Knee injuries Dr Abir Naguib. Knee pain is the most common musculoskeletal complaint (1/3) Source of...
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Transcript of Knee injuries Dr Abir Naguib. Knee pain is the most common musculoskeletal complaint (1/3) Source of...
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
Differential diagnosis of knee pain is extensive
Accurate diagnosis can be achieved by localizing the anatomic site of pain &
patient’s age
•Fracture•Ligament sprain•Tendon rupture•Meniscal tear•Patellar dislocation
Trauma
History1.Pain characteristics:
Onset- location- duration- severity- quality- aggravating and relieving factors
2. Mechanical symptoms:
Pop
Locking
Giving way
5. History of previous injury
3. Effusion:Timing and amount
4. Ability to continue playing
Exclude referred pain (hip injury)
6. Mechanism of injury
Contact (Direction of
blow)
Non-contact(position of knee)
TwistingHyperextension
Deceleration
Non-contact injury
Hyperextension injury
Examination:
Inspection: Swelling (location) Ecchymosis Atrophy
Palpation: Tenderness
ROM
Stability tests
Joint line
Ligament courseActive
passive
Investigations
•RadiologicalX-ray, CT, MRI
•Aspiration(painful swollen joint)Clear yellowBloodBlood + fat droplets
•Arthroscopy
MCL injury
•CO:
Pop at time of injury
Pain , swelling (medial)
•OE:
Tenderness, swelling along ligament course
Valgus stress test
LCL injury
Uncommon
Mechanism: blow to medial aspect knee
Varus force
Similar: (lateral)
Varus stress test
ACL injury
PopImmediate swellingGiving way
Anterior drawer test
Lachman test
ACL
PCL injury
• CO: insecurity of knee
• OE: abrasion on proximal tibia (anterior)
mild swelling posterior drawer test
Posterior sag sign
PCL
Meniscal tear
CO: Pain after quick twisting or squatting
Locking
OE: Swelling
Joint line tenderness
McMurray test
Meniscal tear
Extensor mechanism injury
Quadriceps tendon rupture
Patellar tendon rupture
Patellar instability
Quadriceps tendon ruptureAged, 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
Quadriceps 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 instabilitySubluxation – Dislocation
Mechanism: direct blow, forceful Q contraction
CO: Buckling Anterior knee painDifficulty extending knee
OE: Swelling (effusion-hemarthrosis) Tenderness medial patella
Apprehension signDD: history & X-ray
Young adults
In almost 90% of knee injuries an accurate diagnosis can be reached through thorough history taking and careful clinical examination.
Thank you