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Lower Extremity Workshop
Adam Lucassian, AT, ATCGraduate Assistant Athletic Trainer (Women’s
Soccer)
About Me
• From Michigan (Near Detroit)
• Graduated from Central Michigan University
• Intern:
• Saint Joseph’s University, Philadelphia, PA (Women’s Soccer)
• Florida Gulf Coast University, Ft. Myers, FL (Men’s Soccer, Men/Women Tennis)
• Research:
• Kinesio Tape
• Laser v. Foam Rolling v. Grasten on Performance
What are we going to do?
• Go over Lower Extremity Assessment
• Quick Facts
• Case Studies
• SOAP Approach
• Questions
Quick Facts
• Diagnostic Testing vs. Clinical Evaluation
• Hardy et. Al (2012)
• Study comparing diagnostic testing vs. clinical evaluation
• Lateral/Medial Meniscus
• Findings: Clinical Evaluation comparable to diagnostic testing
• Antero Lateral Ligament (ALL)
• Newly discovered ligament
Case Study #1
Set the Scene
• You are in the Athletic Training Room of a local High School
• A high school basketball player reports to the athletic training room complaining of discomfort in the anterior thigh for the past week.
• GO
Subjective
• What did you do?
• NOW: Bumped in R though
• PRIOR: Kneed in the R thigh ~1 week ago (didn’t report)
• Management: Ibuprofen from home
• Sounds/Sensations
• No Sounds or sensations
• Prior Medical History: None
• Pain
• Discomfort after initial injury, but ok
• Increased pain after current hit
• 7/10 “deep achy pain
• Worse is with Hip flex and extension
• Ambulation
• Can’t continue with practice
• Pain with walking
Differential Diagnosis
Objective- Inspection/Palpation
Inspection
• Partial weight bearing on R leg
• Unable to fully extend during walking
• Redness over mid thigh (impact site)
• Girth Measurement
• 3cm larger than left
Palpation
• Deformity
• Not Detected
• +Palpable muscle spasms
• Point Tenderness
• 8/10 “sharp” pn over impact site
• Skin Temperature
• Warm to the touch
Differential Diagnosis
Objective- Range of Motion
• AROM
• Knee Flexion 0-25
• Unable to perform AROM knee extension without pn (7/10 “sharp”)
• Unable to Hip flexion without pain (7/10 “sharp”)
• PROM
• Knee Flexion 0-30
• Unable to perform hip extension without pain (7/10 “sharp”)
• RROM
• Do not perform due to pain
• The Key to Strains*• Example: Hamstring
• AROM: Pn with Hip Ext
• PROM: Pn with Hip Flex
Objective- Special TestsWhat are we looking for?
Objective- Special Tests
• Compression Test- Negative
• Bump Test- Negative
• Femur Traction/Axial Load- Negative****
• Tuning Fork- Positive when placed over impact site***
Assessment
Quadriceps Contusion (Possible Myositis Ossificans)
• MOI?
• Direct Impact
• Myositis Ossificans
• Treatment
Case Study #2
Set the Scene
• You are a Hockey Athletic Trainer
• During a faceoff, your player gets checked from behind, lands on his right knee, and stays down
• You go out to the player, perform quick assessment, and get the player back to the locker room
• GO
Subjective
• Pain
• Immediate: 8/10 “sharp” pn
• Now: 5/10 “dull” pn
• Location: Inside the Knee
• Sounds/Sensations
• Knee feels “loose and unstable”
• Felt/heard a “pop”
• Prior Medical History: None
• Ambulation
• Getting Off Ice: Needs some support but able to partially weight bear
• Now: Able to walk with an antalgic gait (limp)
• Medication
• Ibuprofen
• When: 2 hours prior
Differential Diagnosis
• ACL
• MCL
• LCL
• PCL
• Medial Meniscus
• Lateral Meniscus
• Unhappy Triad
• Patellar Subluxation
• Knee Dislocation
• Fracture
• Bone Bruise
• Muscle Strain/Tear
Objective- Inspection/Palpation
Inspection
• Swelling
• Moderate Swelling over whole knee
• Discoloration
• Negative
• Deformity
• Negative
Palpation
• Point Tenderness
• Back of the knee (6/10 “sharp”
• Feel “Pressure” as palpating over the knee
• **NO PAIN ANYWHERE ELSE**
• Skin Temperature
• Warm to the touch
• Pulse
• Swelling impedes popliteal
• Dorsal Pedis/Post. Tib?
Differential Diagnosis
• ACL
• MCL
• LCL
• PCL
• Medial Meniscus
• Lateral Meniscus
• Unhappy Triad
• Patellar Subluxation
• Knee Dislocation
• Fracture
• Bone Bruise
• Muscle Strain/Tear
Objective- Range of Motion
• AROM
• Pain and restricted Flex/Ext
• PROM
• Pain with flexion as approaching 90 degrees
• NOT SHARP
• Feel “Pressure”
• RROM
• Do not perform due to pain
•The Key to Strains*• Example: Hamstring
• AROM: Pn with Hip Ext
• PROM: Pn with Hip Flex
Objective- Special TestsWhat are we looking for?
• Anterior Drawer
• Posterior Drawer
• Lachman’s
• Varus Stress Test
• Valgus Stress Test
• Ober’s Test
• Nobel’s
• McMurray’s
• Apley’s Compression/Distraction
• Thessaly Test
• Sag Test
• Quadricep Active Test
• Slocum Drawer Test
• Pivot Shift*
Objective- Special Tests
• Anterior Drawer- Positive*
• Posterior Drawer- Positive
• Lachman’s- Negative
• Varus Stress Test- Negative
• Valgus Stress Test- Negative
• Ober’s Test
• Nobel’s
• McMurray’s- Negative
• Apley’s Compression/Distraction- Negative
• Thessaly Test
• Godfrey’s Test- Positive
• Quadricep Active Test- Positive
• Slocum Drawer Test
• Pivot Shift*
Assessment
• ACL
• MCL
• LCL
• PCL
• Medial Meniscus
• Lateral Meniscus
• Unhappy Triad
• Patellar Subluxation
• Knee Dislocation
• Fracture
• Bone Bruise
• Muscle Strain/Tear
PCL Tear
• RARE
• MOI?
• Posterior Displacement of the tibia on the femur
• Surgery Uncommon
• Why?
• Show and Tell