DOCSLIB.ORG

Essentials of Musculoskeletal Care 5 © 2016 American Academy of Orthopaedic Surgeons SECTION 6 Knee and Lower Leg

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Essentials of Musculoskeletal Care 5 © 2016 American Academy of Orthopaedic Surgeons SECTION 6 Knee and Lower Leg PAIN DIAGRAM Knee and Lower Leg Osteoarthritis of the hip and thigh Iliotibial band syndrome (see Hip and Patellofemoral instability Thigh section) Osteochondritis dissecans (see Pediatric Orthopaedics section) Fracture (intercondylar) Plica syndrome Collateral ligament Collateral ligament tear (LCL) tear (MCL) Osteonecrosis of the Patellofemoral pain Lateral femoral condyle Patellar fracture Meniscal tear Medial (lateral) Meniscal tear Patellar tendinitis (medial) Patellar tendon rupture Fracture Anterior (tibial plateau) Bursitis Lateral (prepatellar) Quadriceps tendon rupture Quadriceps tendinitis Distal femoral fracture Tibiofemoral fracture (Fractures About the Knee) Collateral ligament tear (MCL) Lateral Medial Popliteal cyst Meniscal tear (medial) Arthritis Bursitis Medial gastrocnemius (pes anserine bursitis) tear Medial Posterior 640 Essentials of Musculoskeletal Care 5 © 2016 American Academy of Orthopaedic Surgeons SECTION 6 Knee and Lower Leg 640 Pain Diagram 686 Bursitis of the Knee 715 Home Exercise 739 Patellofemoral Pain 642 Anatomy 690 Procedure: Pes Program for Medial 743 Home Exercise Gastrocnemius Tear Program for 643 Overview of the Knee Anserine Bursa and Lower Leg Injection 717 Meniscal Tear Patellofemoral Pain Plica Syndrome 651 Home Exercise 692 Claudication 722 Home Exercise 746 Program for Knee 694 Collateral Ligament Program for Meniscal 749 Home Exercise Conditioning Tear Tear Program for Plica Syndrome 657 Physical Examination 698 Home Exercise 724 Osteonecrosis of the of the Knee and Program for Collateral Femoral Condyle 751 Popliteal Cyst Lower Leg Ligament Tear 727 Patellar/Quadriceps 754 Posterior Cruciate 668 Anterior Cruciate 701 Compartment Tendinitis Ligament Tear Ligament Tear Syndrome 730 Home Exercise 758 Home Exercise 672 Home Exercise 705 Contusions Program for Patellar/ Program for PCL Injury Quadriceps Tendinitis Program for ACL Tear 707 Fractures About 760 Shin Splints 675 Procedure: Knee Joint the Knee 732 Patellar/Quadriceps Tendon Ruptures 762 Stress Fracture Aspiration/Injection 711 Iliotibial Band 678 Arthritis of the Knee Syndrome 735 Patellofemoral Maltracking 683 Home Exercise 713 Gastrocnemius Tear Program for Arthritis Section Editor Robert A. Gallo, MD Associate Professor Orthopaedic Surgery Hershey Medical Center Hershey, Pennsylvania Contributor Mark C. Hubbard, MPT Physical Therapist Bone and Joint Institute Penn State Milton S. Hershey Medical Center Hershey, Pennsylvania © 2016 American Academy of Orthopaedic Surgeons Essentials of Musculoskeletal Care 5 641 ANATOMY OF THE KNEE AND LOWER LEG Anterior cruciate ligament Posterior cruciate ligament Lateral condyle of femur (articular Medial condyle of femur (articular surface) surface) Popliteus tendon Medial meniscus Fibular collateral ligament Tibial collateral ligament Lateral meniscus Medial condyle of tibia Transverse ligament of knee Tibial tuberosity Head of fibula Gerdy tubercle Knee: Cruciate and Collateral Ligaments (Anterior View, Right Knee in Flexion) Vastus lateralis muscle Vastus medialis muscle Rectus femoris tendon (becoming Patella quadriceps femoris tendon) Iliotibial tract Superior lateral genicular artery Superior medial genicular artery Lateral patellar retinaculum Tibial collateral ligament Biceps femoris tendon Medial patellar retinaculum Inferior lateral genicular artery Inferior medial genicular artery Infrapatellar branch (cut) of Semitendinosus muscle Iliotibial tract Common fibular (peroneal) nerve Saphenous nerve (cut) Semimembranosus muscle Biceps femoris muscle Head of fibula Gracilis muscle Tibial nerve