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All about you knee

All about you knee



ll about to know your Knee & keep it safe...

ll about to know your Knee & keep it safe...



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    All about you knee All about you knee Presentation Transcript

    • All About Your KneeArunesh Chand Mankotia15 May 2013
    • Knee Pain OverviewKnee pain is the most common musculoskeletalcomplaint that brings people to their doctor. Withtodays increasingly active society, the numberof knee problems is increasing. Knee pain has a widevariety of specific causes and treatments.Anatomy of the KneeThe knee joints main function is to bend, straighten,and bear the weight of the body along withthe ankles and hips. The knee, more than just asimple hinged joint, however, also twists and rotates.In order to perform all of these actions and to supportthe entire body while doing so, the knee relies on anumber of structures including bones, ligaments,tendons, and cartilage.
    • BonesThe knee joint involves 4 bones.The thighbone or femur comprises the topportion of the joint.One of the bones in the lower leg(or calf area), the tibia, provides the bottomweight-bearing portion of the joint.The kneecap or patella rides along the front ofthe femur.The remaining bone in the calf, the fibula, isnot involved in the weight-bearing portion ofthe knee joint. It only provides ligamentattachments for stability.
    • LigamentsLigaments are dense fibrous bands thatconnect bones to each other.The knee includes 4 important ligaments, all ofwhich connect the femur to the tibia:The anterior cruciate ligament (ACL)and posterior cruciate ligament (PCL) providefront and back (anterior and posterior) androtational stability to the knee.The medial collateral ligament (MCL) andlateral collateral ligament (LCL) located alongthe inner (medial) and outer (lateral) sides ofthe knee provide medial and lateral stabilityto the knee.
    • TendonsTendons are fibrous bands similar to ligaments.Instead of connecting bones to other bones asligaments do, tendons connect muscles tobones.The 2 important tendons in the knee are (1)the quadriceps tendon connecting thequadriceps muscle, which lies on the front ofthe thigh, to the patella and (2) the patellartendon connecting the patella to the tibia(technically this is a ligament because itconnects 2 bones).The quadriceps and patellar tendons aresometimes called the extensor mechanism,and together with the quadriceps muscle theyfacilitate leg extension (straightening).
    • CartilageCartilaginous structures called menisci (one is ameniscus) line the top of the tibia and lie between thetibia and the 2 knuckles at the bottom of the femur(called the femoral condyles).The meniscis primary job is to provide cushioning forthe knee joint.BursaeBursae (one is a bursa) are fluid-filled sacs that help tocushion the knee. The knee contains 3 importantgroups of bursae:The prepatellar bursae lie in front of the patella.The anserine bursae is located on the inner side of theknee about 2 inches below the joint.The infrapatellar bursae are located underneath thepatella.
    • Home Care for Knee PainInflammation is the body?s physiologic response toan injury. In treating many types of knee pain, acommon goal is to break the inflammatory cycle.The inflammatory cycle starts with an injury.After an injury, substances that causeinflammation invade the knee, which causesfurther injury, which leads to furtherinflammation, and so on. This cycle ofinflammation leads to continued or progressiveknee pain. The cycle can be broken by controllingthe substances that cause inflammation, and bylimiting further injury to tissue.Some common home care techniques for knee painthat control inflammation and help to break theinflammatory cycle are protection, rest, ice,compression, and elevation. This regimen issummarized by the memory device PRICE.
    • PROTECT the knee from further trauma.This can be done with knee padding orsplinting.A pad over the kneecap, for example, helps tocontrol the symptoms of some knee injuries(an example is a form of bursitis sometimescalled housemaids knee) by preventingfurther repetitive injury to the prepatellarbursae.REST the knee.Rest reduces the repetitive strain placed on theknee by activity.Rest both gives the knee time to heal and helpsto prevent further injury.
    • ICE the knee.Icing the knee reduces swelling and can beused for both acute and chronic knee injuries.Most authorities recommend icing the knee 2to 3 times a day for 20-30 minutes eachtime.Use an ice bag or a bag of frozen vegetablesplaced on the knee.COMPRESS the knee with a knee brace orwrap.Compression helps accomplish two goals:First, compression is another way to reduceswelling.Second, in some knee injuries, compressioncan be used to keep the patella aligned andto keep joint mechanics intact.
    • ELEVATE the knee.Elevation also helps reduce swelling.Elevation works with gravity to help fluidthat would otherwise accumulate in theknee flow back to the central circulation.Prop your leg up when you are sitting, oruse a recliner, which naturally elevates thelegs. Elevation works best when the knee-- or any other injured body part -- ishigher than the level of the heart.
    • When to Go to the Hospital for Knee PainIf you cannot put weight on your knee, you shouldconsider going to the ER to be evaluated by a doctorbecause of the possibility of a fracture.Many fractures may require immobilization in a specificposition or surgery.Putting off seeing a doctor may hinder healing.Other signs and symptoms that demand emergencyevaluation:Fever (which may indicate infection)Unbearable painDrainageLarge woundsPuncture woundsSwelling, if you are on a blood thinner(warfarin or Coumadin) or have a bleeding disorder(such as hemophilia)
