Janice’s Painful Knee

Janice’s Painful Knee

1. Anatomy of the knee

   • Articulations
   • Ligaments
   • Bursae
     • Medial view
     • Anterior view
   • Arteries
     • Genicular Anastamosis
   • Muscles of the leg
     • Anterior
     • Posterior
     • Lateral
   • Veins

2. Knee pain

   • causes
     • Injuries
       • ACL injury
       • Fractures
       • Torn meniscus
       • Knee bursitis
       • Patellar tendinitis
     • Mechanical Pain
       • Loose body
       • Iliotibial band syndrome
       • Dislocated kneecap
       • Hip or foot pain
     • Arthritis
       • Osteoarthritis
         • chronic disease characterized by progressive degeneration, destruction, and loss of articular cartilage.
           • Primary
             • in the elderly without an obvious cause
           • Secondary
             • Affects joints damaged by another disease
               • Pathology
                 • Progression
                   • Prognosis
                     • Unpredictable
                     • Depends on joint affected and progression
                     • 40% of old OA patients have x-ray evidence revealing significant OA in their hips and knees
                     • less than 5% will undergo joint replacement surgery.
         • Risk Factors
           • Local Risk Factors
             • Obesity
             • Injury/Surgery
             • Occupation
             • Physical Activity
             • Mechanical factors
             • Alignment
             • Laxity
           • Systemic Risk Factors
             • Age
             • Gender & Hormones
             • Race/Ethnicity
             • Genetics
             • Congenital Conditions
             • Diet
         • common clinical features
           • Pain, dull and deep seated
           • Stiffness of joints,
           • Crepitus, a sound elicited by the opposing joint surfaces
           • Swelling and effusion
           • Heberden nodes involving the finger joints
         • Complications
           • Chondrolysis
           • Osteonecrosis
           • Stress fractures
           • Loss of ability
           • Hemorrhage within the joint
           • Infection
           • Compression of vertebral artery
           • Osteophyte pressing on the esophagus
           • Atrophy
           • Baker’s Cyst (popliteal cysts)
         • Treatment and management
           • Non- pharmacological treatment
             • Life style
             • Exercise
             • Aids and appliances
             • Patient education
             • Heat and cold
             • Weight loss
           • pharmacological treatment
             • Glucosamine is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids
               • It is in the fluid that is around joints.
                 • Can be given to:
                   • Relief the pain within 4-8 weeks NSAIDS “ibuprofen” within
                   • Improve joint function
                   • Slow breakdown of joints
           • Surgery
             • knee Joint replacement
               • surgery to replace a knee joint with a man-made joint. The artificial joint is called a prosthesis.
                 • Recommended in
                   • Pain
                     • from sleeping or doing normal activities.
                   • cannot walk and take care of yourself.
                   • knee pain has not improved with other treatment
                   • understand what surgery and recovery will be like.
           • Unloading in certain joints (eg, knee, hip)
       • Rheumatoid arthritis
       • Gout
       • pseudogout
       • Septic arthritis
   • Signs and symptoms
     • Redness and warmth to the warmth
     • Swelling and stiffness
     • Weakness or instability
     • Popping or crunching noises
     • inability to fully straighten the knee

3. Physical Examination of the knee Joint

   • Introduction
     • (greeting-explaining-privacy-confidentiality-consent).
     • HEPA
       • H: hand washing
       • E: exposure.
       • P:position(patient) and gait
       • A: appearance.
   • Inspection
     • S: symmetry
     • S:skin (discoloration-scars-abnormal creases)
     • Shape
       • joint: swelling
       • Bone: deformity
       • .Muscle: wasting.
     • P: position(of the joint).
   • Palpation
     • Skin(temperature)
     • Muscle(wasting-spasms)
     • Blood vessels(pulse).
     • Bone(bony landmarks)
     • Joint(crepitus-space-swelling).
   • Range of Movements
     • Passive and active
       • Flexion (135 degrees or above).
       • Extension(0 degree).
   • Special tests
     • Anterior Drawer test
     • Posterior Drawer Test
     • Patellar Apprehension Test
     • Collateral ligaments stress test
     • Apley's grinding and distraction test

4. Radiology

   • • osteoarthritis
   • • Rheumatoid Arthritis
   • • gout

Images and files in the map