Joint capsule Patellar ligament Popliteal artery and vein Insertion of sartorius muscle Fibularis (peroneus) longus muscle Tibial tuberosity Tibialis anterior muscle Tibia Sartorius muscle Gastrocnemius muscle Common fibular (peroneal) nerve Superior medial genicular artery Plantaris muscle Soleus muscle Extensor digitorum longus muscle Superior lateral genicular artery Gastrocnemius muscle (medial head) Gastrocnemius muscle (lateral head) Nerve to soleus muscle Lateral sural cutaneous nerve (cut) Extensor hallucis longus muscle Medial sural cutaneous nerve (cut) Small saphenous vein Fibularis (peroneus) brevis muscle Gastrocnemius muscle Fibula Superior extensor retinaculum Lateral malleolus Medial malleolus Soleus muscle Inferior extensor retinaculum Plantaris tendon Tibialis anterior tendon Extensor digitorum longus tendons Medial branch of deep fibular (peroneal) nerve Fibularis (peroneus) tertius tendon Soleus muscle Extensor hallucis longus tendon Extensor digitorum brevis tendons Flexor digitorum longus tendon Extensor hallucis brevis tendon Tibialis posterior tendon Fibularis (peroneus) longus tendon Posterior tibial artery and vein Dorsal digital branches Tibial nerve Fibularis (peroneus) brevis tendon of deep fibular (peroneal) nerve Medial malleolus Calcaneal (Achilles) tendon Dorsal digital nerves Flexor hallucis longus tendon Lateral malleolus Superior fibular (peroneal) retinaculum Flexor retinaculum Muscles of Leg Fibular (peroneal) artery Calcaneal branches of fibular (Superficial Dissection) Calcaneal branch of (peroneal) artery posterior tibial artery Anterior View Calcaneal tuberosity Muscles of Leg (Superficial Dissection): Posterior View 642 Essentials of Musculoskeletal Care 5 © 2016 American Academy of Orthopaedic Surgeons Overview of the Knee and Lower Leg Knee and lower leg problems are diagnosed by obtaining an appropriate medical history, performing a physical examination, and obtaining appropriate imaging studies. Radiographs are the initial imaging study of choice. Patients with knee problems report pain, instability, stiffness, swelling, locking, or weakness. These fi ndings may occur in or around any aspect of the knee. Careful localization of the pain and tenderness will substantially narrow the differential diagnosis. The examination of patients with knee problems also includes a screening evaluation of the hip, spine, and back; some patients with problems intrinsic to the hip present with distal thigh pain and other symptoms that mimic knee disorders, whereas lumbar radiculopathy can produce thigh, knee, or leg pain. Radiographic examination of the adult knee includes AP, 30° weight-bearing, lateral, and axial patellofemoral (Merchant or sunrise) views (Figure 1). Because of a higher incidence of osteochondritis dissecans and reduced likelihood of osteoarthritis, tunnel views obtained with the knee at 40° of fl exion should replace the 30° weight-bearing views in patients younger than 20 years. If the patient is able to stand, weight-bearing AP radiographs of both knees should be obtained to allow comparison of the injured knee with the opposite, uninjured knee. A 30° weight-bearing view has been shown to demonstrate arthritis and joint space loss more readily than the AP view obtained in full extension. An axial patellofemoral view helps visualize the patellofemoral joint. Radiographs should be inspected KNEE AND LOWER LEG LOWER AND KNEE Figure 1 A 30° weight-bearing radiograph demonstrates joint space narrowing in the medial compartment of the left knee (black arrows). Note the more subtle joint space narrowing in the medial compartment of the right knee (white arrows) with less obvious degenerative change. (Reproduced from Johnson TR, Steinbach LS, eds: Essentials of Musculoskeletal Imaging. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, p 532.) 