Janice's painful knee

Janice's painful knee

1. 55 YO Philippines Teacher

   • History Taking
     • Physical examination
       • Investigations
         • X-ray
         • CBC
           • Normal
         • Arthrocentesis
           • Normal levels of Uric Acid
           • Normal levels of Calcium pyrophosphate dehydrate crystals
       • Vitals
         • Normal
           • No fever
         • Overweight
       • Look
         • Modrate swollen knee
       • Feel
         • Tenderness on joint line
       • Move
         • Decreased ROM
         • Crepitus
       • Special Tests
         • Patellar tap
           • Absence of free fluid
         • Anterior & posterior Drawer Tests
         • Distraction and Grinding Apley's tests
     • Onset
       • Chronic for years
       • No history of trauma
       • No history of infection
     • Location
       • Knee Joint
     • Quality & Quantity
       • Severe aching pain and soreness
       • Morning stiffness <20 mins
     • Family History
       • her mother's Osteoarthritis
         • +
     • Aggravating & Alleviating factors
       • worsen with walking and using the stairs
       • Paracetamol Didn't help
       • Worse at night
   • Differential Diagnosis
     • Septic Arthritis
       • --
     • Tuberculosis arthritis
       • --
       • No weight loss
       • No muscles spasm \ wasting
     • Autoimmune Arthritis
       • --
       • Commonly Rheumatoid Arthritis
         • Systemic \ inflammation \ general weakness
     • Gout
       • --
     • Psuedogout
       • --
     • Osteoarthritis
       • Risk Factors
         • Aging
         • Female gender
         • Joint alignment
         • Heredity gene defects
         • Obesity
         • Traumatic injury
       • Pathogenesis
         • Management
           • surgery
             • Arthroplasty
               • PKR
               • TKR
             • Osteotomy
             • Arthrodesis
           • Alternative
             • Stem cells therapy \ chondrocytes implantation
             • Physical therapy
             • Hydrotherapy
           • pharmacological
             • NSAID's
             • Vitamins & supplements
             • injections in the joint space
         • Affected structures
           • 1) Cartilage
             • 2) Bones
               • 3) Ligaments
                 • 4) Muscles
                   • Nociceptors are stimulated and severe pain is felt , patients will avoid using the joints and muscles atrophy can happen
                 • They undergo fibrous denervation
               • subchondral bone is exposed and direct contact lead to bone Eburnation occur
                 • multiple microfractures in which the synovial fluid is forced in and subchodral cysts are seen
                   • Deposition of bone forming cell and osteophytes are created
                     • palpated bony hypertrophy
                       • Heberdens & Bouchard's nodules
                     • Osteophytes
                   • Cysts
             • Histology
             • Erosion and fibrillation occur in which splitting , softening and fragmemntation of the articular cartilages
               • Disturbed proteoglycans \ collagen relation and water is attracted
               • Decreased joint space
           • Knee Joint
             • Lateral and medial menisci
             • Femur , Tibia & fibula
             • Collateral ligaments and cruciate ligaments
             • many related muscles but mainly the quadriceps
         • most common degenerative in the joints and involve articular cartilage destruction
     • Heamarthrosis
       • --
       • No bleeding disorders
       • No tingling pain

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