Common Sports Injuries
of the Knee & Shoulder
James M. Farmer M.D.
Sports Medicine & Orthopaedic
Surgery
Lewis-Gale Physicians
Overview
Knee Injuries
Meniscal Tear
Articular Cartilage Tear
ACL Tear
Patellofemoral Pain
Iliotibial Band Syndrome
James M. Farmer M.D.
540-772-3530
Overview
Shoulder Injuries
Dislocation
A-C Separation
SLAP Lesion
Rotator Cuff Tear
James M. Farmer M.D.
540-772-3530
Knee Anatomy
Femur and Tibia
Articular Cartilage
Meniscus
Ligaments
James M. Farmer M.D.
540-772-3530
Meniscal Tear
Mechanism
Young: twisting or pivoting
Older: minor trauma
Signs and Sx
Swelling
Catching
Giving way
Locking
James M. Farmer M.D.
540-772-3530
Meniscal Tear
James M. Farmer M.D.
540-772-3530
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.
540-772-3530
Articular Cartilage Tear
Mechanism
Acute trauma
Wear and tear
Signs and Sx
Pain
Swelling
James M. Farmer M.D.
540-772-3530
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.
540-772-3530
ACL Tear
Mechanism
Twisting
Pivoting
Sudden stop
Signs and Sx
Acute: swelling, pain, instability
Chronic: frequent giving way, pain
James M. Farmer M.D.
540-772-3530
ACL Tear
James M. Farmer M.D.
540-772-3530
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.
540-772-3530
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.
540-772-3530
Patellofemoral Pain
James M. Farmer M.D.
540-772-3530
Preferred Treatment
Non Surgical!!!
Non Surgical!!!
Non Surgical!!!
Activity modification
Physical Therapy
Taping, Bracing, Orthotics
Injections
Surgery
Not many “Good” options
Arthroscopy, Osteotomy, Resurfacing,
Arthroplasty James M. Farmer M.D.
540-772-3530
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.
540-772-3530
Iliotibial Band Syndrome
James M. Farmer M.D.
540-772-3530
Preferred Treatment
Non Surgical:
Stretching
Physical Therapy: Ice, Ultrasound
Orthotics
Medications
Injections
Surgical:
ITB release
James M. Farmer M.D.
540-772-3530
Shoulder Anatomy
Humerus and Scapula
Labrum
Biceps Tendon
Rotator Cuff
James M. Farmer M.D.
540-772-3530
Shoulder Dislocation
James M. Farmer M.D.
540-772-3530
Preferred Treatment
Non 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.
540-772-3530
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.
540-772-3530
AC Separation
James M. Farmer M.D.
540-772-3530
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.
540-772-3530
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.
540-772-3530
SLAP Lesion &
Biceps Rupture
James M. Farmer M.D.
540-772-3530
SLAP Lesion &
Biceps Rupture
Popeye Deformity
John Elway won 2 Super Bowls
AFTER Biceps rupture!
James M. Farmer M.D.
540-772-3530
Preferred Treatment
Non Surgical:
Activity modification
Physical Therapy
Surgical:
Repair of tendon attachment
Release tendon
Relocate tendon
James M. Farmer M.D.
540-772-3530
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.
540-772-3530
Rotator Cuff Tear
James M. Farmer M.D.
540-772-3530
Preferred Treatment
Non 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.
540-772-3530