6 SECTION © 2016 American Academy of Orthopaedic Surgeons Essentials of Musculoskeletal Care 5 643 Overview of the Knee and Lower Leg Table 1 for changes in bony architecture, including lytic lesions, blastic lesions, and other areas of radiolucencies and opacities. Possible Causes of Acute Weight-bearing AP radiographs obtained with the knee in full Leg and Knee Pain extension and 30° of fl exion are used to evaluate medial and lateral Musculotendinous strains or compartment arthritis, fractures of the distal femur and proximal contusions tibia, and tibiofemoral alignment. Lateral radiographs are helpful in assessing the patella for fractures and malposition (patella alta and Fractures patella baja). Axial patellofemoral views are used to assess patellar Dislocations alignment within the trochlea and arthritis of the patellofemoral joint. Compartment syndrome With the exception of an acute traumatic effusion and no apparent Ligamentous injuries radiographic fracture, MRI is rarely indicated in the initial diagnostic Extensor mechanism injuries workup. However, MRI often plays an important role as an advanced (patellar fracture, quadriceps diagnostic tool or in surgical planning. or patellar tendon rupture) Meniscal injuries Acute Pain Acute pain in the leg and knee often occurs secondary to an injury. Possible diagnoses fall into several categories, any of which can be associated with acute pain (Table 1). Prompt diagnosis of unreduced fractures, unreduced dislocations, or acute compartment syndrome is required to prevent permanent residual sequelae, including substantial loss of limb function. Deformity and acute effusions often indicate the presence of a substantial injury. Fractures can involve any of the periarticular osseous structures; dislocations can affect the tibiofemoral, patellofemoral, or rarely, the tibiofi bular joint. The location of swelling, deformity, and tender areas can narrow the differential diagnosis, and radiographs can often confi rm the presence of a fracture or dislocation. Patellar fractures can result from direct or indirect forces, such as rapid deceleration
Load more

Recommended publications
  • OES Site Color Scheme 1
    Nuisance Problems You will Grow to Love Thomas V Gocke, MS, ATC, PA-C, DFAAPA President & Founder Orthopaedic Educational Services, Inc. Boone, NC [email protected] www.orthoedu.com Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Faculty Disclosures • Orthopaedic Educational Services, Inc. Financial Intellectual Property No off label product discussions American Academy of Physician Assistants Financial PA Course Director, PA’s Guide to the MSK Galaxy Urgent Care Association of America Financial Intellectual Property Faculty, MSK Workshops Ferring Pharmaceuticals Consultant Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. 2 LEARNING GOALS At the end of this sessions you will be able to: • Recognize nuisance conditions in the Upper Extremity • Recognize nuisance conditions in the Lower Extremity • Recognize common Pediatric Musculoskeletal nuisance problems • Recognize Radiographic changes associates with common MSK nuisance problems • Initiate treatment plans for a variety of MSK nuisance conditions Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Inflammatory Response Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Inflammatory Response* When does the Inflammatory response occur: • occurs when injury/infection triggers a non-specific immune response • causes proliferation of leukocytes and increase in blood flow secondary to trauma • increased blood flow brings polymorph-nuclear leukocytes (which facilitate removal of the injured cells/tissues), macrophages, and plasma proteins to injured tissues *Knight KL, Pain and Pain relief during Cryotherapy: Cryotherapy: Theory, Technique and Physiology, 1st edition, Chattanooga Corporation, Chattanooga, TN 1985, p 127-137 Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc.
