Download LOWER EXTREMITY INJURIES

Objective 3: Recognize
common injuries to the
lower extremity…
 Bones
• Femur
• Patella
• Tibia
 Tibial Tuberosity
 Medial Malleolus
• Fibula
 Lateral Malleolus
 Bones
• Tarsals
 Calcaneus
 Talus
 Metatarsals
 Phalanges
 Joints
- Knee
• Tibiofemoral – allows
knee
flexion/extension
• Patellofemoral
 Joints
– Foot & ankle
• Tibiotalar (ankle joint)
 Allows plantar and dorsiflexion
• Subtalar
 Joint between talus and
calcaneus
 Allows inversion and
eversion
• Midfoot – where tarsals
meet metatarsals
• Metatarsal Phalengeal (MP)
 Allows toe flexion and extension
• Interphalengeal (PIP & DIP)
 Allows flexion and extension of
toe segments
 Menisci
of the knee
• Lateral Meniscus – Joint
cartilage that deepens
the knee joint.
• Medial Meniscus – Joint
cartilage that deepens
the knee joint . Has a
deep attachment to the
MCL.
• Outer 1/3 has a blood
supply, rest is avascular.
 Ligaments
of Knee
 Medial Collateral (MCL)
 Resists valgus forces
 Lateral Collateral (LCL)
 Resists varus forces
 Anterior Cruciate (ACL)
 Resists anterior
translation of the tibia
 Posterior Cruciate (PCL)
 Resists posterior
translation of the tibia
 Major Tendons
• Patellar Tendon –
attaches the quadricep
muscles to the tibia
• Achilles Tendon –
attaches the calf
muscles to the
calcaneus
 Ankle
Ligaments
• Anterior Tibiofibular –
resists forced
dorsiflexion and
rotation of the talus
• Anterior Talofibular –
resists plantarflexion
and inversion forces
• Deltoid – resists
eversion forces
Muscle
Location
Function
Quadriceps Femoris
 Rectus Femoris
 Vastus Medialis
 Vastus Lateralis
 Vastus Intermedius
Anterior Thigh
Extends the knee
Hamstrings
 Semimembranosus
 Semitendinosus
 Biceps Femoris
Posterior Thigh
Flexes the knee
Tibialis Anterior
Anterior lower leg
Dorsiflexion of ankle
Gastrocnemius
Posterior lower leg
Plantar flexion of ankle; assists
in knee flexion
Soleus
Deep to the gastrocnemius
Plantar flexion of the ankle
Tibialis Posterior
Posteromedial lower leg
Inversion of the foot/ankle
Peroneus Longus
Lateral lower leg
Eversion of the foot/ankle
Peroneus Brevis
Lateral lower leg
Eversion of the foot/ankle
 Number
#1
 Superficial, midline
 Crosses the hip
 Number
#2
 Found on the lateral
side
 Large Strong
muscle
 Number
#3
 Found on the
medial side.
 Tear drop shape
 Number
#4
 Deepest muscle
 Found between
VMO and VLO
 Medial
side
 Deep (found under
the semitendinosus)
 Medial
side
 Superficial
2
Heads
(origins)
 Found on the
lateral side
Thigh Contusion
Mechanism of
Injury
Signs and
Symptoms
Severe impact to Pain, loss of function,
the thigh
swelling, decreased
musculature
ROM
Treatment
Prevention
Strategies
Ice, compression
Protective
equipment
with knee flexed.
MUST be managed
appropriately to
avoid complications.
Palpation
What do you
feel?
Bilateral
Comparison
Over painful
area of
muscle/tendon
Special Test
Strength
Testing
Indications
Pain, Swelling,
deformity, Lack
of structure.
temperature,
Crepitus
What do you
feel?
Bilateral
Comparison
Indications
Pain, Weakness
Muscle Strains – Quadricep/Hamstring
Mechanism
of Injury
Signs and
Symptoms
Treatment
Prevention
Strategies
Sudden stretch Pain, spasm, loss of RICE, flexibility
Proper warmor sudden
function, swelling,
and strengthening up, stretching
contraction
possible deformity.
exercises.
and
strengthening.
