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