Common Sports Injuries of the Knee & Shoulder James M. Farmer M.D. Sports Medicine & Orthopaedic...
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Transcript of Common Sports Injuries of the Knee & Shoulder James M. Farmer M.D. Sports Medicine & Orthopaedic...
Common Sports Injuriesof the Knee & ShoulderCommon Sports Injuriesof the Knee & Shoulder
James M. Farmer M.D.Sports Medicine &
Orthopaedic SurgeryLewis-Gale Physicians
James M. Farmer M.D.Sports Medicine &
Orthopaedic SurgeryLewis-Gale Physicians
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
OverviewOverview
Knee InjuriesMeniscal TearArticular Cartilage TearACL TearPatellofemoral PainIliotibial Band Syndrome
Knee InjuriesMeniscal TearArticular Cartilage TearACL TearPatellofemoral PainIliotibial Band Syndrome
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
OverviewOverview
Shoulder InjuriesDislocationA-C SeparationSLAP LesionRotator Cuff Tear
Shoulder InjuriesDislocationA-C SeparationSLAP LesionRotator Cuff Tear
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Knee AnatomyKnee Anatomy
Femur and TibiaArticular CartilageMeniscusLigaments
Femur and TibiaArticular CartilageMeniscusLigaments
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Meniscal TearMeniscal Tear
Mechanism Young: twisting or pivotingOlder: minor trauma
Signs and SxSwellingCatchingGiving wayLocking
Mechanism Young: twisting or pivotingOlder: minor trauma
Signs and SxSwellingCatchingGiving wayLocking
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Meniscal TearMeniscal Tear
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Preferred TreatmentPreferred Treatment
Acute: Rest, Ice, Activity Modification, SurgeryMeniscal tears will not normally heal without help unless very young
Chronic: Surgical excision
Acute: Rest, Ice, Activity Modification, SurgeryMeniscal tears will not normally heal without help unless very young
Chronic: Surgical excision
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Articular Cartilage Tear
Articular Cartilage Tear
MechanismAcute traumaWear and tear
Signs and SxPainSwelling
MechanismAcute traumaWear and tear
Signs and SxPainSwelling
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Preferred TreatmentPreferred Treatment
Non Surgical: Activity Modification, Pain Medications, Injections
Surgical:Arthroscopic debridement and removal of lose fragments
Procedures to restore weight bearing surfaceResurfacing, Cartilage Transplant, Joint Replacement
Non Surgical: Activity Modification, Pain Medications, Injections
Surgical:Arthroscopic debridement and removal of lose fragments
Procedures to restore weight bearing surfaceResurfacing, Cartilage Transplant, Joint Replacement
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
ACL TearACL Tear
MechanismTwistingPivotingSudden stop
Signs and SxAcute: swelling, pain, instabilityChronic: frequent giving way, pain
MechanismTwistingPivotingSudden stop
Signs and SxAcute: swelling, pain, instabilityChronic: frequent giving way, pain
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
ACL TearACL Tear
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Preferred TreatmentPreferred Treatment
Non Surgical: Activity Modification, Rehabilitation, Bracing
Surgical: Reconstruction of LigamentGoals of Surgery: Restore normal knee stability and function. Delay onset of degenerative arthritis
Non Surgical: Activity Modification, Rehabilitation, Bracing
Surgical: Reconstruction of LigamentGoals of Surgery: Restore normal knee stability and function. Delay onset of degenerative arthritis
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Patellofemoral PainPatellofemoral Pain
Pain originating from behind the knee cap
Very common conditionExact cause unknown (likely many)Signs and Sx
Aching pain along front of kneeWorse with sitting, stairs and squatting
Giving way and buckling
Pain originating from behind the knee cap
Very common conditionExact cause unknown (likely many)Signs and Sx
Aching pain along front of kneeWorse with sitting, stairs and squatting
Giving way and buckling
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Patellofemoral PainPatellofemoral Pain
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Preferred TreatmentPreferred Treatment
Non Surgical!!!Non Surgical!!!Non Surgical!!!
Activity modificationPhysical TherapyTaping, Bracing, OrthoticsInjections
SurgeryNot many “Good” optionsArthroscopy, Osteotomy, Resurfacing, Arthroplasty
Non Surgical!!!Non Surgical!!!Non Surgical!!!
Activity modificationPhysical TherapyTaping, Bracing, OrthoticsInjections
SurgeryNot many “Good” optionsArthroscopy, Osteotomy, Resurfacing, Arthroplasty
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Iliotibial Band Syndrome
Iliotibial Band Syndrome
Caused by tight ITB rubbing over lateral epicondyle of femur when running.
