Knee Exam Aafp

• [FREE] Knee Exam Aafp | free!
  
  
  The Pittsburgh Knee Rule 2 recommends obtaining a radiograph for patients with a recent fall or blunt-trauma mechanism, those who are younger than 12 years or older than 50 years, and patients who are unable to take four weight-bearing steps in the...
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• [DOWNLOAD] Knee Exam Aafp
  
  
  The presence of any of these items is an indication for radiography. The Ottawa Knee Rule has been more extensively validated in a greater variety of adult populations 4 than other rules, and, therefore, was recommended in a systematic review 1 as...
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• Top Exams 2021
  Lachman test Top right. Stabilize the femur with one hand, and apply pressure to the back of the knee with the other hand with the thumb of the hand exerting pressure placed on the joint line. A positive test result is movement of the knee with a soft or mushy end point. Pivot test Bottom left. Fully extend the knee, rotate the foot internally. Apply a valgus stress while progressively flexing the knee, watching and feeling for translation of the tibia on the femur. McMurray test Bottom right. Flex the hip and knee maximally. Apply a valgus abduction force to the knee while externally rotating the foot and passively extending the knee. An audible or palpable snap during extension suggests a tear of the medial meniscus. For the lateral meniscus, apply a varus adduction stress during internal rotation of the foot and passive extension of the knee. Ann Intern Med ; Applying the Evidence A year-old man experienced a sudden severe pain in his left knee as he was carrying a couch up some stairs while pivoting on that leg.
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• Patellofemoral pain syndrome (runner's knee)
  He initially is able to ambulate, but later develops locking relieved by shaking his leg gently. On examination, he has a small effusion, no erythema, nearly normal range of motion, and slight joint line tenderness medially. There is no tenderness of the patella or head of the fibula. Answer Using the Ottawa Knee rule, a radiograph is not indicated. While he has negative results for anterior drawer, Lachman, and pivot tests for an ACL tear, he has a positive result for the McMurray test. Although his magnetic resonance imaging is negative for ligamentous or meniscal tear, a tear of the medial meniscus is discovered during arthroscopic exploration. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription.
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• A Tool for Evaluating Patients With Knee Injury
  On physical examination, a tender, mobile nodularity is present at the medial aspect of the knee, just anterior to the joint line. There is no joint effusion, and the remainder of the knee examination is normal. Radiographs are not indicated. Pes anserine bursitis is another possible cause of medial knee pain. The tendinous insertion of the sartorius, gracilis, and semi-tendinosus muscles at the anteromedial aspect of the proximal tibia forms the pes anserine bursa. Pes anserine bursitis can be confused easily with a medial collateral ligament sprain or, less commonly, osteoarthritis of the medial compartment of the knee.
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• Sports knee injuries
  The patient with pes anserine bursitis reports pain at the medial aspect of the knee. This pain may be worsened by repetitive flexion and extension. On physical examination, tenderness is present at the medial aspect of the knee, just posterior and distal to the medial joint line. No knee joint effusion is present, but there may be slight swelling at the insertion of the medial hamstring muscles. Valgus stress testing in the supine position or resisted knee flexion in the prone position may reproduce the pain. Radiographs are usually not indicated. Lateral Knee Pain Excessive friction between the iliotibial band and the lateral femoral condyle can lead to iliotibial band tendonitis. Tightness of the iliotibial band, excessive foot pronation, genu varum, and tibial torsion are predisposing factors. The patient with iliotibial band tendonitis reports pain at the lateral aspect of the knee joint. The pain is aggravated by activity, particularly running downhill and climbing stairs.
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• Joint Exam and Injections Course Description
  On physical examination, tenderness is present at the lateral epicondyle of the femur, approximately 3 cm proximal to the joint line. Soft tissue swelling and crepitus also may be present, but there is no joint effusion. Noble's test is used to reproduce the pain in iliotibial band tendonitis. 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.
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• Patellofemoral Pain Syndrome
  Pain symptoms are usually most prominent with the knee at 30 degrees of flexion. Popliteus tendonitis is another possible cause of lateral knee pain. However, this condition is fairly rare. Resultant valgus stress on the knee leads to anterior displacement of the tibia and sprain or rupture of the ligament. Swelling of the knee within two hours after the injury indicates rupture of the ligament and consequent hemarthrosis. On physical examination, 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 see text and Figure 3 in part I of this article 1. Radiographs are indicated to detect possible tibial spine avulsion fracture. MRI of the knee is indicated as part of a presurgical evaluation.
