Knee 膝关节运动损伤_PPT课件.pptVIP

Case 3 31 year old female, L knee pain Recreational runner Localizes pain to front of knee No trauma, insidious onset Localizes pain “around kneecap” Worse with stairs Worse after prolonged sitting Knee occasionally “gives out” Case 3 – Key Questions Mechanism of Injury? Acute or Chronic? Where is the pain? Mechanical Symptoms? (Locking, popping, catching?) Associated instability? Swelling? Previous injuries or surgeries? What makes it worse? What makes it better? Insidious Onset Chronic Anterior knee No, but sometimes gives out None None None Running, Stairs Multiple days of rest Physical Exam Inspection: mild genu valgus Palpation: TTP lateral medial patellar facets ROM: full w/o pain Strength: normal Neurovascular: normal Special Tests: + patellar grind Decreased patellar glide Inflexible hamstrings (Popliteal angle) Patellofemoral Joint Exam Patellofemoral Joint Exam Patellar Grind Test Case 3 – Plain Films AP Lateral Case 3 – Plain Films Tunnel Sunrise What’s your diagnosis? Patellar tendinopathy Patellar instability Patellofemoral syndrome Plica syndrome Patellofemoral Syndrome Treatment: Relative rest; non-painful aerobics Physical Therapy Improve Quad/Hamstring flexibility Quad, Hip abductor strengthening Core strengthening Patellar stabilization brace/taping Foot orthotics Surgery (last-ditch effort) Case 4 34 yo Army MAJ training for 1st marathon Atraumatic onset of R lateral knee pain 1 week ago after 10 mile run Sharp burning pain Better with rest, returns with running Case 4 – Key Questions Mechanism of Injury? Acute or Chronic? Where is the pain? Mechanical Symptoms? (Locking, popping, catching?) Associated instability? Swelling? Previous injuries or surgeries? What makes it worse? What makes it better? Insidious Onset Acute Lateral knee No, but sometimes gives out None None None Running Multiple days of rest Physical Exam Inspection: normal Palpation: TTP over lateral femoral condyle ROM: full Strength: normal Neurovascular: normal Spec