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

Overview
Shoulder Injuries
Dislocation
A-C Separation
SLAP Lesion
Rotator Cuff Tear

James M. Farmer

Knee Anatomy
Femur and Tibia
Articular Cartilage
Meniscus
Ligaments

James M. Farmer

Meniscal Tear
Mechanism
Young: twisting or pivoting
Older: minor trauma

Signs and Sx
Swelling
Catching
Giving way
Locking
James M. Farmer

Meniscal Tear

James M. Farmer

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

Articular Cartilage Tear

Mechanism
Acute trauma
Wear and tear

Signs and Sx
Pain
Swelling

James M. Farmer

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

ACL Tear
Mechanism
Twisting
Pivoting
Sudden stop

Signs and Sx
Acute: swelling, pain, instability
Chronic: frequent giving way, pain
James M. Farmer

ACL Tear

James M. Farmer

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

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

Patellofemoral Pain

James M. Farmer

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

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

Iliotibial Band Syndrome

James M. Farmer

Preferred Treatment
Non Surgical:
Stretching
Physical Therapy: Ice, Ultrasound
Orthotics
Medications
Injections

Surgical:
ITB release
James M. Farmer

Shoulder Anatomy
Humerus and Scapula
Labrum
Biceps Tendon
Rotator Cuff

James M. Farmer

Shoulder Dislocation

James M. Farmer

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

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

AC Separation

James M. Farmer

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

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

SLAP Lesion &

Biceps Rupture

James M. Farmer

SLAP Lesion &

Biceps Rupture
Popeye Deformity
John Elway won 2 Super Bowls
AFTER Biceps rupture!

James M. Farmer

Preferred Treatment
Non Surgical:
Activity modification
Physical Therapy

Surgical:
Repair of tendon attachment
Release tendon
Relocate tendon
James M. Farmer

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

Rotator Cuff Tear

James M. Farmer

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