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Case Study 2

Knee OA with persistent lateral pain and painful limitation of the flexion,

Dynamic study
probe is placed transverse over lateral femoral condyle

at 90 degrees flexion the iliotibial band impinges between 2 osteophytes leading to severe pain and limitation of flexion,with extension the iliotibial band moves anterior and lateral away from the osteophytes with relief of pain.

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Case Study 2

  1. 1. *Female *53years * BMI: 35.53 kg/m2 * Chronic, Bilateral Asymmetric (LT>RT) mechanical Knee Pain *X-Ray: L-K G2 *Bilateral Knee OA *α-D-glucosamine 500mg cap twice daily + NSAIDS
  2. 2. Lt knee Pain  8/10 more on lateral side  10/10 With painful limitation of flexion not > 90 degrees actively
  3. 3. MRI LEFT KNEE -MILD Effusion and synovitis, -Osteophytes, -Cartilage defects at both femoral condyles and post patellar surface, -Intact menisci and cruciate ligaments .
  4. 4. Clinically -Effusion (moderate) -Tenderness along joint line more over lateral femoral condyle - Crepitus - -ve Ant. & Post. drawer , McMurray and Apley's Compression and Distraction Tests
  5. 5. Ultrasound study
  6. 6. Static scan
  7. 7. Main findings : 1- Suprapatellar pouch and 2 recesses : Moderate effusion + Synovial thickening and folding 2- Osteophytes 3- Meniscal subluxation (Med. meniscus)
  8. 8. TTT
  9. 9. 1-US guided Aspiration and IA steroids + HA injection at the same session  1 week  2nd US guided IA HA injection  1 week  3rd US guided IA HA injection Complete Relief of the diffuse knee pain, but persistent lateral knee pain and Limitation of flexion > 90 degrees
  10. 10. Ultrasound study
  11. 11. Static scan
  12. 12. Dynamic scan
  13. 13. Diagnosis
  14. 14. Iliotibial band impingement (between 2 osteophytes at lateral femoral condyle)
  15. 15. TTT
  16. 16. 1- Shock wave therapy Or 2- Surgery
  17. 17. Discussion
  18. 18. Anatomy
  19. 19. Biomechanics

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