1. Almaarefa Medical College Sport Case Senario
Dr. Moaath Alamir

2. Objectives How to approach a case. Taking history keys.
Performing specific examination.
Requesting specific investigation.
Reaching a diagnosis
What specific treatment to request.

3. Case Study 1
A 23 year old male complains of pain in the right knee.

4. History Acute injury history Mechanism of injury: twisting injury
History key: Patient heard a pop in his knee
can not put bare weight on the knee and can’t continue to play
swelling, bruising and subtle sign of effusion in the knee
Chronic injury history
History of giving away
Level of activity or occupation
Plays soccer very often

5. Examination Positive findings No swelling & no tenderness ROM is full
Special tests
Lachman Test was performed with a positive result
Anterior drawer test positive
Pivot shift test positive

6. Images
What is your finding?

7. Treatment Conservative
Physical therapy for strengthening of hamstring muscles if low level of activity life style
Operative
ACL reconstruction if failed physiotherapy and still complainig or high level of activity life style

8. Case Study 2
A 31 year old male complains of pain in the left knee for 4 weeks.

9. History Mechanism of injury: twisting injury after stepping in hole
Painful with walking
Patient is not able to fully flex knee
Key history of locking & clicking

10. Exam Local exam No swelling Joint line tenderness medialy
ROM limited flexion
Special tests:
Mcmurry’s test positive
Lachman Test was negative
Anterior drawer test negative
Pivot shift test negative

11. Images
What is your finding?

12. Treatment Physical therapy for strengthening Diagnostic arthroscope
meniscal repair v.s. meniscectomy
depending on type of tear and zone location of tear

13. What is the diagnosis?
What is the sign called?
What is the treatment?

14. Case Study 3
A 29 year old male k/c of seizure presented in ER complains of left shoulder pain for 2 weeks.

15. History
Mechanism of injury: proceeded by seizure and not compliant to medication
Treated only with sling in ER
Still painful
Still can’t move his shoulder after 2 weeks

16. Exam Asymmetry of shoulders Shoulder is locked in internal rotation
ROM: limited external rotation

17. Images

18. Treatment Less than 2 weeks reduction sling Physical therapy
More than 2 weeks
Operative
Don’t forget to control his epilepsy to prevent redislocation.

19. Case Study 4
A 35 year old male presented in clinic complaining of left shoulder pain and instability.

20. History History of recurrent dislocation
Treated with reductions and physiotherapy
Physiotherapy didn’t work with him

21. Exam
Symmetrical shoulders
ROM is good
Apprehension test is positive

22. Images What are the two findings in recurrent shoulder dislocation?
What do you see?

23. Treatment
Bankart repair and Hill-Sach repair

24. Case Study 5
A 55 year old lady presented in clinic complaining of right shoulder pain.

25. History No Hx of trauma. Pain at night .
Can’t raise her hand above head and get worse with time.
The other shoulder is less severe.
Treated with physiotherapy but failed.

26. Exam Symmetrical shoulders Atrophy of shoulder muscles
Tenderness at GT
ROM: limited abduction
Week abduction & external rotation
Neer’s test positive
Hawkin’s test positive

27. Images
What do you see?

28. Treatment
Since physiotherapy had failed and the patient has complete tear of rotator cuff muscles.
Operative treatment is recommended for repair.

29. Quiz 1 1.What is the most sensitive test for ACL injury?
a. Anterior drawer test
b. Lachman test
c. mcmurry’s test
d. Joint line tenderness

30. Quiz 2 2.Double PCL sign is a sign for? a. Bucket handle tear
b. PCL tear
c. ACL tear
d. Normal sign

31. Quiz 3
3.Which of the following findings found in recurrent dislocation of shoulder joint?
a. Capsule contracture
b. Bankart leision
c. Biceps avulsion
d. Usually normal

32. Quiz 4 4.Exam finding in Posterior dislocation of shoulder?
a. Shoulder locked in internal rotation
b. Shoulder locked in external rotation
c. Full ROM
d. Usually normal

33. Thank You & Good Luck

34. Quiz WRITE YOUR NAME AND NUMBER ON A PAPER
WRITE ONLY THE QUESTION NUMBER AND ANSWER
Ex.
Ahmed mohammed
1.A
2.B
3.C
4.D