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Care of Musculoskeletal Problems in the Outpatient Setting - part 9

Tham khảo tài liệu 'care of musculoskeletal problems in the outpatient setting - part 9', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | 282 E.J. Shahady severe injury. It may take up to 3 months before the patient can return to full involvement in strenuous physical activity. Return to full activity should be accompanied by preparticipation conditioning and stretching exercises. 10. Popliteus Tendonitis This is not a common problem but one that needs to be considered in patients with pain in the popliteal area the back of the knee . The popliteus is the primary internal rotator of the tibia. Its origin is the posterior medial border of the tibia. It inserts on the lateral femoral condyle anterior and inferior to the origin of the fibular collateral ligament. Popliteus tendonitis can be confused with lateral meniscus and lateral collateral ligament injury as well as gastrocnemius injury. The patients usually complain of posterolateral knee pain that extends into the popliteal fossae. The onset of symptoms is gradual and it increases with activity. Examination reveals tenderness in the popliteal fossae and the posterior lateral area of the knee. Resisted external rotation Figure 13.8 while palpating the popliteus produces pain. This test is performed with patients lying on their back with the painful leg placed in 90 of hip flexion Figure 13.8. Resisted external rotation. 13. Lower Leg Problems 283 and 90 of knee flexion. The clinician stands on the lateral side of the knee with one hand supporting the knee and the other placed on the foot resisting external rotation. 10.1. Imaging An MRI may be needed to make a definitive diagnosis. 10.2. Treatment Excessive quadriceps fatigue strains the popliteus so a rehabilitation program emphasizing strengthening of the quadriceps muscle should be instituted. A 2-week course of NSAIDs should also be included in the treatment. Recalcitrant cases may require a local injection of a steroid. Maintaining good quadriceps strength is the key to preventing a recurrence. 11. Retrocalcaneal Bursitis The retrocalcaneal bursa is located behind the calcaneus and in front of