    [Show full text]
  • ICD-10 Diagnoses on Router
    L ARTHRITIS R L HAND R L ANKLE R L FRACTURES R OSTEOARTHRITIS: PRIMARY, 2°, POST TRAUMA, POST _____ CONTUSION ACHILLES TEN DYSFUNCTION/TENDINITIS/RUPTURE FLXR TEN CLAVICLE: STERNAL END, SHAFT, ACROMIAL END CRYSTALLINE ARTHRITIS: GOUT: IDIOPATHIC, LEAD, CRUSH INJURY AMPUTATION TRAUMATIC LEVEL SCAPULA: ACROMION, BODY, CORACOID, GLENOID DRUG, RENAL, OTHER DUPUYTREN’S CONTUSION PROXIMAL HUMERUS: SURGICAL NECK 2 PART 3 PART 4 PART CRYSTALLINE ARTHRITIS: PSEUDOGOUT: HYDROXY LACERATION: DESCRIBE STRUCTURE CRUSH INJURY PROXIMAL HUMERUS: GREATER TUBEROSITY, LESSER TUBEROSITY DEP DIS, CHONDROCALCINOSIS LIGAMENT DISORDERS EFFUSION HUMERAL SHAFT INFLAMMATORY: RA: SEROPOSITIVE, SERONEGATIVE, JUVENILE OSTEOARTHRITIS PRIMARY/SECONDARY TYPE _____ LOOSE BODY HUMERUS DISTAL: SUPRACONDYLAR INTERCONDYLAR REACTIVE: SECONDARY TO: INFECTION ELSEWHERE, EXTENSION OR NONE INTESTINAL BYPASS, POST DYSENTERIC, POST IMMUNIZATION PAIN OCD TALUS HUMERUS DISTAL: TRANSCONDYLAR NEUROPATHIC CHARCOT SPRAIN HAND: JOINT? OSTEOARTHRITIS PRIMARY/SECONDARY TYPE _____ HUMERUS DISTAL: EPICONDYLE LATERAL OR MEDIAL AVULSION INFECT: PYOGENIC: STAPH, STREP, PNEUMO, OTHER BACT TENDON RUPTURES: EXTENSOR OR FLEXOR PAIN HUMERUS DISTAL: CONDYLE MEDIAL OR LATERAL INFECTIOUS: NONPYOGENIC: LYME, GONOCOCCAL, TB TENOSYNOVITIS SPRAIN, ANKLE, CALCANEOFIBULAR ELBOW: RADIUS: HEAD NECK OSTEONECROSIS: IDIOPATHIC, DRUG INDUCED, SPRAIN, ANKLE, DELTOID POST TRAUMATIC, OTHER CAUSE SPRAIN, ANKLE, TIB-FIB LIGAMENT (HIGH ANKLE) ELBOW: OLECRANON WITH OR WITHOUT INTRA ARTICULAR EXTENSION SUBLUXATION OF ANKLE,
    [Show full text]
  • An Unusual Klebsiella Septic Bursitis Mimicking a Soft Tissue Tumor
    Case Report Eur J Gen Med 2013;10(1):47-50 An Unusual Klebsiella Septic Bursitis Mimicking a Soft Tissue Tumor Mehmet Ali Acar1, Nazım Karalezli2, Ali Güleç3 ABSTRACT Because of its subcutaneous location prepatellar bursitis is frequently complicated by an infection. Gram-positive organisms, primarily Staphylococcus aureus account for the majority of cases of septic bursitis. Local cutaneous trauma can lead to direct inoculation of the bursa with normal skin flora in patients with occupations, such as mechanics, carpenters and farmers. A 71-year- old male was admitted to our department with a history of pain and swelling of his right knee over a 20 year period. Physical examination revealed a swollen, suppurative mass with ulceration of the skin and local erythema which mimicked a soft tissue tumor at first sight. Magnetic resonance imaging of the knee revealed a 13*12*10cm well-circumscribed, septated, capsulated, fluid-filled prepatellar bursa without evidence of tendinous or muscular invasion. The mass was excised en bloc, including the bursa and the overlying skin. The defect was closed with a split thickness skin graft. The patient had 100 degrees flexion and full extension after 45 days postoperatively, and he continued to work as a farmer. Key words: Klebsiella, septic bursitis, haemorrhage, mass Yumuşak Doku Tümöre Benzeyen Nadir Klebsiella Septik Bursiti ÖZET ilt altı yerleşiminden dolayı prepatellar bursitlerde enfeksiyon görülmesi sık olur. Gram pozitif mikroorganizmalar, özellikle stafilokokkus aureus en sık etkendir. Tamirciler, halıcılar ve çiftçiler gibi travmaya çok maruz kalan meslek gruplarında direk olarak etken cilt florasından bursaya ulaşabilir. 71 yaşında erkek hasta 20 yılı aşan ağrı ve şişlik nedeni ile kliniğimize başvurdu.
    [Show full text]
  • Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079)
    Local Coverage Article: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Noridian Healthcare Solutions, A and B MAC 01111 - MAC A J - E California - Entire State LLC Noridian Healthcare Solutions, A and B MAC 01112 - MAC B J - E California - Northern LLC Noridian Healthcare Solutions, A and B MAC 01182 - MAC B J - E California - Southern LLC Noridian Healthcare Solutions, A and B MAC 01211 - MAC A J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01212 - MAC B J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01311 - MAC A J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01312 - MAC B J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01911 - MAC A J - E American Samoa LLC California - Entire State Guam Hawaii Nevada Northern Mariana Created on 09/28/2019. Page 1 of 33 CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Islands Article Information General Information Original Effective Date 10/01/2019 Article ID Revision Effective Date A57079 N/A Article Title Revision Ending Date Billing and Coding: Injections - Tendon, Ligament, N/A Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma Retirement Date N/A Article Type Billing and Coding AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT codes, descriptions and other data only are copyright 2018 American Medical Association.