    • The doctor will also want to know a bitabout you.Do you have any major medical problems?How active is your lifestyle?What are the names of the medications you aretaking?The doctor will want to know about anyrelated symptoms.Do you still have normal sensation inyour foot and lower leg?Have you been having fevers?
    • Physical examThe doctor will likely have you disrobe to completely exposethe knee. If possible, wear shorts to your appointment.The doctor will then inspect the knee and press around theknee to see exactly where it is tender.In addition, the doctor may perform a number of maneuversto stress the ligaments, tendons, and menisci of the kneeand evaluate the integrity of each of these.X-rays, CT scans, and other testsDepending on your particular history and exam, the doctormay suggest X-rays of the knee. X-rays show fractures(broken bones) and dislocations of bones in the knee aswell as arthritis and abnormally large or small joint spaces.Rarely, the doctor may order a CT scan (a 3-dimensional X-ray) of the knee to precisely define a fracture or deformity.Both X-rays and CT scans are excellent for diagnosingfractures. They both are also poor, however, at evaluatingsoft tissue structures of the knee such as ligaments,tendons, and the menisci.
    • MRIMagnetic resonance imaging (MRI) uses large magnets tocreate a 3-dimensional image of the knee.In contrast to CT scans, MRIs do not image bones andfractures as well.Also in contrast to CT scans, MRIs are excellent for evaluatingligaments and tendons for injuries.Fluid removalThe knee and all bursae of the knee are filled with fluid.If your symptoms suggest infection or crystallinearthritis, such as gout, your physician may removefluid, with a needle, from the knee.This fluid will then be analyzed to better clarify the diagnosis.Crystals, which suggest crystalline arthritis, often can be seenunder the microscope. Infection may also be detectedunder a microscope by finding bacteria and pus in the fluid.Blood tests: The doctor may also elect to perform certainblood tests to evaluate for signs of infection or diseasessuch as rheumatoid arthritis, lupus, and diabetes
    • ArthroscopyThe orthopedic surgeon may elect to performarthroscopy if you have chronic knee pain.This is a surgical procedure where the doctorwill place a fiber optic telescope within theknee joint. The arthroscope is attached to acamera that relays real-time images to avideo monitor.By doing so, the surgeon may be able to seesmall particles in the knee or to look moreclosely at damaged menisci or cartilage.The doctor may also be able to repair damageby shaving down torn cartilage or removingparticles from the knee while looking at theinside of your knee on a video monitor.
    • Types of Knee PainThe nerves that provide sensation to the kneecome from the lower back and also providehip, leg, and ankle sensation. Pain from adeeper injury (called referred pain) can bepassed along the nerve to be felt on thesurface. Knee pain, therefore, can arise fromthe knee itself or be referred from conditionsof the hip, ankle, or lower back. All of thefollowing sources of knee pain arise from theknee joint itself.In general, knee pain is either immediate(acute) or long-term (chronic). Acute kneepains can be caused by an acute injury orinfection. Chronic knee pain is often frominjuries or inflammation (such as arthritis)but can also be caused by infection.
    • Acute Knee PainSprained and Torn Cruciate LigamentsDescription: An anterior cruciate ligament (ACL) injury is acommon sports injury generally caused by a hard stop or aviolent twisting of the knee. The posterior cruciate ligament(PCL) is stronger than the ACL and much less commonlytorn. The PCL requires strong forces, such as thoseproduced when the dashboard strikes the knee in a caraccident, to tear. Due to these severe forces, PCL injury isoften associated with other ligamentand bone injuries.Symptoms: If you tear your ACL, you may hear a pop. Youwill also notice your knee give way or become unstable andfeel pain that is bad enough that you might feellike vomiting. This will, almost always, be followed bymarked knee swelling over the next couple of hoursbecause the ACL bleeds briskly when torn.Treatment: Surgical repair is recommended for high-levelathletes who demand optimal outcomes. Conservativetreatment and knee braces may prove sufficient for thosewho do not demand quite so much from their knees.
    • Tendon RupturesDescription: Both the quadriceps and patellar tendonsmay rupture partially or completely. A quadricepstendon rupture typically occurs in recreationalathletes older than 40 years (this is the injury formerPresident Clinton suffered while jogging), and apatellar tendon rupture typically occurs in youngerpeople who have had previous tendonitis or steroidinjections to the knee.Symptoms: Rupture of either the quadriceps orpatellar tendon causes pain (especially when trying tokick or extend the knee). Those people with completeruptures are unable to extend the knee. The patella isalso often out of place either upward (with patellartendon rupture) or downward (with quadriceps tendonrupture).Treatment: Tendon ruptures should be evaluatedurgently. Tendon ruptures generally require surgicalrepair. A partial rupture may be treated with splintingalone.
