Janice’s Painful Knee

Anatomy of the knee
1. Articulations
2. Ligaments
3. Bursae
  1. Medial view
  2. Anterior view
4. Arteries
  1. Genicular Anastamosis
5. Muscles of the leg
  1. Anterior
  2. Posterior
  3. Lateral
6. Veins
Knee pain
1. causes
  1. Injuries
    1. ACL injury
    2. Fractures
    3. Torn meniscus
    4. Knee bursitis
    5. Patellar tendinitis
  2. Mechanical Pain
    1. Loose body
    2. Iliotibial band syndrome
    3. Dislocated kneecap
    4. Hip or foot pain
  3. Arthritis
    1. Osteoarthritis
      1. 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.
      2. 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
      3. 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
      4. 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)
      5. 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)
    2. Rheumatoid arthritis
    3. Gout
    4. pseudogout
    5. Septic arthritis
2. Signs and symptoms
  1. Redness and warmth to the warmth
  2. Swelling and stiffness
  3. Weakness or instability
  4. Popping or crunching noises
  5. inability to fully straighten the knee
Physical Examination of the knee Joint
1. Introduction
  1. (greeting-explaining-privacy-confidentiality-consent).
  2. HEPA
    1. H: hand washing
    2. E: exposure.
    3. P:position(patient) and gait
    4. A: appearance.
2. Inspection
  1. S: symmetry
  2. S:skin (discoloration-scars-abnormal creases)
  3. Shape
    1. joint: swelling
    2. Bone: deformity
    3. .Muscle: wasting.
  4. P: position(of the joint).
3. Palpation
  1. Skin(temperature)
  2. Muscle(wasting-spasms)
  3. Blood vessels(pulse).
  4. Bone(bony landmarks)
  5. Joint(crepitus-space-swelling).
4. Range of Movements
  1. Passive and active
    1. Flexion (135 degrees or above).
    2. Extension(0 degree).
5. Special tests
  1. Anterior Drawer test
  2. Posterior Drawer Test
  3. Patellar Apprehension Test
  4. Collateral ligaments stress test
  5. Apley's grinding and distraction test
Radiology
1. 1. osteoarthritis
2. 1. Rheumatoid Arthritis
3. 1. gout

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Janice’s Painful Knee

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	Created by Fatma Shwaylia over 7 years ago