Palpation
What do you
feel?
Bilateral
Comparison
Over painful
area of
muscle/tendon
Special Test
Strength
Testing
Indications
Pain, Swelling,
deformity, Lack
of structure.
temperature,
Crepitus
What do you feel?
Bilateral
Comparison
Indications
Pain,
Decreased
Strength
MCL Sprain
Mechanism of
Injury
Valgus force or
tibial external
rotation
Signs and
Symptoms
Pain medial knee,
mild swelling, joint
stiffness, possible
joint instability.
Treatment
RICE, ROM and
strengthening
exercises, restrict
activity until
asymptomatic.
Prevention
Strategies
Lower extremity
strengthening
and
conditioning.
Palpation
What do you
feel?
Bilateral
Comparison
Medial joint line
of knee.
Medial
Proximal
portion of tibia
Special Test
Valgus Stress
Test
(Place a valgus
force on the
knee 0 and 30
degrees)
Indications
Pain, Swelling,
deformity,
What do you
feel?
Bilateral
Comparison
Indications
Joint Laxity,
Pain
LCL Sprain
Mechanism of
Injury
Varus force or
tibial internal
rotation.
Signs and
Symptoms
Treatment
Pain lateral knee, mild RICE, ROM and
swelling, possible joint strengthening
laxity.
exercises, restrict
activity until
asymptomatic.
Prevention
Strategies
Lower extremity
strengthening
and
conditioning.
Special Test
What do you
feel?
Bilateral
Comparison
Varus Stress
Test
Indications
Joint Laxity,
Pain
(Place a varus
force on the
knee 0 and 30
degrees)
Palpation
Lateral joint
line of knee.
What do you
feel?
Bilateral
Comparison
Indications
Pain, Swelling,
deformity,
ACL Sprain
Mechanism of
Injury
Noncontact:
- decellereation
- foot planted
- rotation
- valgus stress
Contact:
hyperextension
w/foot planted
Signs and
Symptoms
Hears or feels a “pop”,
rapid swelling, joint
instability.
Treatment
Prevention
Strategies
RICE, restore ROM and Lower extremity
strength, surgery
strengthening and
required to reconstruct conditioning.
the ligament.
ACL Injury Video
Palpation
What do you
feel?
Bilateral
Comparison
Pain, Swelling,
Anterior Joint
Line
Special Test
Lachman Test
Indications
What do you
feel?
Bilateral
Comparison
Indications
Pain, Joint
laxity, soft end
feel
Special Test
Anterior
Drawer Test
What do you
feel?
Bilateral
Comparison
Indications
Pain, Joint
laxity, soft end
feel
PCL Sprain
Mechanism of
Injury
-Falling on bent
knee
- direct force to
front of knee
- rotational
forces
Signs and
Symptoms
Treatment
Hears or feels a “pop”, RICE, restore ROM
minimal swelling,
and strength.
posterior tibial sag.
Surgery is
controversial.
Prevention
Strategies
Lower extremity
strengthening
and conditioning.
Palpation
What do you
feel?
Bilateral
Comparison
Posterior of
knee.
Anterior portion
of knee
Special Test
Posterior Sag
Sign
Indications
Pain, Swelling,
deformity.
Step Deformity
What do you
feel?
Bilateral
Comparison
Indications
Pain, Step
deformity,
Medial Meniscus Injury and
Surgery Video Link
Meniscus Tear
Mechanism of
Injury
Weight bearing
with rotational
force.
Signs and
Symptoms
Swelling, joint line
pain, loss of motion,
locking or giving way.
Treatment
RICE
Avascular area:
Surgically trimmed
and smoothed.
Vascular area:
Surgically repaired.
Prevention
Strategies
Lower extremity
strengthening
and conditioning.
Palpation
What do you
feel?
Bilateral
Comparison
Pain, Swelling,
Knee bent to
45 degrees.
