Anatomy for problem solving in sports medicine: The Knee
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About this ebook
Although each problem is different, practitioners will always follow a similar pattern in arriving at a differential diagnosis. In every case, four main areas need to be covered: the type of sport; the clinical history; physical assessment; and appropriate investigations. By taking a logical, step-by-step approach to solving clinical problems, this book offers a valuable resource for the wide range of health professionals who manage knee injuries.
Contents include:
Introduction to solving sports injury problems and the role of anatomy
Introduction to the anatomy of the knee
Topographical anatomy of the knee
Posterior structures
Medial structures
Lateral structures
Major intra-articular structures
The patella and patellofemoral joint
Philip F Harris MD, MSc, MB ChB, Hon. Fellow Anatomical Society, Emeritus Professor of Anatomy, University of Manchester, UK. Special interest in musculoskeletal system and application of anatomy to sports medicine
Craig Ranson BSc, Post-grad Dip Sports Physiotherapy, PhD, Senior Lecturer Sports & Exercise Medicine, School of Sport, Cardiff Metropolitan University, Wales Rugby Team Physiotherapist
Angus Robertson, BSc, MB ChB, FRCSEd(Tr. & Orth.), FFSEM (UK), Post-grad. Dip. Sports & Exercise Medicine , Hon. Senior Lecturer Sports & Exercise Medicine, School of Sport, Cardiff Metropolitan University. Specialist in Orthopaedic Sports Medicine
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Anatomy for problem solving in sports medicine - Philip F harris
elbow.
1
Introduction to solving sports injury problems and the role of anatomy
This book presents the structural and functional anatomy of the knee that is particularly relevant to the understanding of sports injuries. When combined with a consideration of the surface and living anatomy of the knee, including special examination tests (Harris & Ranson 2008), this should enable the reader to apply their knowledge when solving problems in a clinical setting.
This book takes a logical approach in order to successfully solve clinical problems. Although each problem is different, practitioners should always follow a similar pattern in arriving at a differential diagnosis. In every case, four main factors need to be kept in mind:
1. The type of sport
2. The clinical history
3. The physical assessment
4. Appropriate investigations
1. The type of sport
Certain structures are more likely to be injured in particular sports. For example, damage to the anterior cruciate ligament is common in sports such as football (soccer) or rugby, where the lower limbs can be subjected to considerable torsional forces.
2. The clinical history
The clinical history must include the mechanism of injury and the presenting symptoms. For instance, sudden torsional loading may damage ligaments or menisci, whereas repetitive minor trauma may result in insertional tendinopathies.
Symptoms of pathology in the knee may include pain, swelling, a feeling of instability or ‘giving way’, popping, grinding and locking. Pain may be acute, as when a sudden force damages a ligament, or it may be of gradual onset as in progressive damage to articular cartilage (osteoarthritis). Locating the pain is important, and anatomical knowledge can help the practitioner identify the structures that are likely to be involved. For example, pain over the joint line, with precise tenderness over the midpoint on the medial side, suggests damage to the medial collateral ligament or meniscus. Pain and tenderness anteriorly, at the inferior pole of the patella, could indicate patellar tendinopathy.
Generalised swelling of the knee may occur with an effusion, due to excessive fluid (synovial or blood) in the joint, and may be acute or chronic, whereas localised swelling may be as a result of damage to a particular structure such as the medial collateral ligament. Sometimes swelling is associated with inflammation of a bursa, which are particularly common around the knee. A feeling of instability, ‘giving way’ or ‘popping’ may result from a ligament strain or rupture so that the articulating surfaces between femur and tibia are no longer optimally stabilised. A grinding sensation in the joint may be caused by damage to the normally ultra-smooth surface of articular cartilage or may result from an unstable meniscal tear. Locking of the joint occurs when it cannot be completely extended. The inability to extend the joint may be caused by a meniscus tear (where a meniscal fragment becomes loose and catches between the articulating surfaces) or it may result from a ‘loose body’ when a piece of cartilage breaks away and impinges.
3. Physical assessment
Physical assessment includes inspection, manipulation and the use of special techniques and manoeuvres to test specific structures. A knowledge of the functional anatomy of structures is of prime importance in performing and understanding assessment