Professional Documents
Culture Documents
Cure Conference
Mike Mazzone
Waukesha Family Medicine
Outline
Brief Review of evaluation of the
knee
Discuss Differential Diagnosis
Review Treatment Modalities
Brief Overview
1/3 of all musculo-skeletal problems
seen in Primary Care are about the
Knee
54% of all Atheletes will experience
some knee pain EVERY YEAR
Things to think about in History
Pain characteristics PQRST
Mechanical Symptoms
Locking
Popping
Giving Way
Effusion
Rapid (< 2 hours) hemarthrosis
Slow (24-48 hours) ligamentous strain, meniscal Injury
Mechanism of Injury
Direct blow?
Foot planted
Decelerating or landing from a jump
Twisting
Hyperextension
Medical History
Previous Knee pain or Surgery
Physical Exam
Inspection
Palpation
ROM Normal 0 degrees to 135 degrees
Neuro
Special Tests
Lachman or Drawer for ACL problems
McMurray or Apley Grinder Meniscal Injuries
Milking of Suprapetallar Pouch
PatelloFemoral Tracking
Q angle (>15 degrees predisposes to Patellar
Subluxation
Patellar Aprehension Test push patella laterally
Varus and Valgus Stress MCL and LCL
Ottawa Rules for Obtaining a
radiograph in Acute Knee Injuries
Ottawa Rules Pittsburg Rules
age 55 or over Blunt trauma or a fall as
isolated tenderness of the patella mechanism of injury plus either
(no bone tenderness of the knee of the following:
other than the patella)
tenderness at the head of the Age younger than 12 years or
older than 50 years
fibula
Inability to walk four weight-
inability to flex to 90 degrees bearing steps in the emergency
inability to weight bear both department
immediately and in the ER (4
steps - unable to transfer weight Sensitivity 99%
twice onto each lower limb Specificity 60%
regardless of limping).
Reduced Radiographs by 57%
Sensitivity 97%
Specificity 27%
Reduced Radiographs by 28%
What Radiographs to Order
Most Patients 3 views
AP
Lateral
Merchants
Teenagers with chronic knee pain
and recurrent effusion
Add Tunnel View (PA with knee flexed
40-50 degrees)
Loooks for osteochondritis dissecans on
Femoral Condyles)
AP View Lateral View