Brachial plexus

1. Brachial plexus

2. The Knee PSE4U

3. Bones • Femur • Tibia • Fibula • Patella

4. Ligaments • Medial Collateral • Lateral Collateral

5. Ligaments • Anterior Cruciate • Posterior Cruciate

6. Meniscus • Medial meniscus • Lateral meniscus

7. Bursa(e) • A bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.

8. Muscles • Quadriceps • Function is knee extension. • Vastusmedialis • Vastusintermedius • Vastuslateralis • Rectus femoris

9. Muscles • Hamstrings • function is knee flexion. • Semitendinosus • Semimemranosus • Biceps femoris

10. Tendons • Quadriceps tendon • Patellar ligament • Hamstring tendons

11. Knee Injuries • Quadricep strain • Hamstring strain • Contusion • Patellar/Quadriceps tendonitis • Patellar/Quadriceps tendon rupture • Osgood-Slatter disease • Bursitis • Meniscal tear • MCL/LCL sprain • ACL/PCL sprain

12. Quadriceps strain Grade 1: • Tightness in the thigh, • Unable to walk properly. • Probably not much swelling. Grade 2: • Probably cannot walk properly. • The athlete may notice swelling. • Straightening the knee against resistance causes pain. • Unable to fully bend the knee. Grade 3: • Unable to walk properly without the aid of crutches. • In severe pain. • Bad swelling appearing immediately. • Expect to be out of competition for 3 to twelve weeks.

13. Hamstring Strain Grade 1: • Might have tightness in the thigh. • May be able to walk properly. • Probably won't have much swelling. Grade 2: • Bending the knee against resistance causes pain. • Might be unable to fully straighten the knee. • Some swelling Grade 3: • Unable to walk properly without the aid of crutches. • In severe pain. • Bad swelling appear immediately.

14. Contusion • Caused by a direct blow to the muscle. Most likely to occur in the quadriceps.

15. Hyperextended knee • In this injury, your knee extends beyond its normally straightened position so that it bends back on itself.

16. Quadriceps Tendonitis • A person experiencing quadriceps tendonitis will have particular pain straightening the lower leg, or decelerating when walking. The major point of pain coming from above the kneecap.

17. Patellar Tendonitis What is patellar tendonitis? • Patellar tendonitis, also called jumper's knee, is inflammation in the band of tissue (the patellar tendon) that connects the kneecap (patella) to the shinbone (tibia). How does it occur? • The most common activity causing patellar tendonitis is too much jumping. Other repeated activities such as running, walking, or bicycling may lead to patellar tendonitis. All of these activities put repeated stress on the patellar tendon, causing it to be inflamed.

18. Patellofemoral Syndrome • Gradual onset of anterior knee pain or pain around the patella • More common in adolescents, young adults and females are more prone than males • Often aggravated by sports such as running, volleyball and basketball • There is quite a bit of disagreement in the sport medicine community as to its cause

19. “Jumper’s Knee”

20. Factors Contributing to PFS • Overuse/Overload: • repeated weight bearing impact, landing from jumps • Biomechanical Instability: • flat feet (pronation) causes internal rotation of tibia and femur which stresses the PF joint • high arches puts undue stress on PF joint • Q-angle? • Muscles • Muscle weakness or imbalance (especially quadriceps and hamstrings)

21. Patellar tendon rupture

22. Patellar dislocation What is a dislocated patella? • A dislocated patella occurs when the kneecap (patella) pops out from its normal position. This can occur as the result of force or, is more often related to a developmental condition that leads to an improper alignment of the kneecap with the thighbone (femur). This is sometimes called "unstable kneecap."

23. Patellar fracture

24. Dislocated Knee

25. Osgood-Slatter disease • Osgood-Schlatter (OS) disease is one of the most common causes of knee pain in the adolescent. • During periods of rapid growth, stress from contraction of the quadriceps is transmitted through the patellar tendon onto a small portion of the partially developed tibialtuberosity.

26. Osgood-Slatter disease

27. Bursitis • “Housemaid” or “Carpet layers” knee. This is caused by direct trauma.

28. Meniscal tear • One may tear the meniscus by twisting the knee, pivoting, cutting or decelerating. In athletes, meniscal tears often happen in combination with other injuries such as a torn ACL (anterior cruciate ligament).

29. Meniscal tear • Signs and Symptoms • Pain and “clicking” while walking or bending knee. • Pain and clicking while going upstairs. • Remedies: RICE with medication, or surgery.

30. Meniscal tears

31. Meniscal injury tests

32. Medial Collateral injury • What causes Medial Collateral Ligament Sprain?By far the most common cause of medial collateral ligament sprain is a blow or sudden impact to the outside (lateral) of the knee joint. This causes the outside of the knee to collapse inward toward the midline of the body and the inside of the knee (where the medial collateral ligament is located) to widen and open up. This opening up stretches the ligament, which results in the injury.

33. Medial Collateral injury • What are the Signs & Symptoms of Medial Collateral Ligament Sprain? • The most common symptom of a MCL injury is pain around the inside of the knee joint. Also common is bruising and swelling.

34. Collateral Ligament Tests

35. Lateral Collateral sprain • Apply everything from an MCL injury, except the mechanism of injury is a direct blow from the medial side of the knee.

36. Anterior Cruciate sprain • How is the anterior cruciate ligament injured?The ACL or anterior cruciate ligament is injured either through twisting the knee or through an impact to the side of the knee - often the outside.

38. Anterior Cruciate sprain Signs and Symptoms Pain at time of the injury. Athlete and/or people in the area will hear a “pop”. Swelling. In the later stages when the swelling has decreased there may be instability in the joint. For a partial rupture pain may be felt on the Anterior Drawer test where the tibia is pulled.

39. The Q-Angle • Q-angle stands for the quadriceps angle • The Q angle is formed by two lines drawn: • From the Anterior Superior Illiac Spine (ASIS) through the centre of the patella • From the tibialtuberosity through the centre of the patella • Research indicates that a Q-angle greater than 20 increases the risk of knee injuries

40. Measuring Your Q-Angle • Find a friend • Locate the ASIS, tibialtuberosity and the centre of the patella • Create two lines to form your Q-angle • Use a protractor to measure your Q angle • Report your results on the board

42. Q angle

43. Unhappy Triad • Medial Meniscus tear • Medial Collateral ligament tear • Anterior Cruciate ligament tear

44. Female Anterior Cruciate injury • NCAA study showed that women suffered ACL injuries four times more often in basketball; three times more often in gymnastics; and two-and-a-half times more often in soccer.

45. Posterior Cruciate sprain • Mechanism of injury • PCL tears can occur when a football or soccer player falls on a bent knee. Motor vehicle accidents are another common cause of injury to the PCL. When the driver or passenger strikes the bent knee just below the kneecap (patella) against the dashboard, the force can tear the PCL and damage other ligaments, bones and muscles.

46. PCL Injury

47. Posterior Cruciate sprain • Signs and symptoms • Marked, immediate swelling (within three hours of the injury) • Difficulty walking after the injury • Painful to move the knee • Occasionally, a feeling of instability, or the knee "giving way"