatment (too aggressive)
  
• Signs and Symptoms
• X-ray shows calcium deposit 2-6 weeks following
  injury
  
• Pain, weakness, swelling, decreased ROM
• Tissue tension and point tenderness w/ palpation

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• Etiology
• Multiple theories of injury
• Hamstring and quad contract together
• Change in role from hip extender to knee flexor
• Fatigue, posture, leg length discrepancy, lack of
  flexibility, strength imbalances,
  
• Signs and Symptoms
• Muscle belly or point of attachment pain
• Capillary hemorrhage, pain, loss of function and
  possible discoloration
  
• Grade 1 - soreness during movement and point
  tenderness (
  
• Grade 2 - partial tear, identified by sharp snap
  or tear, severe pain, and loss of function (
  of fiber torn)
  
• Grade 3 - Rupturing of tendinous or muscular
  tissue, involving major hemorrhage and
  disability, edema, loss of function, ecchymosis,
  palpable mass or gap

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• Etiology
• Most at risk during 90 degrees of flexion
• Fall on bent knee is most common mechanism
• Can also be damaged as a result of a rotational
  force
  
• Signs and Symptoms
• Feel a pop in the back of the knee
• Tenderness and relatively little swelling in the
  popliteal fossa
  
• Laxity w/ posterior sag test

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2 Part Question!!

• Etiology
• Relationship between neck and shaft of femur
• Normal angle is 15 degrees anterior to the long
  axis of the femur and condyles
  
• Internal rotation in excess of 35 degrees is
  indicative of 1, 45 degrees of external rotation
  is an indicator of 2
  

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• Etiology
• Sudden stretch when athlete falls on bent knee or
  experiences sudden contraction
  
• Associated with weakened or over constricted
  muscle
  
• Signs and Symptoms
• Peripheral tear causes fewer symptoms than deeper
  tear
  
• Pain, point tenderness, spasm, loss of function
  and little discoloration
  
• Complete tear may live athlete w/ little
  disability and discomfort but with some deformity

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• Etiology
• Most common MOI is rotary force w/ knee flexed or
  extended
  
• Can be longitudinal, oblique or transverse tears
• Signs and Symptoms
• Effusion developing over 48-72 hour period
• Joint line pain and loss of motion
• Intermittent locking and giving way
• Pain w/ squatting
• Portions may become detached causing locking,
  giving way or catching w/in the joint
  
• If chronic, recurrent swelling or muscle atrophy
  may occur
  

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• Etiology
• Generally involving shaft and requiring great
  force
  
• Occurs in middle third due to structure and point
  of contact
  
• Signs and Symptoms
• Pain, swelling, deformity, spasm
• Immediate loss of function
• Shock possible

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• Etiology
• Irritation of the to this area, often related to
  chondromalcia
  
• Signs and Symptoms
• Possible history of knee pain/injury
• Recurrent episodes of painful pseudo-locking
• Possible snapping and popping
• Pain w/ stairs and squatting
• Little or no swelling, and no ligamentous laxity

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• Etiology
• Inflammation at the site where the gluteus medius
  ties into the IT-band
  
• Signs and Symptoms
• Complaint of lateral hip pain that may radiate
  down the leg
  
• Palpation reveals tenderness over lateral aspect
  of greater trochanter
  
• IT-band and TFL tests should be performed

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• Etiology
• Partial or complete separation of articular
  cartilage and subchondral bone
  
• Cause is unknown but may include blunt trauma,
  possible skeletal or endocrine abnormalities,
  prominent tibial spine impinging on medial
  femoral condyle, or impingement due to patellar
  facet
• Signs and Symptoms
• Aching pain with recurrent swelling and possible
  locking
  
• Possible quadriceps atrophy and point tenderness

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• Etiology
• Due to substantial support, any unusual movement
  exceeding normal ROM may result in damage
  
• Force from opponent/object or trunk forced over
  planted foot in opposite direction
  
• Signs and Symptoms
• Signs of acute injury and inability to circumduct
  hip
  
• Similar S S to stress fracture
• Pain in hip region, w/ hip rotation increasing
  pain

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• Etiology
• Compression of this structure due to a direct
  blow
  
• Signs and Symptoms
• Local pain and possible shooting nerve pain
• Numbness and paresthesia in cutaneous
  distribution of the nerve
  
• Added pressure may exacerbate condition
• Generally resolves quickly -- in the event it
  does not resolve, it could result in drop foot

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• Etiology
• Rarely occurs in sport
• Result of traumatic force directed along the long
  axis of the femur (or w/ hip flexed and adducted
  and knee flexed)
  
