1. Common Sports Injuries of the Knee & Shoulder
James M. Farmer M.D.
Sports Medicine & Orthopaedic Surgery
Lewis-Gale Physicians

2. Overview Knee Injuries Meniscal Tear Articular Cartilage Tear ACL Tear
Patellofemoral Pain
Iliotibial Band Syndrome
James M. Farmer M.D.

3. Overview Shoulder Injuries Dislocation A-C Separation SLAP Lesion
Rotator Cuff Tear
James M. Farmer M.D.

4. Knee Anatomy Femur and Tibia Articular Cartilage Meniscus Ligaments
James M. Farmer M.D.

5. Meniscal Tear Mechanism Signs and Sx Young: twisting or pivoting
Older: minor trauma
Signs and Sx
Swelling
Catching
Giving way
Locking
James M. Farmer M.D.

6. Meniscal Tear
James M. Farmer M.D.

7. Preferred Treatment Acute: Rest, Ice, Activity Modification, Surgery
Meniscal tears will not normally heal without help unless very young
Chronic: Surgical excision
James M. Farmer M.D.

8. Articular Cartilage Tear
Mechanism
Acute trauma
Wear and tear
Signs and Sx
Pain
Swelling
James M. Farmer M.D.

9. Preferred Treatment
Non Surgical: Activity Modification, Pain Medications, Injections
Surgical:
Arthroscopic debridement and removal of lose fragments
Procedures to restore weight bearing surface
Resurfacing, Cartilage Transplant, Joint Replacement
James M. Farmer M.D.

10. ACL Tear Mechanism Signs and Sx Twisting Pivoting Sudden stop
Acute: swelling, pain, instability
Chronic: frequent giving way, pain
James M. Farmer M.D.

11. ACL Tear
James M. Farmer M.D.

12. Preferred Treatment
Non Surgical: Activity Modification, Rehabilitation, Bracing
Surgical: Reconstruction of Ligament
Goals of Surgery: Restore normal knee stability and function. Delay onset of degenerative arthritis
James M. Farmer M.D.

13. Patellofemoral Pain Pain originating from behind the knee cap
Very common condition
Exact cause unknown (likely many)
Signs and Sx
Aching pain along front of knee
Worse with sitting, stairs and squatting
Giving way and buckling
James M. Farmer M.D.

14. Patellofemoral Pain
James M. Farmer M.D.

15. Preferred Treatment Non Surgical!!! Surgery Activity modification
Physical Therapy
Taping, Bracing, Orthotics
Injections
Surgery
Not many “Good” options
Arthroscopy, Osteotomy, Resurfacing, Arthroplasty
James M. Farmer M.D.

16. Iliotibial Band Syndrome
Caused by tight ITB rubbing over lateral epicondyle of femur when running.
Signs and Sx
Sharp pain over lateral knee when running or cycling
Occassional swelling
James M. Farmer M.D.

17. Iliotibial Band Syndrome
James M. Farmer M.D.

18. Preferred Treatment Non Surgical: Surgical: Stretching
Physical Therapy: Ice, Ultrasound
Orthotics
Medications
Injections
Surgical:
ITB release
James M. Farmer M.D.

19. Shoulder Anatomy Humerus and Scapula Labrum Biceps Tendon Rotator Cuff
James M. Farmer M.D.

20. Shoulder Dislocation
James M. Farmer M.D.

21. Preferred Treatment Non Surgical: Surgical:
Acute: Immobilization, Rest, Ice, Rehab
Chronic: Rehab, Meds
Surgical:
Arthroscopic stabilization as effective as open procedures
Repair bankart lesion, tighten capsule
James M. Farmer M.D.

22. A-C Separation
Sprain of joint between collar bone and shoulder blade at tip of shoulder
Mechanism: Fall onto tip of shoulder
Signs and Sx
Pain
Deformity
James M. Farmer M.D.

23. AC Separation
James M. Farmer M.D.

24. Preferred Treatment Grades 1 & 2: Non Surgical Grades 4-6: Surgical
Grade 3: Debatable
Non Surgical: Adequate for most
Rest acutely then resume activities
Surgical: Primarily for overhead athletes and military
Acute: reduce and stabilize joint
Chronic: Reconstruct ligaments
James M. Farmer M.D.

25. SLAP Lesion & Biceps Rupture
Injuries to Biceps tendon origin in the shoulder
Mechanism: Acute: sudden pull on arm. Chronic: Degenerative, overuse
Signs and Sx
Pain reaching upward with palm
Weakness
Possible deformity if ruptured
James M. Farmer M.D.

26. SLAP Lesion & Biceps Rupture
James M. Farmer M.D.

27. SLAP Lesion & Biceps Rupture
Popeye Deformity
John Elway won 2 Super Bowls AFTER Biceps rupture!
James M. Farmer M.D.

28. Preferred Treatment Non Surgical: Surgical: Activity modification
Physical Therapy
Surgical:
Repair of tendon attachment
Release tendon
Relocate tendon
James M. Farmer M.D.

29. Rotator Cuff Tear Continuum from Impingement to Complete Tear
Mechanism: Acute: trauma. Chronic: degeneration with age due to poor blood supply to tendon
Signs and Sx
Pain reaching overhead
Pain sleeping
Weakness and dysfunction
James M. Farmer M.D.

30. Rotator Cuff Tear
James M. Farmer M.D.

31. Preferred Treatment Non Surgical: Surgical: Activity modification
Physical Therapy
Injections
Surgical:
Arthroscopic or Open repair of tendon and removal of bone spurs
Shoulder replacement
James M. Farmer M.D.