Knee 膝关节运动损伤
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• Neg Lachman, Anterior Drawer, McMurray, varus stress
+ mild increased gap on valgus stress (compared to left) with good endpoint
Special Tests - ACL Injury
menisci
Meniscal zones
• White-white • Red-white • Red-red
Knee Exam Overview
Inspection Palpation Range of Motion Strength Neurovascular Special Tests
Quadriceps tendon Patellar tendon Medial & lateral patellar
retinaculua
MCL
LCL
Anatomy – Menisci 来自百度文库f the Knee
Medial meniscus Lateral meniscus
• Meniscal ligaments • Functions of the
popping, catching?) Associated instability? Swelling? Previous injuries or surgeries?
Case 1 - Exam
Inspection: Mild medial knee edema Palpation: + ttp medial knee ROM: can’t bend >80d Strength: mildly decreased Neurovascular: normal Special tests:
Delayed onset local medial edema, stiffness
Able to bear weight
Key Questions in the History
Mechanism of Injury? Acute or Chronic? Location and level of pain? Able to walk? Mechanical Symptoms? (Locking,
5 Ottawa Knee Rules
i.e. When to order a knee xray after acute injury
Age > 55 or < 18 Unable to walk TTP on PATELLA TTP on FIBULAR HEAD Unable to flex 90 deg
Case 1 - Imaging
Case 1 – Differential Diagnosis
More Likely
Less Likely
Meniscal Tear Ligamentous Injury
• Which ligament?
ACL PCL MCL LCL
Muscle Strain
MCL Sprain
Treatment?
MS3 Sports Medicine Workshop
Family Medicine Clerkship
Knee Problems
MS3 Family Medicine
Anatomy Review
FTeibmiaur
• Medial & lateral
Condyles
• GerEdpyic’sontudybleerscle • TPreoscahnlesaerrignreooavreea • ITnibteiarlcotunbdeyrloasrintyotch
1. Unable to bear weight
2. Can’t flex >90d
3. Patella TTP
4. Fibular head TTP
5. Age <18 or >55
6. All of the above
17% 17% 17% 17% 17% 17%
UnablFeiAtlblACougaloebfna’erPtt<aahfh1rtle8eeelawalxoedrabi>oTg>T9vT5hT0teP5Pd
Fracture Patellofemoral Pain Plica
MCL Sprain
What grade of sprain is likely present of the MCL?
25% 1. Grade 1: no laxity, but hurts 25% 2. Grade 2: mild laxity, still intact 25% 3. Grade 3: complete tear 25% 4. Grade 4: hurts like *^%*
Lachman Test
Special Tests - PCL Injury
Posterior Drawer Test
Sag Sign Quad-Active Test
Varus/Valgus stress for LCL and MCL Injury
Features that should prompt an xray after acute knee injury include:
Case 1 – Medial Right Knee Pain
16yo HS soccer player, previously healthy
Tackled from right side while running
Immediate onset of medial jt line pain
• Tibial plateau
P•atTeiblliaal spines
• Superior pole (base)
F•ibIunlfaerior pole (apex)
• MHeaddial & lateral facets • Neck
Anatomy – Major Ligaments & Tendons
+ mild increased gap on valgus stress (compared to left) with good endpoint
Special Tests - ACL Injury
menisci
Meniscal zones
• White-white • Red-white • Red-red
Knee Exam Overview
Inspection Palpation Range of Motion Strength Neurovascular Special Tests
Quadriceps tendon Patellar tendon Medial & lateral patellar
retinaculua
MCL
LCL
Anatomy – Menisci 来自百度文库f the Knee
Medial meniscus Lateral meniscus
• Meniscal ligaments • Functions of the
popping, catching?) Associated instability? Swelling? Previous injuries or surgeries?
Case 1 - Exam
Inspection: Mild medial knee edema Palpation: + ttp medial knee ROM: can’t bend >80d Strength: mildly decreased Neurovascular: normal Special tests:
Delayed onset local medial edema, stiffness
Able to bear weight
Key Questions in the History
Mechanism of Injury? Acute or Chronic? Location and level of pain? Able to walk? Mechanical Symptoms? (Locking,
5 Ottawa Knee Rules
i.e. When to order a knee xray after acute injury
Age > 55 or < 18 Unable to walk TTP on PATELLA TTP on FIBULAR HEAD Unable to flex 90 deg
Case 1 - Imaging
Case 1 – Differential Diagnosis
More Likely
Less Likely
Meniscal Tear Ligamentous Injury
• Which ligament?
ACL PCL MCL LCL
Muscle Strain
MCL Sprain
Treatment?
MS3 Sports Medicine Workshop
Family Medicine Clerkship
Knee Problems
MS3 Family Medicine
Anatomy Review
FTeibmiaur
• Medial & lateral
Condyles
• GerEdpyic’sontudybleerscle • TPreoscahnlesaerrignreooavreea • ITnibteiarlcotunbdeyrloasrintyotch
1. Unable to bear weight
2. Can’t flex >90d
3. Patella TTP
4. Fibular head TTP
5. Age <18 or >55
6. All of the above
17% 17% 17% 17% 17% 17%
UnablFeiAtlblACougaloebfna’erPtt<aahfh1rtle8eeelawalxoedrabi>oTg>T9vT5hT0teP5Pd
Fracture Patellofemoral Pain Plica
MCL Sprain
What grade of sprain is likely present of the MCL?
25% 1. Grade 1: no laxity, but hurts 25% 2. Grade 2: mild laxity, still intact 25% 3. Grade 3: complete tear 25% 4. Grade 4: hurts like *^%*
Lachman Test
Special Tests - PCL Injury
Posterior Drawer Test
Sag Sign Quad-Active Test
Varus/Valgus stress for LCL and MCL Injury
Features that should prompt an xray after acute knee injury include:
Case 1 – Medial Right Knee Pain
16yo HS soccer player, previously healthy
Tackled from right side while running
Immediate onset of medial jt line pain
• Tibial plateau
P•atTeiblliaal spines
• Superior pole (base)
F•ibIunlfaerior pole (apex)
• MHeaddial & lateral facets • Neck
Anatomy – Major Ligaments & Tendons