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Osteitis Pubis Repetitive overuse of hip adductors and abdominal muscles (rectus) Repetitive overuse of hip adductors and abdominal muscles (rectus) Symptoms.

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Presentation on theme: "Osteitis Pubis Repetitive overuse of hip adductors and abdominal muscles (rectus) Repetitive overuse of hip adductors and abdominal muscles (rectus) Symptoms."— Presentation transcript:

1 Osteitis Pubis Repetitive overuse of hip adductors and abdominal muscles (rectus) Repetitive overuse of hip adductors and abdominal muscles (rectus) Symptoms of progressive groin pain Symptoms of progressive groin pain Occasional popping sensation Occasional popping sensation Tenderness over pubis symphysis Tenderness over pubis symphysis One leg stance with hop elicits pain One leg stance with hop elicits pain May need bone scan to r/o fracture May need bone scan to r/o fracture Treatment includes rest, stretching, NSAIDs and strengthening Treatment includes rest, stretching, NSAIDs and strengthening

2 Osteitis Pubis rectus adductors

3 Pediatric And Adolescent Injuries Or Conditions At The Thigh Iliotibial band syndrome Iliotibial band syndrome Myosytis ossificans Myosytis ossificans Iliotibial band Gerdys tubercle

4 Iliotibial Band Syndrome Relatively common among Relatively common among long distance runners long distance runners Overuse of knee in flexion/extension Overuse of knee in flexion/extension Provokes swelling underneath Provokes swelling underneath the ITB and ITB itself the ITB and ITB itself Appears friction from repetitive flexion/extension causes Appears friction from repetitive flexion/extension causes impingement impingement

5 Iliotibial Band Syndrome Predisposition Increase in quality and quantity of training Increase in quality and quantity of training Improper warm up and stretching Improper warm up and stretching Too much downhill running Too much downhill running Worn out shoes Worn out shoes Running in same direction on banked track Running in same direction on banked track Excessive pronation Excessive pronation

6 Iliotibial Band Syndrome Physical Exam Lateral knee pain Lateral knee pain Lateral thigh pain Lateral thigh pain Pain after running Pain after running Tenderness at lateral epicondyle or Gerdys tubercle or along entire ITB Tenderness at lateral epicondyle or Gerdys tubercle or along entire ITB Ober test

7 Iliotibial Band Syndrome Treatment Stretches Stretches Modalities Modalities NSAIDs NSAIDs Correction of training errors Correction of training errors

8 Myositis Ossificans Heterotopic bone formation caused by deep muscle contusion especially after large hematoma Heterotopic bone formation caused by deep muscle contusion especially after large hematoma Most common in Quadriceps Most common in Quadriceps

9 Myositis Ossificans Follows injury by 3-6 weeks Follows injury by 3-6 weeks May remodel or reabsorb over 6 to 12 months May remodel or reabsorb over 6 to 12 months May need bone scan to detect activity May need bone scan to detect activity

10 Myositis Ossificans Treatment PRICES (protection, rest, ice, compression, elevation, support) PRICES (protection, rest, ice, compression, elevation, support) Early on no massage or heat ( can worsen) Early on no massage or heat ( can worsen)

11 Myositis Ossificans Excision rarely Excision rarely -After maturation usually > 1yr -Check bone scan if needed to be done sooner -If excised early can reoccur

12 Pediatric Injuries And Conditions Around The Knee Osteochondritis Dissecans Osteochondritis Dissecans Osgood-Schlatter Disease Osgood-Schlatter Disease Sinding-Larsen- Sinding-Larsen- Johansson Syndrome Johansson Syndrome Jumpers knee Jumpers knee Discoid meniscus Discoid meniscus Patellar femoral pain syndrome Patellar femoral pain syndrome Plica Plica Torn ACL Torn ACL Meniscal tears Meniscal tears Patellar dislocation Patellar dislocation