Anterior joint
line.
Medial/Lateral
Special Test
Compression
Distraction
Indications
What do you
feel?
Bilateral
Comparison
Indications
Pain, Pinching
Special Test
What do you
feel?
Bilateral
Comparison
Mcmurray’s
Special Test
Thessely’s
(0 – 30
degrees bend
at knee)
Indications
Pain, Pinching,
Instability
What do you
feel?
Bilateral
Comparison
Indications
Pain, Pinching
Patellar Subluxation/Dislocation
Mechanism of
Injury
Signs and
Symptoms
Combination of
Obvious deformity,
foot planted,
pain, swelling, limited
deceleration, and ROM.
change of
direction.
Treatment
Prevention
Strategies
RICE and
immobilization
initially, then ROM
and strengthening
exercises.
McConnell taping or
bracing.
Lower extremity
strengthening
and conditioning.
Palpation
What do you feel?
Bilateral
Comparison
Indications
Structures
medial and
slightly superior
to patella.
Pain, Swelling,
deformity,
Lateral femoral
condyle
Pain (indicates
bruising from
patella)
Special Test
Apprehension
Test
What do you
feel?
Bilateral
Comparison
Indications
Excessive
lateral tracking,
pain (medial or
lateral)
Patellar Tendinitis – “Jumper’s Knee”
Mechanism of
Injury
Repetitive
deceleration
Signs and Symptoms
Vague pain and
tenderness of patellar
tendon that worsens with
running/jumping
activities.
Treatment
Rest, ice, NSAID
medications, patellar
strap, friction
massage, and lower
extremity
strengthening.
Prevention
Strategies
Progressive
increase in
frequency/intensity
of training. Lower
extremity
strengthening and
conditioning.
Palpation
What do you
feel?
Bilateral
Comparison
Indications
Pain, Swelling,
deformity,
Patellar Tendon.
Infrapatellar Fat
pad. (behind
patellar tendon)
Strength
Testing
Knee extension
Measurement
Bilateral
Comparison
Indications
Decrease
ROM, Pain
over patellar
tendon
Patellofemoral Syndrome
Mechanism of
Injury
Signs and Symptoms
-Tight hamstring
and calf muscles
-Increased Q-angle
-Weak quadriceps
muscles
-Poor foot
mechanics
Tenderness of one or
more patellar edge, dull
ache, crepitus, pain with
compression, positive
Apprehension test.
Treatment
NSAIDs, quadricep
strengthening, sleeve
with buttress and/or
McConnell taping,
orthotic foot insert.
Prevention
Strategies
Lower extremity
strengthening and
conditioning.
Palpation
What do you
feel?
Bilateral
Comparison
Patellar tendon
and soft tissue
structures
around the
patella.
Special Test
Patellar
Orientation
(Tilt, Glide,
Rotation)
Indications
Pain, Swelling,
deformity,
Point
tenderness
Measurement
Bilateral
Comparison
Indications
Pain in glide,
maltracking
patella
Medial Tibial Stress Syndrome – “Shin Splints”
Mechanism of
Injury
Repetitive running
activities.
Signs and Symptoms
Diffuse pain in distal
medial tibia, increasing
with activity.
Treatment
Correct faulty foot
mechanics with
footwear, or orthotic
foot insert, calf
stretching
Prevention
Strategies
Appropriate
footwear for
activity, lower leg
flexibility and
strengthening,
orthotic foot
inserts.
Palpation
What do you feel?
Bilateral
Comparison
Pain, Swelling,
Posterior Medial
Portion of tibia
Gait Analysis What do you See?
Watch Patient
walk, Pay
attention to foot,
Knee, and hip
mechanics
Indications
Bilateral
Comparison
Indications
Abnormal Gait,
Pronation, Toe
out Gait
Ankle Sprains – Lateral
Mechanism of
Injury
Inversion: forced
inversion and plantar
flexion “rolling”
Signs and
Symptoms
Pain, swelling, decreased
ROM, possible joint laxity.