    • Meniscal InjuriesDescription: Injuries to the meniscus aretypically traumatic injuries but can also bedue to overuse. Often, a piece of themeniscus will tear off and float in the kneejoint.Symptoms: Meniscal injuries may cause theknee to lock in a particular position, or eitherclick or grind through its range of motion.Meniscal injuries may also cause the knee togive way. Swelling typically accompaniesthese symptoms although the swelling ismuch less severe than with an ACL injury.Treatment: Meniscal injuries often requirearthroscopic surgical repair. A locking knee ora knee that "gives" should be evaluated forarthroscopic repair.
    • Meniscal InjuriesDescription: Injuries to the meniscus aretypically traumatic injuries but can also bedue to overuse. Often, a piece of themeniscus will tear off and float in the kneejoint.Symptoms: Meniscal injuries may cause theknee to lock in a particular position, or eitherclick or grind through its range of motion.Meniscal injuries may also cause the knee togive way. Swelling typically accompaniesthese symptoms although the swelling ismuch less severe than with an ACL injury.Treatment: Meniscal injuries often requirearthroscopic surgical repair. A locking knee ora knee that "gives" should be evaluated forarthroscopic repair.
    • Knee DislocationDescription: Knee dislocation is a true limb-threatening emergency. This is also a rare injury.Dislocation of the knee is caused by a particularlypowerful blow to the knee. The lower legbecomes completely displaced with relation tothe upper leg. This displacement stretches andfrequently tears not only the ligaments of theknee but also arteries and nerves. Untreatedarterial injuries leave the lower leg without ablood supply. If circulation is notrestored, amputation may be required. Nerveinjuries, on the other hand, may leave the lowerleg viable but without strength or sensation.Symptoms: Knee dislocations are severely painfuland produce an obvious deformity of the knee.Many dislocations are reduced -- or put back intoalignment -- on their own. As this occurs, manywill report feeling a dull clunk.
    • Treatment: If the knee dislocation has not been put back into place on itsown, the doctor will immediately reduce the dislocation. Medicaltreatment, however, does not stop here. Whether a dislocation reduces byitself or is put back into place in the hospital, it requires further evaluationand care. After reduction, people with these injuries are observed in thehospital where they usually do a number of tests to ensure that no arterialor nerve injury has occurred. If such an injury is found, it must berepaired immediately in the operating room.Dislocated Kneecap (patella)Description: A common injury caused by direct trauma or forcefulstraightening of the leg, such as an injury that happens when serving involleyball or tennis. Kneecap dislocation is more common inwomen, theobese, knock-kneed people, and in those with high-ridingkneecaps.Symptoms: If you have this injury, you will notice the patella being out ofplace and may have difficulty flexing or extending your knee.Treatment: The doctor will move the patella back into place (reduce thedislocation). Even if the patella goes back into place by itself, however, itneeds to be X-rayed for a fracture. After reducing the patella and ensuringthe absence of a fracture, the doctors will treat these injuries by splintingthe knee for 3 weeks to allow the soft tissues around the patella to healfollowed by strengthening exercises to keep the patella in line. This injuryoften causes damage to the cartilage on the back of the patella.
    • Knee Pain PreventionKnee pain has a host of causes. Many typesof pain are difficult to prevent, but youcan do some general things to reduce thelikelihood of sustaining a knee injury.Stay SlimStaying slim reduces the forces placed onthe knee during both athletics andeveryday walking and may, according tosome medical research, reduceosteoarthritis.Keeping your weight down may also reducethe number of ligament and tendoninjuries for similar reasons.
    • Keep Limber, Keep FitMany knee problems are caused by tight orimbalanced musculature. Stretching andstrengthening, therefore, also help to preventknee pain.Stretching keeps your knee from being tootight and aids in preventing bothpatellofemoral syndrome and iliotibial bandsyndrome.Strengthening exercises particularly of thequadriceps (straight leg raises and legextensions are two excellent exercises, butplease see a book on exercise and training formore) can help prevent knee injury.
    • Exercise WiselyIf you have chronic kneepain, consider swimming or water exercises.In water, the force of buoyancy supports some ofour weight so our knees do not have to.If you dont have access to a pool or do not enjoywater activities, at least try to limit hardpounding and twisting activities such asbasketball, tennis, or jogging.You may find that your aching knees will act up ifyou play basketball or tennis every day but willnot if you limit your pounding sports to twice aweek.Whatever you do, respect and listen to your body.If it hurts, change what you are doing.If you are fatigued, consider stopping -- manyinjuries occur when people are tired.
    • Protect the KneeWearing proper protection for the activity athand can help avoid knee injuries.When playing volleyball or when layingcarpet, protecting your knees may includekneepads.When driving, knee protection may includewearing a seatbelt to avoid the knee-versus-dashboard injuries as well asinjuries to other parts of your body.