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Knee injuries. Dr Abir Naguib. Knee pain is the most common musculoskeletal complaint (1/3) Source of significant disability Most prevalent in physically active individuals.

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Knee injuries


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Presentation Transcript
knee injuries

Knee injuries

Dr Abir Naguib

slide2

Knee pain is the most common musculoskeletal complaint (1/3)

  • Source of significant disability
  • Most prevalent in physically active individuals
slide3

Differential diagnosis of knee pain is extensiveAccurate diagnosis can be achieved by localizing the anatomic site of pain & patient’s age

slide6

Trauma

  • Fracture
  • Ligament sprain
  • Tendon rupture
  • Meniscal tear
  • Patellar dislocation
slide7

History

  • Pain characteristics:
  • Onset- location- duration- severity- quality- aggravating and relieving factors
  • 2. Mechanical symptoms:
  • Pop
  • Locking
  • Giving way
slide8

3. Effusion:

Timing and amount

4. Ability to continue playing

5. History of previous injury

Exclude referred pain (hip injury)

slide9

6. Mechanism of injury

Contact

(Direction of blow)

Non-contact

(position of knee)

Twisting

Hyperextension

Deceleration

slide12

Examination:

Inspection:

Swelling (location)

Ecchymosis

Atrophy

Palpation:

Tenderness

ROM

Stability tests

Joint line

Ligament course

Active

passive

slide13

Investigations

  • Radiological
  • X-ray, CT, MRI
  • Aspiration
  • (painful swollen joint)
  • Clear yellow
  • Blood
  • Blood + fat droplets
  • Arthroscopy
slide15

CO:

  • Pop at time of injury
  • Pain , swelling (medial)
  • OE:
  • Tenderness, swelling along ligament course
  • Valgus stress test
lcl injury
LCL injury

Uncommon

Mechanism: blow to medial aspect knee

Varus force

Similar: (lateral)

Varus stress test

acl injury
ACL injury

Pop

Immediate swelling

Giving way

slide23
CO:insecurity of knee
  • OE:abrasion on proximal tibia (anterior)

mild swelling

posterior drawer test

slide26

Meniscal tear

CO:Pain after quick twisting or squatting

Locking

OE:Swelling

Joint line tenderness

McMurray test

slide29

Extensor mechanism injury

Quadriceps tendon rupture

Patellar tendon rupture

Patellar instability

slide30

Quadriceps tendon rupture

Aged, poorly conditioned (descending,jumping)

CO:severe anterior knee pain

snap

fall suddenly

OE:swelling, tenderness (local)

Palpable gap proximal to patella

inability to extend knee

patellar tendon rupture
Patellar tendon rupture

young athletic patients

eccentric loading of quadriceps

OE: Swelling, tenderness

palpable defect at distal pole patella

Impaired knee extension

patellar instability
Patellar instability

Subluxation – Dislocation

Young adults

Mechanism:direct blow, forceful Q contraction

CO:Buckling

Anterior knee pain

Difficulty extending knee

OE:Swelling (effusion-hemarthrosis)

Tenderness medial patella

Apprehension sign

DD: history & X-ray

slide39

In almost 90% of knee injuries an accurate diagnosis can be reached through thorough history taking and careful clinical examination.