This document provides guidance on evaluating and diagnosing knee pain. It begins by describing how to take a history regarding pain characteristics, mechanical symptoms, injury mechanism, and medical history. Examination involves inspection for swelling/bruising, palpation for tenderness and effusion, and movement tests including range of motion and specialized tests for ligaments and meniscus. Differential diagnoses are provided for different populations, including overuse injuries, trauma, infection, and arthritis. Specific conditions like patellofemoral pain, meniscal tears, and osteoarthritis are described in terms of typical presentation, examination findings, and initial testing.
Knee pain is an extremely common complaint, and there are many causes.
Family physicians, Orthopedic surgeons and internist, Pediatricians and other doctors frequently encounter patients with knee pain.
Approach to Knee Pain I Dr.RAJAT JANGIR JAIPUR
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To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Knee pain is an extremely common complaint, and there are many causes.
Family physicians, Orthopedic surgeons and internist, Pediatricians and other doctors frequently encounter patients with knee pain.
Approach to Knee Pain I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
Tendoachilles rupture and its managementRohan Vakta
Achilles tendon is the strongest tendon of body. There are many causes of its rupture. It can be acute or chronic rupture. Management of chronic rupture by semitendinosus tendon is mentioned here.
Clinical examination notes based on TU/KU curriculum of MBBS in nepal. Hope this will be very much helpful in step wise approach to you people especially during exam time.
Knee pain is a very common condition. Traditional measures only address symptoms while the underlying cause is still present. Find out why and what additional steps need to be taken.
Learn more at www.HyProCure.com.
references:
Campbell’s operative orthopaedics 11th edition
Text book of orthopaedics & fractures 5th edition Dr B. Aalami Harandi
Gray’s anatomy 2nd edition
Clinical anatomy Richard S. Snell
Clinical examination notes based on TU/KU curriculum of MBBS in nepal. Hope this will be very much helpful in step wise approach to you people especially during exam time.
Knee pain is a very common condition. Traditional measures only address symptoms while the underlying cause is still present. Find out why and what additional steps need to be taken.
Learn more at www.HyProCure.com.
references:
Campbell’s operative orthopaedics 11th edition
Text book of orthopaedics & fractures 5th edition Dr B. Aalami Harandi
Gray’s anatomy 2nd edition
Clinical anatomy Richard S. Snell
MRI imaging of knee joint -- from radiological anatomy to pathology. inspired from my dear professor Mamdouh Mahfouz, professor of radio diagnosis - Cairo university.
Visit my Blog for more on Dentistry and Medicine :
http://dentistryandmedicine.blogspot.com/
Free Download e Books,PPT's and Lecture notes
Contents
Knee Joint anatomy with Diagrams
Anatomical Components of Knee
Anatomy of Patella
Innervations of the Knee
Knee Movements
Osteoarthritis in the Knee
Management of Disorders in Knee joint
What/Where is the true source of PFP?
What theories do we use for diagnosing PFP and how does literature support the theories?
How can we better treat “PFPS” patients through a more thorough evaluation and the developing classifications of PF disorders?
Quick and effective way to use right nutrition,supplements and exercises on a daily basis. I tested all supplements on my body many times and from my own experience I can say one things that it helps me a lot to fully recover after sustained injury.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
How to Give Better Lectures: Some Tips for Doctors
Approach knee pain
1. Approach to Knee pain
Dr. Faisal Al Hadad
Consultant of Family Medicine
& Occupational Health
PSMMC
2. History
PAIN CHARACTERISTICS
Onset (rapid or insidious)
Location (anterior, medial, lateral, or posterior)
Duration
Severity
Quality (e.g., dull, sharp, achy)
Aggravating and alleviating factors
Whether the patient was able to continue activity or
bear weight after acute injury or was forced to cease
activities immediately.
4. History
MECHANISM OF INJURY
if the patient sustained a direct blow to the knee
if the foot was planted at the time of injury
if the patient was decelerating or stopping suddenly
if the patient was landing from a jump
if there was a twisting component to the injury
if hyperextension occurred.
5. History
MEDICAL HISTORY
History of knee injury or surgery.
