The Diagnosis-Driven Physical Exam of the Knee - Society of General ...

[Pages:31]4/1/2014

The Diagnosis-Driven Physical Exam of the Knee

April 25, 2014 Carlin Senter MD, Natalie Voskanian MD, Veronica Jow MD

Carlin Senter, MD Assistant Clinical Professor

UCSF Sports Medicine

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Natalie Voskanian, MD Assistant Clinical Professor

UCSD Sports Medicine

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Veronica Jow, MD Associate Team Physician

UC Berkeley

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Small group experts: UCSF residents and faculty

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Outline

? Knee anatomy ? Knee exam ? Knee hands on exam practice ? Cases ? Questions

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Knee: top 3 diagnoses in primary care referrals to ortho (at UCSF)

1. Osteoarthritis (OA) 2. Meniscus tear 3. Patellofemoral pain

1. Patellofemoral pain syndrome 2. Patellofemoral chondromalacia

Musculoskeletal work-up

? History ? Inspection ? Palpation ? Range of motion ? Other Tests

? Strength ? Neurovascular

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Knee Anatomy

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The quadriceps muscles extend the

knee



+Leg+-+Lecture+Notes

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The quadriceps muscles merge to form the quadriceps tendon... patellar tendon

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The hamstrings flex the knee



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Pes anserine bursa

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Common cause of medial knee pain (hurts with side to side or twisting maneuvers): +TTP below the jointline; can extend from posteromedial pes tendons to anteromedial bursa on medial tibia. Tx = PT, nsaids, injection

There are 4 main ligaments in the knee

MCL: resists valgus - medial femoral condyle to medial tibia (crosses medial jointline) LCL: resists varus -Lateral femoral condyle to fibular head (crosses lateral jointline) - resists varus ACL: resists anterior tibial translation PCL: resists posterior tibial translation

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Meniscus

? Medial ? Lateral

? Cushion the knee joint and protect the articular cartilage

? Pain and tenderness in medial or lateral jointline ? +/- effusion ? May or may not have h/o trauma

? OA pts get degenerative tears (XR is sufficient in these pts)

Knee history: MOI

? Acute vs sub-acute or chronic

? Direct fall onto patella

? Patellar fracture or cartilage damage or prepatellar bursitis

? Varus or valgus force to the knee

? MCL or LCL

? Noncontact with a pop

? ACL

, Accessed 10/04/05. Accessed 10/4/05

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