    [Show full text]
  • Imaging of the Bursae
    Editor-in-Chief: Vikram S. Dogra, MD OPEN ACCESS Department of Imaging Sciences, University of HTML format Rochester Medical Center, Rochester, USA Journal of Clinical Imaging Science For entire Editorial Board visit : www.clinicalimagingscience.org/editorialboard.asp www.clinicalimagingscience.org PICTORIAL ESSAY Imaging of the Bursae Zameer Hirji, Jaspal S Hunjun, Hema N Choudur Department of Radiology, McMaster University, Canada Address for correspondence: Dr. Zameer Hirji, ABSTRACT Department of Radiology, McMaster University Medical Centre, 1200 When assessing joints with various imaging modalities, it is important to focus on Main Street West, Hamilton, Ontario the extraarticular soft tissues that may clinically mimic joint pathology. One such Canada L8N 3Z5 E-mail: [email protected] extraarticular structure is the bursa. Bursitis can clinically be misdiagnosed as joint-, tendon- or muscle-related pain. Pathological processes are often a result of inflammation that is secondary to excessive local friction, infection, arthritides or direct trauma. It is therefore important to understand the anatomy and pathology of the common bursae in the appendicular skeleton. The purpose of this pictorial essay is to characterize the clinically relevant bursae in the appendicular skeleton using diagrams and corresponding multimodality images, focusing on normal anatomy and common pathological processes that affect them. The aim is to familiarize Received : 13-03-2011 radiologists with the radiological features of bursitis. Accepted : 27-03-2011 Key words: Bursae, computed tomography, imaging, interventions, magnetic Published : 02-05-2011 resonance, ultrasound DOI : 10.4103/2156-7514.80374 INTRODUCTION from the adjacent joint. The walls of the bursa thicken as the bursal inflammation becomes longstanding.
    [Show full text]
  • Bursitis of the Knee
    Bursitis of the knee What is bursitis? The diagram below shows the position of the Bursitis means inflammation within a bursa. A prepatellar and infrapatellar bursa in the knee. bursa is a small sac of fluid with a thin lining. There are a number of bursae in the body. Bursae are normally found around joints and in places where ligaments and tendons pass over bones and are there to stop the ligaments and bone rubbing together. What is prepatellar bursitis? Prepatellar bursitis is a common bursitis in the knee and can also be known as ‘housemaid’s knee’. There are four bursae located around the knee joint. They are all prone to inflammation. What causes prepatellar bursitis? There are a number of different things that can cause prepatellar bursitis, such as: • A sudden, one-off injury to the knee such as a fall or direct blow on to the knee during sport. People receiving steroid treatment or those on chemotherapy treatment for cancer are also at • Recurrent minor injury to the knee such as an increased risk of developing bursitis. spending long periods of time kneeling down, i.e. at work or whilst cleaning. Prepatellar bursitis is more common in tradesmen who spend long periods of time Infection: the fluid in the prepatellar bursa sac kneeling. For example, carpet fitters, concrete can become infected and cause bursitis. This is finishers and roofers. particularly common in children with prepatellar bursitis and usually follows a cut, scratch or injury to the skin on the surface of the knee. This What are the symptoms of injury allows bacteria (germs) to spread infection prepatellar bursitis? into the bursa.