13 Osteochondritis Dissicans Can occur at the knee, ankle or elbow Can occur at the knee, ankle or elbow Most commonly seen in the knee at the lateral aspect of medial femoral condyle Most commonly seen in the knee at the lateral aspect of medial femoral condyle Etiology ? Thought to be a result of trauma to a flexed knee Etiology ? Thought to be a result of trauma to a flexed knee Results in the separation of an abnormal ossification area within the epiphysis covered by articular cartilage Results in the separation of an abnormal ossification area within the epiphysis covered by articular cartilage

14 Osteochondritis Dissicans Boys more common than girls Boys more common than girls Localized pain, effusion, locking and giving way Localized pain, effusion, locking and giving way Younger patients have best prognosis Younger patients have best prognosis Treatment: usually requires surgical intervention Treatment: usually requires surgical intervention

15 Osteochondritis Dissicans

16

17 Osgood-Schlatter Disease Usually an overuse type injury to the tibial tubercle apophyses Usually an overuse type injury to the tibial tubercle apophyses Activity-related pain that is aggravated by jumping, squatting, and kneeling Activity-related pain that is aggravated by jumping, squatting, and kneeling X-rays shows tubercle enlargement and fragmentation X-rays shows tubercle enlargement and fragmentation

18 Osgood-Schlatter Disease

19 Treatment Treatment – Reassurance about this benign condition – Resolution sometimes 12-18 months – Activity modification (not elimination)

20 Osgood-Schlatter Disease Treatment – Symptomatic treatment with ice massage, knee pad, NSAIDS, quadricep & hamstring flexibility and strengthening exercises – If separate ossicle persists surgical excision may be required

21 Sindig-Larsen-Johanssons Disease Sequela of traction on the immature distal pole by the patellar tendon Sequela of traction on the immature distal pole by the patellar tendon Analogous to Osgood-Schlatter Disease Analogous to Osgood-Schlatter Disease Pre-teen age group Pre-teen age group Radiographs may show avulsions at distal pole of patella Radiographs may show avulsions at distal pole of patella Treatment similar to Osgood-Schlatter Disease (conservative symptomatic care) Treatment similar to Osgood-Schlatter Disease (conservative symptomatic care)

22 Sindig-Larsen-Johanssons Disease

23 Jumpers Knee Patellar tendonitis Patellar tendonitis An inflammation of the proximal patellar tendon An inflammation of the proximal patellar tendon Cause is repetitive stress from jumping Cause is repetitive stress from jumping Seen in adolescents Seen in adolescents Condition can progress to produce intratendinous degeneration and Condition can progress to produce intratendinous degeneration and necrosis necrosis

24 Jumpers Knee

25 Discoid Meniscus A congenital abnormality in which the meniscus is discoid not semilunar A congenital abnormality in which the meniscus is discoid not semilunar There is abnormal peripheral attachments that lead to hypermobility and hypertrophy There is abnormal peripheral attachments that lead to hypermobility and hypertrophy Clinical finding is a disc of meniscal cartilage covering the lateral tibial plateau Clinical finding is a disc of meniscal cartilage covering the lateral tibial plateau Most discoid menisci remain asymptomatic Most discoid menisci remain asymptomatic

26 Discoid Meniscus Symptoms - include lateral knee pain, popping, swelling, giving way Symptoms - include lateral knee pain, popping, swelling, giving way Diagnosis - MRI, Arthrogram, arthroscopy Diagnosis - MRI, Arthrogram, arthroscopy Treatment of symptomatic discoid menisci is to remove the torn portion, sculping of the meniscus by excision of the central portion, or complete meniscectomy Treatment of symptomatic discoid menisci is to remove the torn portion, sculping of the meniscus by excision of the central portion, or complete meniscectomy

27 Discoid Meniscus

28 Anterior Knee Pain

29 Many names Chondromalacia patella Chondromalacia patella Patellofemoral pain syndrome Patellofemoral pain syndrome Patellofemoral dysfunction Patellofemoral dysfunction Patellalgia Patellalgia Patellar compression syndrome Patellar compression syndrome