• Signs and Symptoms
• Flexed, adducted and internally rotated hip
• Palpation reveals displaced femoral head,
  posteriorly
  
• Serious pathology
• Soft tissue, neurological damage and possible fx

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• Etiology
• Result of twisting with both feet on the ground,
  stumbles forward, falls backward, steps too far
  down, heavy landings on one leg, bends forward
  with knees locked during lifting
• Causes irritation and stretching of sacrotuberous
  or sacrospinous ligaments and possible anterior
  or posterior rotation of innominate bones
  
• With pelvic rotation hypomobility is the norm,
  however, during the healing process hypermobility
  may result and allow the joint to sublux

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• Signs and Symptoms
• Palpable pain and tenderness over the joint,
  medial to the PSIS w/ some muscle guarding
  
• Pelvic asymmetries, measurable leg length
  deformities, blocked normal movement during trunk
  flexion
  
• Pain after 45 degrees during the straight leg
  raise and increased pain during side bending when
  moving toward the painful side
  
• Pain may radiate posteriorly, laterally, or
  anteriorly down the thigh and may even be vaguely
  located in the groin
  
• Increased pain w/ unilateral stance
• Movement from sit to stand will create pain
• Sitting is usually comfortable

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• Etiology
• Acute, chronic or recurrent swelling
• Prepatellar continued kneeling
• Infrapatellar overuse of patellar tendon
• Signs and Symptoms
• Prepatellar may be localized swelling above knee
  that is ballotable
  
• Swelling in popliteal fossa may indicate a
  Bakers cyst
  
• Associated w/ semimembranosus or medial head of
  gastrocnemius
  
• Commonly painless and causing little disability
• May progress and should be treated accordingly

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• Etiology
• Result of temporary or permanent loss of blood
  supply to proximal femur
  
• Can be caused by traumatic conditions (hip
  dislocation), or non-traumatic circumstances
  (steroids, blood coagulation disorders, excessive
  alcohol use compromising blood vessels)
• Signs and Symptoms
• Early stages - possibly no SS
• Joint pain w/ weight bearing progressing to at
  times of rest
  
• Pain gradually increases (mild to severe)
  particularly as bone collapse occurs
  
• May limit ROM
• Osteoarthritis may develop
• Progression of SS can develop over the course of
  months to a year

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• Etiology
• This refers to degeneration of the vertebrae due
  to congenital weakness (stress fracture results)
  
• Slipping of one vertebrae above or below another
  is referred to as ????
  
• Signs and Symptoms
• Begins unilaterally
• Pain and persistent aching, low back stiffness
  with increased pain after activity
  
• Frequent need to change position
• Full ROM w/ some hesitation in regards to
  flexion
  
• Localized tenderness and some possible segmental
  hypermobility
  
• Step off deformity may be present

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• Etiology
• Direct or indirect trauma (severe pull of
  tendon)
  
• Forcible contraction, falling, jumping or
  running
  
• Signs and Symptoms
• Hemorrhaging and joint effusion w/ generalized
  swelling
  
• Indirect injuries may cause capsular tearing,
  separation of bone fragments and possible
  quadriceps tendon tearing
  
• Little bone separation w/ direct injury
• Inability or painful active straight leg hip
  flexion and passive knee flexion
  

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• Etiology
• Avascular necrosis of the femoral head in child
  ages 4-10
  
• Trauma accounts for 25 of cases
• Articular cartilage becomes necrotic and
  flattens
  
• Signs and Symptoms
• Pain in groin that can be referred to the abdomen
  or knee
  
• Limping is also typical
• Varying onsets and may exhibit limited ROM

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• Etiology
• Caused by abnormal stresses and degeneration due
  to use (forward bending and twisting)
  
• Signs and Symptoms
• Centrally located pain that radiate unilaterally
  in dermatomal pattern
  
• Symptoms are worse in the morning
• Onset is sudden or gradual, pain may increase
  after the athlete sits and then tries to resume
  activity
  
• Forward bending and sitting increase pain, while
  back extension reduces pain
  
• Straight leg raise to 30 degrees is painful
• Decreased muscle strength and tendon reflexes
  Valsalva maneuver increases pain

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• Etiology
• Deceleration w/ simultaneous cutting in opposite
  direction (valgus force at knee)
  
• Some athletes may be predisposed to injury
• Repetitive injury will impose stress to medial
  restraints
  
• Signs and Symptoms
• Less sever injury will cause pain and swelling,
  restricted ROM, palpable tenderness over adductor
  tubercle
  
• More severe will result in total loss of
  function
  

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• Etiology
• Common in young female dancers, gymnasts,
  hurdlers
  