    [Show full text]
  • Focal Knee Swelling Clinical Presentation
    Focal Knee Swelling Clinical Presentation Click for referral info for MSK Triage Click for History and Examination more info Click for Medial or Lateral Focal Click for Baker's Cyst more Swelling Bursitis more info info Consider meniscal Cysts Refer for Weight Bearing Refer for diagnostic Assessment and Management X-ray AP and Lateral ultrasound scan • depends on its aetiology • have a low threshold for performing, or referring for, aspiration to rule out septic arthritis Ganglion or Meniscal Cyst · likely to be a degenerative tear Osteoarthritis Normal · majority can be treated conservatively confirmed Non-septic Bursitis Click for Click for more Septic Bursitis more info info Conservative Management Refer for diagnostic Manage as per (where appropriate) ultrasound scan Osteoarthritis pathway Self-management for 6 Immediate referral to weeks secondary care Click for Refer to MSK triage more Manage as per See pathway If no improvement with info pathology Knee Pain Management conservative management Physio for 6 weeks If no improvement with self-management Physio to refer to MSK triage Click for more If no improvement with physio info Back to History and examination pathway History Ask about: · History of trauma · Pain: nature, onset · Stiffness · Fever, systemic illness · Locking or clicking · Past medical history · Occupational and recreational activities that may have precipitated pathology Examination · Look: assess location of swelling (generalised/media/lateral/ popliteal fossa), overlying erythema, lesions to overlying skin · Feel:
    [Show full text]
  • Patellofemoral SMCA 2014 Handout
    Patellofemoral Pain Syndrome / How can a Sesamoid Bone Anterior Knee Pain / Runners’ Knee cause So Many Problems? _ n Most common cause of Patellofemoral Pain and knee pain Patella Instability n Most common symptom presenting to SM n Diagnostic challenge n Treatment controversies n Lack of evidence to support Sarah Kerslake BPHTY Ax and Rx PFPS Patellofemoral Anatomy n Multifactorial Etiology n Considering the PF joint is one of the most n Non-operative treatment is successful highly loaded joints in the human body, the prevalence of AKP is not surprising. n Strong evidence supports treatment with multimodal therapy n Anatomy: n Sesamoid bone in extensor apparatus n Routine clinical Ax of muscle strength in athletes may not detect deficits n Acts as pulley/cam in extensor mechanism n Protects the tibiofemoral joint n More challenging functional tests required n Anchored by Active and Passive elements PFPS Anatomy PFPS Anatomy n Active (Dynamic) restraints n Passive (Static) restraints n Quadriceps muscle n Bony anatomy (Facets <=> Trochlea) n Vastus Lateralis Obliquus/Longus n Quadriceps Fascia + Patellar Tendon n Rectus Femoris + Vastus Intermedius n Lateral Peripatellar Retinaculum n Vastus Medialis Obliquus/Longus n Medial Peripatellar Retinaculum, particularly n Patella Tendon the medial patellofemoral ligament n Iliotibial band n Balance between structures is v. important 1 PFPS Symptoms PFPS Pathology n Symptoms include pain, swelling, n Patellar Tracking weakness, instability, mechanical n Patellar Tendinopathy symptoms & functional
    [Show full text]
  • Plica: Pathologic Or Not? J
    Plica: Pathologic or Not? J. Whit Ewing, MD Abstract A fold that occurs within a joint is referred to as a plica synovialis. Three such pli- in which the only finding to explain cae are seen with regularity within the human knee joint. These folds are normal the symptoms is the presence of a structures that represent remnants of mesenchymal tissue and/or septa formed thickened, hypertrophic plica. during embryonic development of the knee joint, and can be seen during arthro- Chronic anteromedial knee pain and scopic inspection of the knee joint. Controversy exists within the orthopaedic com- a sense of tightness in the subpatellar munity as to whether a plica can develop pathologic changes sufficient to cause region on squatting are the common disabling knee symptoms. The author defines the clinical syndrome, describes the complaints expressed by patients arthroscopic appearance of pathologic plica, and outlines nonsurgical and surgi- found to have a pathologic plica. The cal methods of management of this uncommon condition. ligamentum mucosum is not a J Am Acad Orthop Surg 1993;1:117-121 source of these types of symptoms. Additional symptoms are snapping sensations, buckling, knee pain on A plica synovialis is a membranous commonly referred to as a medial shelf sitting, and pain with repetitive fold or ridge found in the synovial or medial plica. This shelflike fold of activity.4 Recurrent effusions and lining of a joint. Three such folds are synovial membrane extends from the locking of the knee joint are not typi- found with regularity in the human infrapatellar fat pad to the medial wall cal in patients with this syndrome.