30 Anterior Knee Pain One of the most common musculoskeletal complaints presenting to FPs office One of the most common musculoskeletal complaints presenting to FPs office In one study approx 17,000 pts – 11.3% In one study approx 17,000 pts – 11.3% 25% of all athletes 25% of all athletes More common in females More common in females Encompasses a wide variety of potential problems, from short duration acute symptoms to chronic long standing problems Encompasses a wide variety of potential problems, from short duration acute symptoms to chronic long standing problems

31 Anterior Knee Pain Very frustrating for physician & patient Very frustrating for physician & patient Frequent lack of an easily identifiable objective pathological cause Frequent lack of an easily identifiable objective pathological cause Commonly only subjective Commonly only subjective

32 Anterior Knee Pain Very frustrating for physician & patient Very frustrating for physician & patient Frequent lack of an easily identifiable objective pathological cause Frequent lack of an easily identifiable objective pathological cause Commonly only subjective Commonly only subjective

33 Causes Of Anterior Knee Pain Intrinsic Intrinsic Abnormality of articular cartilage Abnormality of articular cartilage Abnormality of subchondral bone Abnormality of subchondral bone Poor healing after trauma Poor healing after trauma Extrinsic Extrinsic VMO atrophy VMO atrophy Patellar position, shape, or instability Patellar position, shape, or instability Femoral rotation Femoral rotation Tibial torsion Tibial torsion Medial facet overuse Medial facet overuse

34 Patellofemoral Weight Bearing With Activity Walking.5 x body weight Stairs up or down 3.3 x body weight Squatting 6.0 x body weight Reid, Sports Injury Assessment and Rehabilitation, 1992 Churchill

35 Patellofemoral Weight Bearing with ROM 5 degrees of flexion 30% body weight 30 degrees of flexion 2 x body weight 45 degrees of flexion 3 x body weight 75 degrees of flexion 6 x body weight Reid, Sports Injury Assessment and Rehabilitation, 1992 Churchill

36 Anterior Knee Pain History Specific initial event Specific initial event Overuse ( usually recent increase or change in training) Overuse ( usually recent increase or change in training) Vague, nonspecific, dull, aching and stiff (B/L in 2/3 s of the cases) Vague, nonspecific, dull, aching and stiff (B/L in 2/3 s of the cases) Occasional feelings of giving way Occasional feelings of giving way

37 Anterior Knee Pain Physical Exam Check gait (feet supinated or pronated) Check gait (feet supinated or pronated) Genu varus or genu valgus Genu varus or genu valgus Q angle (males 10 degrees or less; females up to 15 degrees Q angle (males 10 degrees or less; females up to 15 degrees Q- angle

38 Anterior Knee Pain Clarke sign Apprehension test Patellar facet test

39 Anterior Knee Pain Treatment Conservative treatments is successful 80% of the time Conservative treatments is successful 80% of the time Modify activity Modify activity Modalities Modalities

40 Anterior Knee Pain Treatment Treatment Therapeutic exercises (stretch & strengthen) Therapeutic exercises (stretch & strengthen) Taping or Bracing Taping or Bracing Surgical ( usually after 6 month of conservative treatments) Surgical ( usually after 6 month of conservative treatments)

41 PFPS Rehabilitation Relative rest: avoid deep knee bends, stairs, etc. Relative rest: avoid deep knee bends, stairs, etc. Ice: 5-10 minutes before and after activity Ice: 5-10 minutes before and after activity VMO strengthening (short arc quad sets & leg presses) VMO strengthening (short arc quad sets & leg presses) Increase flexibility (hamstrings, ITB, quads) Increase flexibility (hamstrings, ITB, quads) Isometric quads & adductor stretching Isometric quads & adductor stretching

42 PFPS Rehabilitation (cont.) Gradual increase of activity (full ROM & 80% normal strength), and pain free Gradual increase of activity (full ROM & 80% normal strength), and pain free Home exercise program Home exercise program Patellar sleeve to augment proprioception Patellar sleeve to augment proprioception Cardiovascular conditioning Cardiovascular conditioning NSAID's NSAID's


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