1. Lower Extremity Workshop
Adam Lucassian, AT, ATC Graduate Assistant Athletic Trainer (Women’s Soccer)

2. About Me From Michigan (Near Detroit)
Graduated from Central Michigan University
Intern:
Saint Joseph’s University, Philadelphia, PA (Women’s Soccer)
Florida Gulf Coast University, Ft. Myers, FL (Men’s Soccer, Men/Women Tennis)
Research:
Kinesio Tape
Laser v. Foam Rolling v. Grasten on Performance

3. What are we going to do? Go over Lower Extremity Assessment
Quick Facts
Case Studies
SOAP Approach
Questions

4. Quick Facts Diagnostic Testing vs. Clinical Evaluation
Hardy et. Al (2012)
Study comparing diagnostic testing vs. clinical evaluation
Lateral/Medial Meniscus
Findings: Clinical Evaluation comparable to diagnostic testing
Antero Lateral Ligament (ALL)
Newly discovered ligament

5. Case Study #1

6. Set the Scene
You are in the Athletic Training Room of a local High School
A high school basketball player reports to the athletic training room complaining of discomfort in the anterior thigh for the past week. GO

7. Subjective What did you do? Pain Sounds/Sensations
NOW: Bumped in R though
PRIOR: Kneed in the R thigh ~1 week ago (didn’t report)
Management: Ibuprofen from home
Sounds/Sensations
No Sounds or sensations
Prior Medical History: None
Pain
Discomfort after initial injury, but ok
Increased pain after current hit
7/10 “deep achy pain
Worse is with Hip flex and extension
Ambulation
Can’t continue with practice
Pain with walking

8. Differential Diagnosis

9. Objective- Inspection/Palpation
Partial weight bearing on R leg
Unable to fully extend during walking
Redness over mid thigh (impact site)
Girth Measurement
3cm larger than left
Palpation
Deformity
Not Detected
+Palpable muscle spasms
Point Tenderness
8/10 “sharp” pn over impact site
Skin Temperature
Warm to the touch

10. Differential Diagnosis

11. Objective- Range of Motion
AROM
Knee Flexion 0-25
Unable to perform AROM knee extension without pn (7/10 “sharp”)
Unable to Hip flexion without pain (7/10 “sharp”)
PROM
Knee Flexion 0-30
Unable to perform hip extension without pain (7/10 “sharp”)
RROM
Do not perform due to pain
The Key to Strains*
Example: Hamstring
AROM: Pn with Hip Ext
PROM: Pn with Hip Flex

12. Objective- Special Tests What are we looking for?

13. Objective- Special Tests
Compression Test- Negative
Bump Test- Negative
Femur Traction/Axial Load- Negative****
Tuning Fork- Positive when placed over impact site***

14. Assessment

15. Quadriceps Contusion (Possible Myositis Ossificans)
MOI?
Direct Impact
Myositis Ossificans
Treatment

16. Case Study #2

17. Set the Scene You are a Hockey Athletic Trainer
During a faceoff, your player gets checked from behind, lands on his right knee, and stays down
You go out to the player, perform quick assessment, and get the player back to the locker room GO

18. Subjective Pain Ambulation Sounds/Sensations Medication
Immediate: 8/10 “sharp” pn
Now: 5/10 “dull” pn
Location: Inside the Knee
Sounds/Sensations
Knee feels “loose and unstable”
Felt/heard a “pop”
Prior Medical History: None
Ambulation
Getting Off Ice: Needs some support but able to partially weight bear
Now: Able to walk with an antalgic gait (limp)
Medication
Ibuprofen
When: 2 hours prior

19. Differential Diagnosis
ACL
MCL
LCL
PCL
Medial Meniscus
Lateral Meniscus
Unhappy Triad
Patellar Subluxation
Knee Dislocation
Fracture
Bone Bruise
Muscle Strain/Tear

20. Objective- Inspection/Palpation
Swelling
Moderate Swelling over whole knee
Discoloration
Negative
Deformity
Palpation
Point Tenderness
Back of the knee (6/10 “sharp”
Feel “Pressure” as palpating over the knee
**NO PAIN ANYWHERE ELSE**
Skin Temperature
Warm to the touch
Pulse
Swelling impedes popliteal
Dorsal Pedis/Post. Tib?

21. Differential Diagnosis
ACL
MCL
LCL
PCL
Medial Meniscus
Lateral Meniscus
Unhappy Triad
Patellar Subluxation
Knee Dislocation
Fracture
Bone Bruise
Muscle Strain/Tear

22. Objective- Range of Motion
AROM
Pain and restricted Flex/Ext
PROM
Pain with flexion as approaching 90 degrees
NOT SHARP
Feel “Pressure”
RROM
Do not perform due to pain
The Key to Strains*
Example: Hamstring
AROM: Pn with Hip Ext
PROM: Pn with Hip Flex

23. Objective- Special Tests What are we looking for?
Anterior Drawer
Posterior Drawer
Lachman’s
Varus Stress Test
Valgus Stress Test
Ober’s Test
Nobel’s
McMurray’s
Apley’s Compression/Distraction
Thessaly Test
Sag Test
Quadricep Active Test
Slocum Drawer Test
Pivot Shift*

24. Objective- Special Tests
Anterior Drawer- Positive*
Posterior Drawer- Positive
Lachman’s- Negative
Varus Stress Test- Negative
Valgus Stress Test- Negative
Ober’s Test
Nobel’s
McMurray’s- Negative
Apley’s Compression/Distraction- Negative
Thessaly Test
Godfrey’s Test- Positive
Quadricep Active Test- Positive
Slocum Drawer Test
Pivot Shift*

25. Assessment ACL MCL LCL PCL Medial Meniscus Lateral Meniscus
Unhappy Triad
Patellar Subluxation
Knee Dislocation
Fracture
Bone Bruise
Muscle Strain/Tear

26. PCL Tear RARE MOI? Surgery Uncommon Show and Tell
Posterior Displacement of the tibia on the femur
Surgery Uncommon
Why?
Show and Tell