Signs and SxSharp pain over lateral knee when running or cycling
Occassional swelling
Caused by tight ITB rubbing over lateral epicondyle of femur when running.
Signs and SxSharp pain over lateral knee when running or cycling
Occassional swelling
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Iliotibial Band Syndrome
Iliotibial Band Syndrome
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Preferred TreatmentPreferred Treatment
Non Surgical:StretchingPhysical Therapy: Ice, Ultrasound
OrthoticsMedicationsInjections
Surgical:ITB release
Non Surgical:StretchingPhysical Therapy: Ice, Ultrasound
OrthoticsMedicationsInjections
Surgical:ITB release
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Shoulder AnatomyShoulder Anatomy
Humerus and ScapulaLabrumBiceps TendonRotator Cuff
Humerus and ScapulaLabrumBiceps TendonRotator Cuff
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Shoulder DislocationShoulder Dislocation
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Preferred TreatmentPreferred Treatment
Non Surgical:Acute: Immobilization, Rest, Ice, Rehab
Chronic: Rehab, MedsSurgical:
Arthroscopic stabilization as effective as open procedures
Repair bankart lesion, tighten capsule
Non Surgical:Acute: Immobilization, Rest, Ice, Rehab
Chronic: Rehab, MedsSurgical:
Arthroscopic stabilization as effective as open procedures
Repair bankart lesion, tighten capsule
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
A-C SeparationA-C Separation
Sprain of joint between collar bone and shoulder blade at tip of shoulder
Mechanism: Fall onto tip of shoulder
Signs and SxPainDeformity
Sprain of joint between collar bone and shoulder blade at tip of shoulder
Mechanism: Fall onto tip of shoulder
Signs and SxPainDeformity
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
AC SeparationAC Separation
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Preferred TreatmentPreferred Treatment
Grades 1 & 2: Non SurgicalGrades 4-6: SurgicalGrade 3: Debatable
Non Surgical: Adequate for mostRest acutely then resume activities
Surgical: Primarily for overhead athletes and militaryAcute: reduce and stabilize jointChronic: Reconstruct ligaments
Grades 1 & 2: Non SurgicalGrades 4-6: SurgicalGrade 3: Debatable
Non Surgical: Adequate for mostRest acutely then resume activities
Surgical: Primarily for overhead athletes and militaryAcute: reduce and stabilize jointChronic: Reconstruct ligaments
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
SLAP Lesion &Biceps RuptureSLAP Lesion &Biceps Rupture
Injuries to Biceps tendon origin in the shoulder
Mechanism: Acute: sudden pull on arm. Chronic: Degenerative, overuse
Signs and SxPain reaching upward with palmWeaknessPossible deformity if ruptured
Injuries to Biceps tendon origin in the shoulder
Mechanism: Acute: sudden pull on arm. Chronic: Degenerative, overuse
Signs and SxPain reaching upward with palmWeaknessPossible deformity if ruptured
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
SLAP Lesion &Biceps RuptureSLAP Lesion &Biceps Rupture
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
SLAP Lesion &Biceps RuptureSLAP Lesion &Biceps Rupture
Popeye DeformityJohn Elway won 2 Super Bowls AFTER Biceps rupture!
Popeye DeformityJohn Elway won 2 Super Bowls AFTER Biceps rupture!
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Preferred TreatmentPreferred Treatment
Non Surgical:Activity modificationPhysical Therapy
Surgical:Repair of tendon attachmentRelease tendonRelocate tendon
Non Surgical:Activity modificationPhysical Therapy
Surgical:Repair of tendon attachmentRelease tendonRelocate tendon
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Rotator Cuff TearRotator Cuff Tear
Continuum from Impingement to Complete Tear
Mechanism: Acute: trauma. Chronic: degeneration with age due to poor blood supply to tendon
Signs and SxPain reaching overheadPain sleepingWeakness and dysfunction
Continuum from Impingement to Complete Tear
Mechanism: Acute: trauma. Chronic: degeneration with age due to poor blood supply to tendon
Signs and SxPain reaching overheadPain sleepingWeakness and dysfunction
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Rotator Cuff TearRotator Cuff Tear
James M. Farmer M.D.540-772-3530
James M. Farmer M.D.540-772-3530
Preferred TreatmentPreferred Treatment
Non Surgical:Activity modificationPhysical TherapyInjections
Surgical:Arthroscopic or Open repair of tendon and removal of bone spurs
Shoulder replacement
Non Surgical:Activity modificationPhysical TherapyInjections
Surgical:Arthroscopic or Open repair of tendon and removal of bone spurs
Shoulder replacement