Treatment
RICE, symptomatic
modalities, taping and/or
bracing.
Prevention
Strategies
Appropriate footwear
for activity, lower leg
strengthening,
proprioceptive
training, taping and/or
bracing of joint.
Palpation
What do you feel?
Bilateral
Comparison
Pain, Swelling,
Anterior Inferior
of lateral
Malleolus
(lateral ankle
bone) “Sinus
Tarsi”
Special Test
Anterior
Drawer
(ankle plantar
flexed 20-30
degrees)
(anterior slide
of talus)
Indications
What do you
feel?
Bilateral
Comparison
Indications
Pain, Joint laxity
Special Test
Talar tilt
(10-20
degrees) Tilt
talus inward
What do you
feel?
Bilateral
Comparison
Indications
Pain, Joint laxity
Ankle Sprains – Medial
Mechanism of
Injury
Eversion: forced
eversion of ankle – high
risk for fracture.
Signs and
Symptoms
Pain, swelling, decreased
ROM, possible joint laxity.
Treatment
RICE, symptomatic
modalities, taping and/or
bracing.
Prevention
Strategies
Appropriate footwear
for activity, lower leg
strengthening,
proprioceptive
training, taping and/or
bracing of joint.
Palpation
What do you feel?
Bilateral
Comparison
Pain, Swelling,
Inferior to
medial
malleolus
(medial ankle
bone)
Special Test
Medial Talar tilt
(10-20
degrees) tilt
talus outward
Indications
What do you
feel?
Bilateral
Comparison
Indications
Pain, Joint
Laxity
Ankle Sprains – Syndesmotic (High)
Mechanism of
Injury
Syndesmosis (high):
forced inversion with
rotation of the talus.
Signs and
Symptoms
Pain, swelling, decreased
ROM, possible joint laxity.
Treatment
RICE, symptomatic
modalities, taping and/or
bracing.
Prevention
Strategies
Appropriate footwear
for activity, lower leg
strengthening,
proprioceptive
training, taping and/or
bracing of joint.
Palpation
What do you feel?
Bilateral
Comparison
Pain, Swelling,
Distal portion of
Tibia and Fibula
Special Test
Kliegers Test
(Dorsiflexion
and Eversion
Indications
What do you
feel?
Bilateral
Comparison
Indications
Pain, Possible
laxity.
Special Test
Squeeze Test
(Squeeze mid
Tibia/Fibula)
What do you
feel?
Bilateral
Comparison
Indications
Pain over distal
aspect of
Anterior
Tibiofibular
Ligament
Plantar Fasciitis
Mechanism of
Injury
Tight calf muscles,
poor arch support,
possible leg length
discrepancy, over
striding while
running.
Signs and
Symptoms
Medial heel pain,
particularly in the
morning; pain with
forced dorsiflexion of
the toes.
Treatment
Prevention
Strategies
Calf stretching, plantar Calf flexibility,
fascial stretching, heel correction of faulty
foot mechanics.
cup, orthotic foot
inserts.
Palpation
What do you feel?
Bilateral
Comparison
Pain, Swelling,
Medial
Longitudinal
Arch (Common
Arch of foot)
Special Test
Extension of
toes with
Dorsiflexion
Indications
What do you
feel?
Bilateral
Comparison
Indications
Pain
“Turf Toe”
Mechanism of
Injury
Hyperextension
sprain of the great
toe. MP joint. Can
be related to either
trauma or overuse.
Signs and
Symptoms
Pain at MP joint of
great toe, increasing
with extension of the
joint.
Treatment
Steel toe insoles or
taping, symptomatic
modalities.
Prevention
Strategies
Appropriate
footwear,
correction of faulty
foot mechanics.
Palpation
What do you feel?
Bilateral
Comparison
Indications
Pain, Swelling
Metatarsal
Phalangeal joint
(Base of big toe)
Special Test
Extension/
Flexion of Toe
Active and
Passive
What do you
feel?
Bilateral
Comparison
Indications
Pain