Previous attempts to treat knee pain, including the
use of medications, supporting devices, and physical
therapy.
History of gout, pseudogout, rheumatoid arthritis, or
other degenerative joint disease.
6. Ottawa knee rules
A knee x-ray is only required for knee injury patients with any of
:these findings
age 55 or over
isolated tenderness of the patella (no bone tenderness of the
knee other than the patella)
tenderness at the head of the fibula
inability to flex to 90 degrees
inability to weight bear both immediately and in the casualty
department .
10. Children and Adolescents
Patellar subluxation
Tibial apophysitis (Osgood- Schlatter lesion)
Patellar tendonitis (Jumper’s knee)
Slipped capital femoral epiphysis
11. PATELLAR SUBLUXATION
Occurs
more often in teenage girls
Presents
knee.
Pain
test.
with giving-way episodes of the
is reproduced by patellar apprehension
12. TIBIAL APOPHYSITIS
The typical patient is a 13- or 14-year-old boy (or a 10- or 11-yearold girl) who has recently gone through a growth spurt.
Presents with anterior knee pain localized to the tibial tuberosity.
The pain worsens with squatting, walking up or down stairs, or
forceful contractions of the quadriceps muscle.
On PE, the tibial tuberosity is tender and swollen, and may feel
warm. The knee pain is reproduced with resisted active extension
or passive hyperflexion of the knee.
Radiographs are usually negative; rarely, they show avulsion of the
apophysis at the tibial tuberosity.
13. PATELLAR TENDONITIS
Most commonly occurs in teenage boys, particularly during a
growth spurt.
The patient reports vague anterior knee pain that has persisted
for months and worsens after activities such as walking down
stairs or running.
On PE, the patellar tendon is tender, and the pain is reproduced
by resisted knee extension.
Radiographs are not indicated.
14. SLIPPED CAPITAL FEMORAL
EPIPHYSIS
Most commonly occurs in overweight teenagers
The patient usually reports poorly localized knee pain.
The affected hip is slightly flexed and externally rotated. Hip pain is
elicited with passive internal rotation or extension of the hip.
Radiographs typically show displacement of the epiphysis of the
femoral head. However, negative radiographs do not rule out the
diagnosis in patients with typical clinical findings. CT scanning is
indicated in these patients.
16. Patellofemoral pain syndrome
Patients typically present with a vague history of mild to moderate
anterior knee pain that usually occurs after prolonged periods of sitting
(“theater sign”).
On PE, a slight effusion may be present, along with patellar crepitus on
range of motion.
The patient’s pain may be reproduced by applying direct pressure at the
anterior aspect of the patella. Patellar tenderness may be elicited by
subluxing the patella medially or laterally and palpating the superior and
inferior facets of the patella.
Radiographs usually are not indicated.
17. Medial plica syndrome
The plica, a redundancy of the joint synovium medially, can
become inflamed with repetitive overuse
The patient presents with acute onset of medial knee pain after a
marked increase of usual activities.
On PE, a tender,mobile nodularity is present at the medial aspect
of the knee, just anterior to the joint line.
Radiographs are not indicated.
18. .Iliotibial band tendonitis
Commonly occurs in runners and cyclists, although it may develop in
any person subsequent to activity involving repetitive knee flexion.
The patient reports pain at the lateral aspect of the knee joint
aggravated by activity, particularly running downhill and climbing
stairs.
On PE, tenderness is present at the lateral epicondyle of the femur.
Noble’s test is used to reproduce the pain. With the patient in a
supine position, the physician places a thumb over the lateral
femoral epicondyle as the patient repeatedly flexes and extends the
knee.
Radiographs are not indicated.
19. Trauma
Anterior Cruciate Ligament Sprain.
Injury to the anterior cruciate ligament usually occurs because of noncontact
deceleration forces, as when a runner plants one foot and sharply turns in the
opposite direction. Resultant valgus stress on the knee leads to anterior
displacement of the tibia and sprain or rupture of the ligament.
The patient usually reports hearing or feeling a “pop” at the time of the injury, and
must cease activity or competition immediately. Swelling of the knee within two
hours after the injury indicates rupture of the ligament and consequent
hemarthrosis.