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• Approach to knee pain aafp
  Medial Collateral Ligament Sprain Injury to the medial collateral ligament is fairly common and is usually the result of acute trauma. 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. Valgus stress testing of the knee flexed to 30 degrees reproduces the pain see text and Figure 4 in part I of this article 1.
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• Meniscal tear
  A clearly defined end point on valgus stress testing indicates a grade 1 or grade 2 sprain, whereas complete medial instability indicates full rupture of the ligament grade 3 sprain. Lateral Collateral Ligament Sprain Injury of the lateral collateral ligament is much less common than injury of the medial collateral ligament. 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.
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• AAFP 3 Flashcards Preview
  On physical examination, point tenderness is present at the lateral joint line. Instability or pain occurs with varus stress testing of the knee flexed to 30 degrees see text and Figure 4 in part I of this article 1. Radiographs are not usually indicated. 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 physical examination, a mild effusion is usually present, and there is tenderness at the medial or lateral joint line. Atrophy of the vastus medialis obliquus portion of the quadriceps muscle also may be noticeable.
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• Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis
  The patient with septic arthritis reports abrupt onset of pain and swelling of the knee with no antecedent trauma. Even slight motion of the knee joint causes intense pain. Arthrocentesis reveals turbid synovial fluid. Common pathogens include Staphylococcus aureus, Streptococcus species, Haemophilus influenzae, and Neisseria gonorrhoeae. Hematologic studies show an elevated WBC, an increased number of immature polymorphonuclear cells i. Older Adults.
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• Examination of the Knee
  Nigel Hope Background Medial and lateral knee joint menisci serve to transfer load and absorb shock, aid joint stability and provide lubrication. The meniscus is the most commonly injured structure in the knee joint. Imaging techniques such as magnetic resonance imaging may be warranted but are no substitute for thorough clinical history and examination. Discussion Magnetic resonance imaging can confirm clinical concern for meniscal tear, review intra- and extra-articular anatomical structures and exclude alternative diagnoses.
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• Knee Physical Exam - Adult - Recon - Orthobullets
  Meniscal tears can be assessed arthroscopically for stability and vascularity. Even partial meniscectomy may lead to osteoarthritis. On the basis of the findings, treatment can be considered in terms of four Rs: Rest and Rehabilitate the patient with physiotherapy , and if the patient is not improving on Review, Refer to an orthopaedic surgeon. New experimental surgical techniques seek to replace damaged tissue. These include meniscal allograft transplantation, biosynthetic scaffolds, growth factor and gene therapy, or a combination of these. Injury of the knee joint meniscus is one of the most prevalent injuries in the human body.
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• A Tool for Evaluating Patients with a Knee Injury -- FPM
  Its investigation and treatment includes surgical techniques that are among the most commonly performed orthopaedic procedures worldwide. The past few decades have seen striking advances in our understanding of meniscal structure, function and the treatment of meniscal injuries. Attitudes toward total meniscectomy have undergone reversal in the past 30 years, and even today, practices are rapidly changing. Early, clinical examination, appropriate investigation and treatment of meniscal injuries may prevent later degenerative disease and inappropriate surgical treatment that can predispose to later degenerative change. This article outlines the aetiology, presentation, diagnosis both clinical and radiographic and management of these important injuries.
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• Approach to the Low Back Exam
  The menisci of the knee have several important roles: shock absorption and distributing load throughout the joint increasing stability providing nutrition for articular cartilage limiting extreme flexion and extension controlling the movements of the knee joint. The medial meniscus is more frequently torn, partly because of this different shape but also because of its attachment to the medial collateral ligament, whereas the lateral is pulled out of the way of compression between femur and tibia by politeus. Superior and inferior branches of the medial and lateral geniculate arteries supply the peripheral third of the menisci via the perimeniscal capillary plexus. In younger patients, this is typically a twisting force on a weightloaded flexed knee. These are often 'bucket-handle tears', in which there is a vertical or oblique tear in the posterior horn running toward the anterior horn,5 forming a loose section which remains attached anteriorly and posteriorly.
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• Knee Physical Exam - Adult
  The difference in tear type between these populations is explained by the three-dimensional fibrous structure of the meniscus: horizontal delamination occurs in degenerative injuries, while the fibrous structure is ruptured in a vertical fashion in younger patients. Meniscal tear incidence may be as high as six per population6 with a 2. Age of injury peaks at 20—29 years. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion.