• Habitual movement predispose muscles around hip
  to become imbalanced (lateral rotation and
  flexion)
  
• Related to structurally narrow pelvis, increased
  hip abduction and limited lateral rotation
  
• Hip stability is compromised
• Signs and Symptoms
• Pain w/ balancing on one leg, possible
  inflammation
  
• C/O a snapping pain in hip

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• Etiology
• Inflammatory condition of this nerve nerve
• Nerve root compression from intervertebral disk
  protrusion, structural irregularities w/in the
  intervertebral foramina or tightness of the
  piriformis muscle
• Signs and Symptoms
• Arises abruptly or gradually produces sharp
  shooting pain, tingling and numbness
  
• Sensitive to palpation while straight leg raises
  intensify the pain
  

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• Etiology
• Softening and deterioration of the articular
  cartilage
  
• Possible abnormal patellar tracking due to genu
  valgum, external tibial torsion, foot pronation,
  femoral anteversion, patella alta, shallow
  femoral groove, increased Q angle, laxity of quad
  tendon
• Signs and Symptoms
• Pain w/ walking, running, stairs and squatting
• Possible recurrent swelling, grating sensation w/
  flexion and extension
  
• Pain at inferior border during palpation

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• Etiology
• Contusion of iliac crest or abdominal
  musculature
  
• Result of direct blow (same MOI for iliac crest
  fx and epiphyseal separation
  
• Signs and Symptoms
• Pain, spasm, and transitory paralysis of soft
  structures
  
• Decreased rotation of trunk or thigh/hip flexion
  due to pain

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• Etiology
• 1 is an apophysitis occurring at the tibial
  tubercle
  
• Begins cartilagenous and develops a bony callus,
  enlarging the tubercle
  
• Resolves w/ aging
• Common cause repeated avulsion of patellar
  tendon
  
• 2 is the result of excessive pulling on the
  inferior pole of the patella
  
• Signs and Symptoms
• Both elicit swelling, hemorrhaging and gradual
  degeneration of the apophysis due to impaired
  circulation
  
• Pain w/ kneeling, jumping and running
• Point tenderness

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• Etiology
• Sudden extension contraction overload generally
  in conjunction w/ some type of rotation
  
• Chronic strain associated with posture and
  mechanics
  
• Signs and Symptoms
• Pain may be diffuse or localized pain w/ active
  extension and passive flexion
  
• No radiating pain distal to the buttocks no
  neurological involvement

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• Etiology
• Seen in distance runners
• Repetitive stress on pubic symphysis and adjacent
  muscles
  
• Signs and Symptoms
• Chronic pain and inflammation of groin
• Point tenderness on pubic tubercle
• Pain w/ running, sit-ups and squats
• Acute case may be the result of bicycle seat

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• Etiology
• Jumping or kicking - placing tremendous stress on
  this area
  
• Sudden or repetitive extension
• Signs and Symptoms
• Pain and tenderness at inferior pole of patella
• 3 phases - 1)pain after activity, 2)pain during
  and after, 3)pain during and after (possibly
  prolonged) and may become constant
  

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• Etiology
• Congenital anomalies
• Mechanical defects of the spine (posture, obesity
  and body mechanics)
  
• Back trauma
• Recurrent and chronic low back pain
• Signs and Symptoms
• Pain, possible weakness, antalgic gait,
  propensity to ligamentous sprain, muscle strains
  and bony defects
  
• Neurological signs and symptoms if it becomes
  disk related

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• Etiology
• Sudden, powerful quad contraction
• Generally does not occur unless a chronic
  inflammatory condition persist resulting in
  tissue degeneration
  
• Occur primarily at point of attachment
• Signs and Symptoms
• Palpable defect, lack of knee extension
• Considerable swelling and pain (initially)

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• Etiology
• Seen in distance runners - repetitive cyclical
  forces from ground reaction force
  
• More common in women than men
• Common site include inferior pubic ramus, femoral
  neck and subtrochanteric area of femur
  
• Signs and Symptoms
• Groin pain, w/ aching sensation in thigh that
  increases w/ activity and decreases w/ rest
  
• Standing on one leg may be impossible
• Deep palpation results in point tenderness
• Intense interval or competitive racing may cause

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• Etiology
• Result of wedge fractures of 5 degrees or greater
  in 3 or more consecutive vertebrae w/ disk space
  abnormalities and irregular epiphyseal endplates
  
• Can develop into more serious conditions
• Signs and Symptoms
• Kyphosis of the thoracic spine and lumbar
  lordosis w/out back pain
  
• Progresses to point tenderness of the spinous
  processes young athlete may complain of backache
  at the end of a very physically active day
  
• Hamstring muscles are characteristically tight

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