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

2. Osteitis Pubis
rectus
adductors

3. Pediatric And Adolescent Injuries Or Conditions At The Thigh
Iliotibial band syndrome
Myosytis ossificans
Iliotibial band
Gerdy’s tubercle

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

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

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

7. Iliotibial Band Syndrome
Treatment
Stretches
Modalities
NSAID’s
Correction of training errors

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

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

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

11. Myositis Ossificans 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
Osgood-Schlatter Disease
Sinding-Larsen-
Johansson Syndrome
Jumper’s knee
Discoid meniscus
Patellar femoral pain syndrome
Plica
Torn ACL
Meniscal tears
Patellar dislocation

13. Osteochondritis Dissicans
Can occur at the knee, ankle or elbow
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
Results in the separation of an abnormal ossification area within the epiphysis covered by articular cartilage

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

15. Osteochondritis Dissicans

16. Osteochondritis Dissicans

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

18. Osgood-Schlatter Disease

19. Osgood-Schlatter Disease
Treatment
Reassurance about this benign condition
Resolution sometimes months
Activity modification (not elimination)

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

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

22. Sindig-Larsen-Johansson’s Disease

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

24. Jumper’s Knee

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

26. Discoid Meniscus
Symptoms- include lateral knee pain , popping, swelling, giving way
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

27. Discoid Meniscus

28. Anterior Knee Pain

29. Anterior Knee Pain Many names Chondromalacia patella
Patellofemoral pain syndrome
Patellofemoral dysfunction
Patellalgia
Patellar compression syndrome

30. Anterior Knee Pain
One of the most common musculoskeletal complaints presenting to FP’s office
In one study approx 17,000 pts – 11.3%
25% of all athletes
More common in females
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
Frequent lack of an easily identifiable objective pathological cause
Commonly only subjective

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

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

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

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

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

37. Anterior Knee Pain Physical Exam
Check gait (feet supinated or pronated)
Genu varus or genu valgus
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
Modify activity
Modalities

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

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

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