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Download PPG-Knee-Talk - NP/PA/CNM Professional Practice Group
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NP/CNM/PA PROFESSIONAL PRACTICE GROUP CITY & COUNTY OF SAN FRANCISCO APRIL 21, 2011 CONFERENCE Dan Bertheau, NP, MPH Orthopaedic Trauma Institute SFGH/UCSF Knee Examination DISCLOSURE I have no relevant financial disclosures related to topics in this lecture KNEE EXAM- TOPICS • Anatomy • Three Typical Conditions • History • Physical Exam Tests • Diagnostics • Red Flag/Emergent/Urgent • Referrals • Physical Exam KNEE ANATOMY www.aclsolutions.com KNEE ANATOMY www.aclsolutions.com THREE TYPICAL CONDITIONS • DJD • Ligament Injury (ACL- most common) • Meniscus Injury HISTORY • Mechanism of Injury • Edema • Duration • Neurovascular • Walking Tolerance (# blocks) • Range of Motion (~0-140) • Locking? (unable to fully extend- r/o Bucket Handle) • Sensation • Motor • Previous Treatment (success/failure) • Assistive Devices PAIN • Anterior- Patella & Associated Soft Tissues • Medial- Meniscus, OA • Lateral- Iliotibial Band Friction, Meniscus, OA • Posterior- Meniscus, Baker’s Cyst KNEE DJD LACHMAN- ACL Snider, R. ANTERIOR DRAWER- ACL Snider, R. MRI – NORMAL ACL – SAGITTAL VIEW Helms, C. A. MRI – ACL RUPTURE – SAGITTAL VIEW VARUS STRESS- LCL VALGUS STRESS- MCL www.aafp.org POSTERIOR SAG- PCL Snider, R. MCMURRAY TEST- MENISCUS MRI – MENISCAL TEAR – SAGITTAL VIEW MENISCUS TEAR www.leadingmd.com X-RAY IMAGING ***WEIGHT BEARING*** • AP • Tibiofemoral Joint • LAT • Patellofemoral Joint • Rosenberg (Bent Knee PA) • Tibiofemoral Joint • Sunrise (Merchant, Axial) • Patellofemoral Joint MRI IMAGING • Order Plain X-Rays First • R/O Soft Tissue Injury • Do Not Order In Patient With Known DJD LAB • CBC with Differential • ESR • CRP RED FLAG/EMERGENT/URGENT • Knee Dislocation • Septic Knee • Acute Fractures • Bucket Handle Tear of Meniscus REFERRAL- LESS THAN IDEAL “knee pain” REFERRAL- IDEAL “64 year old male with several years of progressive right knee pain; less than 2 block walking tolerance for last 6 months; failed NSAIDs; started PT 3 months ago; Jan 2011 WB x-rays = arthritic changes; interested in op & non-op options” PATIENT HANDOUTS • PCP “Bridge” to Physical Therapy • Online (in the future) REFERENCES • Atlas of Human Anatomy, 2 nd Edition, Netter, Frank, 2003, Icon Learning Systems • Essentials of Musculoskeletal Care, Snider, Robert K., Ed.,2003, American Academy of Orthopedic Surgeons • Fundamentals of Skeletal Radiology, 2 nd Ed., Helms, Clyde A., 1995, W. B. Saunders • Orthopaedist’s Guide to Plain Film Imaging, Pavlov, H., Burke, M., Giesa, M., Seager, K.R., White, E.T.,1999, Thieme Medical Publishers • Orthopedic Physical Assessment, 4 th Ed., Magee, David J., 2002, Elsevier Sciences • Physical Examination of the Spine & Extremities, Hoppenfeld, Stanley, 1976, Appleton-Century-Crofts Thank You!
