膝关节运动损伤PPT课件

MS3SportsMedicineWorkshopFamilyMedicineClerkshipKneeProblemsMS3FamilyMedicineAnatomyReviewFemur•Medial&lateralCondylesEpicondyles•Trochleargroove•IntercondylarnotchPatella•Superiorpole(base)•Inferiorpole(apex)•Medial&lateralfacetsTibia•Medial&lateralCondyles•Gerdy’stubercle•Pesanserinearea•Tibialtuberosity•Tibialplateau•TibialspinesFibula•Head•NeckAnatomy–MajorLigaments&TendonsQuadricepstendonPatellartendonMedial&lateralpatellarretinaculuaMCLLCLAnatomy–MeniscioftheKneeMedialmeniscusLateralmeniscus•Meniscalligaments•FunctionsofthemenisciMeniscalzones•White-white•Red-white•Red-redKneeExamOverviewInspectionPalpationRangeofMotionStrengthNeurovascularSpecialTestsCase1–MedialRightKneePain16yoHSsoccerplayer,previouslyhealthyTackledfromrightsidewhilerunningImmediateonsetofmedialjtlinepainDelayedonsetlocalmedialedema,stiffnessAbletobearweightKeyQuestionsintheHistoryMechanismofInjury?AcuteorChronic?Locationandlevelofpain?Abletowalk?MechanicalSymptoms?(Locking,popping,catching?)Associatedinstability?Swelling?Previousinjuriesorsurgeries?Case1-ExamInspection:MildmedialkneeedemaPalpation:+ttpmedialkneeROM:can’tbend80dStrength:mildlydecreasedNeurovascular:normalSpecialtests:•NegLachman,AnteriorDrawer,McMurray,varusstress+mildincreasedgaponvalgusstress(comparedtoleft)withgoodendpointSpecialTests-ACLInjuryLachmanTestSpecialTests-PCLInjuryPosteriorDrawerTestSagSignQuad-ActiveTestVarus/ValgusstressforLCLandMCLInjuryFeaturesthatshouldpromptanxrayafteracutekneeinjuryinclude:UnabletobearweightCan’tflex90dPatellaTTPFibularheadTTPAge18or55Alloftheabove17%17%17%17%17%17%1.Unabletobearweight2.Can’tflex90d3.PatellaTTP4.FibularheadTTP5.Age18or556.Alloftheabove5OttawaKneeRulesi.e.WhentoorderakneexrayafteracuteinjuryAge55or18UnabletowalkTTPonPATELLATTPonFIBULARHEADUnabletoflex90degCase1-ImagingCase1–DifferentialDiagnosisMoreLikelyLessLikelyMeniscalTearLigamentousInjury•Whichligament?ACLPCLMCLLCLMuscleStrainFracturePatellofemoralPainPlicaMCLSprainWhatgradeofsprainislikelypresentoftheMCL?25%25%25%25%1.Grade1:nolaxity,buthurts2.Grade2:mildlaxity,stillintact3.Grade3:completetear4.Grade4:hurtslike*^%*MCLSprainTreatment?•RICE•RelativeRest•HingeBraceonlyifunstableonexam•AchievefullROM•ProgressiveStrengthening•NeuromuscularControl(Balanceexercises)•FunctionalExercises(Sport-specific)Case256yoretiredArmyLTC15yearsworseningLRkneepainFormerparachutist,nospecifictraumaNopreviouskneesurgeriesStiffnessworseinmorningPainisworsewithactivity,betterwithrestCase2–KeyQuestionsMechanismofInjury?AcuteorChronic?Where/howbadispain?MechanicalSymptoms?(Locking,popping,catching?)Associatedinstability?Swelling?Previousinjuriesorsurgeries?Whatmakesitworse?Whatmakesitbetter?InsidiousOnsetChronicDifficulttolocalize;mildNoNoneOccasionalLotsof“BadLandings”NosurgeryActivityRestCase2–PhysicalExamInspection:•Genuvarus•BonyenlargementatMed/LatjointlinesPalp:PosteriormedialjointlinettpROM:Decreasedflexion,110deg,mildcrepitusStrength:normalNeurovascular:normalSpecialTests:noligamentouslaxity,negmeniscaltestsSpecialTests-MeniscalInjuriesJointlinetendernessMcMurrayTestsThessalytestBounce-hometestFullSquatCase2–PlainFilmsJointspacenarrowingSubchondralSclerosisOsteophytesSubchondralCystsWhatisyourdiagnosis?MeniscaltearPlicasyndromeOsteoarthritisBonetumor25%25%25%25%1.Meniscaltear2.Plicasyndrome3.Osteoarthritis4.BonetumorOsteoarthritisNonpharmacologicTreatment:•Nonpainfulaerobicactivity•Weightloss•PhysicalTherapyImproveROM,increasestrength•BracingPharmacologicTreatment:•APAP•SupplementsGlucosamineandChondroitin•NSAIDs,COX-2’s•Tramadol•Viscosupplementation•IntrarticularSteroidsCase331yearoldfemale,LkneepainRecreationalrunnerLocalizespaintofrontofkneeNotrauma,insidiousonsetLocalizespain“aroundkneecap”WorsewithstairsWorseafterprolongedsittingKneeoccasionally“givesout”Case3–KeyQuestionsMechanismofInjury?AcuteorChronic?Whereisthepain?MechanicalSymptoms?(Locking,popping,catching?)Associatedinstability?Swelling?Previousinjuriesorsurgeries?Whatmakesitworse?Whatmakesitbetter?InsidiousOnsetChronicAnteriorkneeNo,butsometimesgivesoutNoneNoneNoneRunning,StairsMultipledaysofrestPhysicalExamInspection:mildgenuvalgusPalpation:TTPlateralmedialpatellarfacetsROM:fullw/opainStrength:normalNeurovascular:normalSpecialTests:•+patellargrind•Decreasedpatellarglide•Inflexiblehamstrings(Poplitealangle)PatellofemoralJointExamPatellofemoralJointExamPatellarGrindTestCase3–PlainFilmsAPLateralCase3–PlainFilmsTunnelSunriseWhat’syourdiagnosis?PatellartendinopathyPatellarinstabilityPatellofemoralsyndromePlicasyndrome25%25%25%25%1.Patellartendinopathy2.Patellarinstability3.Patellofemoralsyndrome4.PlicasyndromePatellofemoralSyndromeTreatment:•Relativerest;non-painfulaerobics•PhysicalTherapyImproveQuad/HamstringflexibilityQuad,HipabductorstrengtheningCorestrengthening•Patellarstabilizationbrace/taping•Footorthotics•Surgery(last-ditcheffort)Case434yoArmyMAJtrainingfor1stmar