    [Show full text]
  • Causes of Anterior Knee Pain
    Castleknock GAA club member and Chartered Physiotherapist, James Sherry MISCP, has prepared an article on Anterior knee pain and how best to treat this common complaint. To book your physiotherapy appointment contact James on 087-7553451 or email [email protected]. Causes of Anterior Knee Pain Anterior knee pain is an umbrella term which encompasses a wide range of related but significantly different conditions resulting in pain around or behind the knee cap. 25% of the population will be affected at some time and it is the most common overuse syndrome affecting sports people – although you do not have to be sporty to be affected. It is also a leading cause of chronic knee pain in adolescents. Sometimes pain can be pinpointed by the patient, occurring at the front and centre of the knee, sometimes it may be just above or below the knee cap, or perhaps dominated by pain behind the knee cap. Most anterior knee pain arises from patellofemoral joint irritation and is termed patellofemoral pain syndrome (PFPS) or chondromalacia patellae . This occurs when the knee cap is misaligned relative to the thigh bone, which therefore places more stress through the joint during activity. As a result this may cause damage to structures of the joint (such as cartilage) and result in swelling and pain around the knee cap. It can be as a result of weakness in the quadriceps muscles which causes poor tracking of the kneecap on the thigh bone and affects the way the knee cap works during running or activity. A tight Iliotibial Band (IT band) can place excessive pulling force on the kneecap causing stress on the Patello-femoral joint.
    [Show full text]
  • Diagnosing & Treating Non-Traumatic Knee Pain
    ORTHOPEDIC PRIMARY CARE: Diagnosing & Treating Non-Traumatic Knee Pain © Jackson Orthopaedic Foundation www.jacksonortho.org Acknowledgement This lecture was originally developed as part of Orthopedic Primary Care, a six-month continuing education program presented yearly by the Jackson Orthopaedic Foundation, a non-profit organization in Oakland, California. More information at: OrthoPrimaryCare.Info www.jacksonortho.org Disclosure Statement of Unapproved/Investigative Use • This presentation contains no discussion of the unapproved/investigative use of any commercial product or device. www.jacksonortho.org Disclosure Statement of Financial Interest Neither Dr. Benham nor Dr. Geier has any financial interests/arrangements or affiliations with one or more organizations that could be perceived to have real or apparent conflicts of interest in the context of the subject of this presentation. www.jacksonortho.org Learning Objectives • At the conclusion of this presentation, participants will be able to 1. Identify likely causes of non-traumatic, non-arthritic knee pain based on presentation and history. 2. Appropriately apply specialty exam techniques and order diagnostic imaging as needed to definitively diagnose non-traumatic, non-arthritic knee pain. 3. Implement appropriate treatment plans to include integrative and pharmaceutical modalities. The use and effects of the following pharmaceutical types will be discussed: acetaminophen, NSAIDs, injectable corticosteroids and topical analgesics. www.jacksonortho.org Learning Objectives • At the conclusion of this presentation, participants will be able to 1. Identify likely causes of non-traumatic, non-arthritic knee pain based on presentation and history. 2. Appropriately apply specialty exam techniques and order diagnostic imaging as needed to definitively diagnose non-traumatic, non-arthritic knee pain.
    [Show full text]
  • Nontraumatic Knee Pain: Hawks, MD Nellis Family Medicine Residency Program, a Diagnostic & Treatment Guide Nellis Air Force Base, Nev (Drs
    Carlton J. Covey, MD, FAAFP; Matthew K. Nontraumatic knee pain: Hawks, MD Nellis Family Medicine Residency Program, A diagnostic & treatment guide Nellis Air Force Base, Nev (Drs. Covey and Hawks); Uniformed Services University of the Health Little has been written about nontraumatic nonarthritic Sciences, Bethesda, Md knee pain in adults. This article seeks to fill that void with (Dr. Covey) practical tips and an at-a-glance resource. [email protected] The authors reported no potential conflict of interest relevant to this article. The opinions and assertions CASE u Jane T, age 42, comes to see you because of right knee contained herein are the Practice pain that she’s had for about 6 months. She denies any trau- private views of the authors and are not to be construed recommendationS ma. ms. T describes the pain as vague and poorly localized, as official or as reflecting the views of the US Air Force › Consider radiography for but worse with activity. She says she started a walking/running Medical Department or the a patient with patellofemoral program 9 months ago, when she was told she was overweight US Air Force at large. pain syndrome if (body mass index, 29). She has lost 10 pounds since then, ms. T examination reveals an says, and hopes to lose more by continuing to exercise. upon effusion, the patient is age further review, you find that ms. T has had increasing pain 50 years or older, or the while ascending and descending stairs and that the pain is also condition does not improve exacerbated when she stands after prolonged sitting.
    [Show full text]