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Knee injuries

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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  1. Knee injuries Dr Abir Naguib

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

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

  4. Trauma • Fracture • Ligament sprain • Tendon rupture • Meniscal tear • Patellar dislocation

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

  6. 3. Effusion: Timing and amount 4. Ability to continue playing 5. History of previous injury Exclude referred pain (hip injury)

  7. 6. Mechanism of injury Contact (Direction of blow) Non-contact (position of knee) Twisting Hyperextension Deceleration

  8. Non-contact injury

  9. Hyperextension injury

  10. Examination: Inspection: Swelling (location) Ecchymosis Atrophy Palpation: Tenderness ROM Stability tests Joint line Ligament course Active passive

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

  12. MCL injury

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

  14. LCL injury Uncommon Mechanism: blow to medial aspect knee Varus force Similar: (lateral) Varus stress test

  15. ACL injury Pop Immediate swelling Giving way

  16. Anterior drawer test

  17. Lachman test

  18. ACL

  19. PCL injury

  20. CO:insecurity of knee • OE:abrasion on proximal tibia (anterior) mild swelling posterior drawer test

  21. Posterior sag sign

  22. PCL

  23. Meniscal tear CO:Pain after quick twisting or squatting Locking OE:Swelling Joint line tenderness McMurray test

  24. Meniscal tear

  25. Extensor mechanism injury Quadriceps tendon rupture Patellar tendon rupture Patellar instability

  26. 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

  27. Quadriceps tendon rupture

  28. Patellar tendon rupture young athletic patients eccentric loading of quadriceps OE: Swelling, tenderness palpable defect at distal pole patella Impaired knee extension

  29. 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

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

  31. Thank you

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