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• Patellofemoral pain syndrome (runner's knee): Treatment and more
  The typical meniscal pain profile comprises well localised joint-line pain with medial pain generally being indicative of a medial tear and vice-versa. Meniscal pain occurs during torsional, weight bearing knee movements classically pivoting on the knee while walking as a sharp stab lasting several seconds, often followed by a dull ache for several hours. Pain may wake the patient from sleep as the tender medial aspect of the knee strikes the other side as the patient rolls over in bed. There is no resting pain. Locking presents in two ways. Most commonly it is impossible to fully extend the knee; more accurately described as stiffness termed 'pseudo locking' due either to a small effusion requiring increased force to bend the tense joint capsule or to pain inhibition as the femoral condyle compresses the torn meniscus.
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• AAFP SmartBrief
  True locking is less common, and suggests a bucket-handle tear, with the torn fragment preventing full extension. Weakness, grinding, instability or giving way rarely result from meniscal pathology. On examination, there may be joint effusion, joint line tenderness, and the joint is held in a flexed position. On MRI, meniscal tears are evident as a linear signal intensity that extends through the meniscal substance to a free edge17 Figure 4. Tears are typically vertical in young patients and horizontal in the elderly Figure 5. Magnetic resonance imaging can also be effectively used to estimate the vascular zone classification see Treatment of tears. Indications for specialist referral The absolute indication for specialist referral is the locked knee — loss of joint function necessitates surgical intervention. Referral is also indicated if the diagnosis is uncertain for review and to access MRI. In older patients, referral is appropriate if conservative management fails to improve symptoms.
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• RACGP - Sports knee injuries Assessment and management
  As the risk of osteoarthritis is increased if meniscal structures are not optimally functional,7 it may also be appropriate to refer all young patients for opinion if symptoms do not rapidly improve. Figure 1. McMurray test: The patient lies supine on the bed with the hip and knee both flexed. With the foot as close to the hip as possible, the clinician holds the knee joint with fingers along the joint line with one hand, and the other hand rotates the tibia internally and externally while extending and flexing the knee. Apley test grinding test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. The clinician applies axial pressure to the foot and rotates the tibia internally and externally. Thessaly test: The clinician holds the patient's outstretched hands for support, while the patient stands flat-footed with their knee flexed to 20 degrees and rotates their body and knee three times, internally and externally.
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• Low Back Exam, Approach to | Stanford Medicine 25 | Stanford Medicine
  The test is positive if symptoms are reproduced on rotation 10 Treatment Nonoperative treatments are an important part of the management of all patients, regardless of whether surgery is being considered. Immediate conservative measures include the RICE regimen: Rest with weight bearing as tolerated or with crutches Ice Compression bandaging Elevation of the affected limb to minimise acute swelling and inflammation. Longer term measures include activity modification, nonsteroidal antiinflammatory drugs NSAIDs and physiotherapy. Physiotherapy at two visits per week for at least 8 weeks is recommended. Nonoperative treatments are often successful in patients with certain types of tear — patients who have no loss of joint function, suffer minimal pain or swelling and are willing to reduce their activities — temporarily or in the long term.
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• ACL Injury - ACL Injury Symptoms & Treatment | medicoguia.com
  Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. This is termed the 'red-red zone' denoting area of vascularity. Damaged avascular meniscus must be removed. For patients requiring meniscectomy, meniscal autograft has been utilised with good outcomes,29—31 but is only performed in specialist centres.
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• Baker's cyst - Diagnosis and treatment - Mayo Clinic
  Research is currently investigating the possibility of implantation of collagen, allogenic and xenogenic cells, embryonic and adult stem cells, or scaffolds derived from polymers, hydrogels, tissues and extracellular matrix,7 and action of biological stimuli eg. Figure 4. Proton weighted sagittal image demonstrates an example of a posterior horn medial meniscal horizontal tear white arrow. The anterior horn of the medial meniscus demonstrates half of the normal anatomic 'bow-tie configuration'. Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface Figure 5. Coronal proton weighted MRI of horizontal tear of lateral meniscus white arrow with complicating ganglion black arrow at the lateral margin of the meniscus Key points Meniscal injury is common, and the medial meniscus is more frequently injured. Younger and elderly patients typically sustain different types of tears. Optimal diagnosis and management is essential to prevent long term sequelae.
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• The Hong Kong Practitioner
  The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. Magnetic resonance imaging is first line for investigating potential meniscal lesions, but should not replace thorough clinical history and examination. Conservative management is important in all patients with acute rest, intensive rehabilitation with physiotherapy and modification of activity. Referral to an orthopaedic surgeon is important if the diagnosis is uncertain or there is minimal improvement at clinical review. Conflict of interest: none declared. Apley's Concise System of Orthopaedics and Fractures. Great Britain: Hodder Arnold, Jarit G, Bosco J. Meniscal repair and reconstruction.
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