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
Osteitis Pubis
rectus
adductors
Pediatric And Adolescent
Injuries Or Conditions At
The Thigh
Iliotibial band
syndrome
 Myosytis
ossificans

Iliotibial band
Gerdy’s
tubercle
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
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
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
Iliotibial Band Syndrome
Treatment

Stretches
 Modalities
 NSAID’s
 Correction of
training errors
Myositis Ossificans

Heterotopic bone
formation caused by deep
muscle contusion
especially after large
hematoma
 Most common in
Quadriceps
Myositis Ossificans

Follows injury by
3-6 weeks
 May remodel or
reabsorb over 6 to
12 months
 May need bone
scan to detect
activity
Myositis Ossificans
Treatment

PRICES (protection,
rest, ice, compression,
elevation, support)
 Early on no massage
or heat ( can worsen)
Myositis Ossificans

Excision rarely
-After maturation
usually > 1yr
-Check bone scan
if needed to be
done sooner
-If excised early
can reoccur
Pediatric Injuries And
Conditions Around The
Knee

Osteochondritis
Dissecans
 Osgood-Schlatter
Disease
 Sinding-LarsenJohansson
Syndrome
Jumper’s knee
 Discoid meniscus
 Patellar femoral
pain syndrome
 Plica
 Torn ACL
 Meniscal tears
 Patellar dislocation

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
Osteochondritis Dissicans

Boys more common than
girls
 Localized pain, effusion,
locking and giving way
 Younger patients have
best prognosis
 Treatment: usually
requires surgical
intervention
Osteochondritis Dissicans
Osteochondritis Dissicans
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
Osgood-Schlatter Disease
Osgood-Schlatter Disease
Treatment
– Reassurance about this benign
condition
– Resolution sometimes 12-18 months
– Activity modification (not elimination)
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
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)
Sindig-Larsen-Johansson’s
Disease
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
Jumper’s Knee
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
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
Discoid Meniscus
Anterior Knee Pain
Anterior Knee Pain
Many names

Chondromalacia patella
 Patellofemoral pain syndrome
 Patellofemoral dysfunction
 Patellalgia
 Patellar compression syndrome
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
Anterior Knee Pain

Very frustrating for physician & patient
 Frequent lack of an easily identifiable
objective pathological cause
 Commonly only subjective
Anterior Knee Pain

Very frustrating for physician & patient
 Frequent lack of an easily identifiable
objective pathological cause
 Commonly only subjective
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
Patellofemoral Weight
Bearing With Activity
Walking
Stairs up or down
.5 x body weight
3.3 x body weight
Squatting
6.0 x body weight
Reid, Sports Injury Assessment
and Rehabilitation, 1992 Churchill
Patellofemoral Weight
Bearing with ROM
5 degrees of flexion
30 degrees of flexion
45 degrees of flexion
75 degrees of flexion
30% body weight
2 x body weight
3 x body weight
6 x body weight
Reid, Sports Injury Assessment and
Rehabilitation, 1992 Churchill
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”
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
Qangle
Anterior Knee Pain
Clarke sign
Apprehension
test
Patellar facet
test
Anterior Knee Pain
Treatment

Conservative treatments is successful
80% of the time
 Modify activity
 Modalities
Anterior Knee Pain
Treatment

Therapeutic exercises (stretch &
strengthen)
 Taping or Bracing
 Surgical ( usually after 6 month of
conservative treatments)
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
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