On PE, the patient has a moderate to severe joint effusion that limits range of
motion. The anterior drawer test may be positive, but can be negative because of
hemarthrosis and guarding by the hamstring muscles. The Lachman test should be
positive and is more reliable than the anterior drawer test.
Radiographs are indicated to detect possible tibial spine avulsion fracture. MRI of
the knee is indicated as part of a presurgical evaluation.
20. Trauma
Medial Collateral Ligament Sprain
The patient reports a misstep or collision that places
valgus stress on the knee, followed by immediate onset of
pain and swelling at the medial aspect of the knee.
On PE, the patient with medial collateral ligament injury
has point tenderness at the medial joint line. Valgus
stress testing of the knee reproduces the pain .
21. Trauma
Lateral Collateral Ligament Sprain
Lateral collateral ligament sprain usually results from varus stress to
the knee, as occurs when a runner plants one foot and then turns
toward the ipsilateral knee.
The patient reports acute onset of lateral knee pain that requires
prompt cessation of activity.
On PE, point tenderness is present at the lateral joint line. Instability or
pain occurs with varus stress testing of the knee.
Radiographs are not usually indicated.
22. Trauma
Meniscal Tear.
The meniscus can be torn acutely with a sudden twisting injury of the
knee, such as may occur when a runner suddenly changes direction.
The patient usually reports recurrent knee pain and episodes of catching
or locking of the knee joint, especially with squatting or twisting of the
knee.
On PE, a mild effusion is usually present, and there is tenderness at the
medial or lateral joint line. Atrophy of the the quadriceps muscle also may
be noticeable. The McMurray test may be positive, but a negative test
does not eliminate the possibility of a meniscal tear.
MRI is the radiologic test of choice because it demonstrates most
significant meniscal tears.
23. INFECTION
Infection of the knee joint may occur in patients of any age but
is more common in those whose immune system has been
weakened by cancer, diabetes mellitus, alcoholism, acquired
immunodeficiency syndrome, or corticosteroid therapy.
The patient with septic arthritis reports abrupt onset of pain and
swelling of the knee with no antecedent trauma.
On PE, the knee is warm, swollen, and exquisitely tender. Even
slight motion of the knee joint causes intense pain.
24. Synovial fluid analysis
Arthrocentesis reveals turbid synovial fluid.
Analysis of the fluid yields a WBC count higher than 50,000 per
mm3 with more than 75 percent PMN cells, an elevated protein
content , and a low glucose concentration.
Gram stain of the fluid may demonstrate the causative
organism.
Hematologic studies show an elevated WBC, an increased
number of immature PMN cells (i.e., a left shift), and an
elevated ESR.
26. OSTEOARTHRITIS
The patient presents with knee pain that is aggravated by weightbearing activities and relieved by rest.
The patient usually awakens with morning stiffness that dissipates
somewhat with activity. In addition to chronic joint stiffness and
pain, the patient may report episodes of acute synovitis.
Findings on PE include decreased range of motion, crepitus, a mild
joint effusion, and palpable osteophytic changes at the knee joint.
Weight-bearing radiograph is recommended. Radiographs show
joint-space narrowing, subchondral bony sclerosis, cystic changes,
and hypertrophic osteophyte formation
27. CRYSTAL-INDUCED INFLAMMATORY
ARTHROPATHY
Patient with gout or pseudogout presents with pain, and
swelling in the absence of trauma
On PE, the knee joint is erythematous, warm, tender, and
swollen. Even minimal range of motion is exquisitely painful.
Microscopy of the synovial fluid displays negatively birefringent
rods in the patient with gout and positively birefringent
rhomboids in the patient with pseudogout.
28. (Popliteal cyst (Baker’s cyst
The patient reports insidious onset of mild to moderate
pain in the popliteal area of the knee
On PE, palpable fullness is present at the medial aspect
of the popliteal area. The McMurray test may be positive if
the medial meniscus is injured.
Definitive diagnosis of a popliteal cyst may be made with
arthrography, ultrasonography, CT scanning, MRI.