Orthopedic surgery pptx - طلاب المرحلة الخامسة

بسم الله الرحمن الرحيم

SYMPTOMS

PAIN
STIFFNESS
DEFORMITY
SWELLING
LIMPING

Normal Knee – Anterior, Extended

Surface Anatomy - Anterior, Extended*

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Patella

Hollow

Indented

Normal Knee – Anterior, Flexed

Surface Anatomy - Anterior, Flexed

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Head
Of
Fibula

Patella

Tibial
Tuberosity

Palpation – Anterior*

Patella:

Lateral and Medial Patellar Facets

Superior
And
Inferior
Patellar Facets

Patellar Tendon**

Lateral Fat Pad
Medial Fat
Pat

Surface Anatomy - Medial

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Medial
Femoral
Condyle

Patella

Joint
Line

Medial
Tibial
Condyle

Tibial

Tuberosity

Palpation - Medial

Medial Collateral Ligament (MCL)*

Pes anserine
bursa**

Medial joint

line

Surface Anatomy – Lateral

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Patella

Head

Of
Fibula

Tibial

Tuberosity

Quadriceps

Palpation – Lateral*
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Lateral joint

line

Lateral Collateral

Ligament (LCL)**

How to Start
• IPEEP
• INTRODUCE.
• PERMISSION.
• EXPLANTION.
• EXPOSURE.
• POSITION.

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The Apley System

All joint examinations follow this system:
Look
Feel
Move : Active then Passive
Special Tests
Radiograpgy.

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LOCAL EXAMINATION OF THE THIGH AND KNEE

Inspection (LOOK)
Bone contours and alignment
Soft-tissue contours
Colour and texture of skin
Scars or sinuses

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Instability - Example

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http://www.carletonsportsmed.com/Libraria_medicus/PF_patella_dislocation.JPG
Patellar dislocation

diffuse swelling of the knee can

arise only from three fundamental
causes:
I) thickening of bone;
2) fluid within the joint;
and
3) thickening of the synovial membrane

Distinction between effusions of blood, serous fluid, and pus is

made
partly from the history,
partly from the clinical examination.

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(haemarthrosis)

An
effusion of blood appears within an hour or two of an
injury and rapidly becomes tense.
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clear fluid

An effusion develops
slowly (twelve to twenty-four hours) and is never so tense as a blood.

An effusion of pus is associated with general illness and

Palpation (FEEL)

Skin temperature
Bone contours
Soft-tissue contours
Local tenderness

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Measurement of thigh girth

Comparative measurements at precisely
the same level In each limb.
(Note particularly the bulk of the quadriceps muscle)

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Movements (active and passive)

against normal knee for comparison)

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? Pain on movement
? Crepitation on movement
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Flexion.

patients can flex enough to bring the heel in contact with the buttock.

The range of the sound knee must be taken as the normal for the individual.

Extension

It is wrong to accept 0 degrees as the start in point of movement:
therefore the range on the sound side must be taken as the yardstick of

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Power

(tested against resistance of examiner)

Flexion

Extension

Stability

Medial ligament
Lateral ligament
Anterior cruciate ligament
Posterior cruciate ligament

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Tests for stability

Testing the medial and lateral ligaments.

Collateral Ligament Assessment

Patient and Examiner
Position*

Valgus Stress Test for MCL*

Note Direction Of Forces

Varus Stress Test for LCL*
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• Note direction of forces

Rotation tests (McMurray)
(Of value mainly when a torn
meniscus is suspected)

The maneuver is carried

out by repeatedly
I) flexing the knee, first fully but in succeeding tests progressively less fully
then
2) rotating the tibia upon the femur, first laterally but in further tests medially;
and finally
3) extending the knee while the rotation of the tibia is still
maintained.

A loud click,

distinct from the normal patellar click and usually associated with pain,

suggests a tag tear (not a 'bucket-handle‘ tear) of a meniscus.

Testing the anterior and posterior cruciate ligaments.

Anterior Drawer Test for ACL

Physician Position & Movements*
Patient Position

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• Note direction of forces

Posterior Drawer Testing- PCL*

• Note direction of forces

Stance and gait

EXAMINATION OF POTENTIAL EXTRINSIC SOURCES OFTHIGH OR KNEE SYMPTOMS

This is important if a satisfactory explanation for the symptoms is not found on local examination.
The investigation should include:
I) the spine.
2) the hip.

GENERAL EXAMINATION

General survey of other parts of the body.
The local symptoms may be only one manifestation of a widespread disease.

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CLASSIFICATION OF DISORDERS OF THE THIGHAND KNEEDISORDERS OF THE THIGH

INFECTIONS

Acute osteomyelitis
Chronic osteomyelitis
Syphilitic infection

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TUMOURS

Benign bone tumors
Malignant bone tumors

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ARTICULAR DISORDERS OF THE KNEE

ARTHRITIS
Pyogenic arthritis
Rheumatoid arthritis
Tuberculous arthritis
Osteoarthritis
Haemophilic arthritis
Neuropathic arthritis
Chondromalacia of the patella

MECHANICAL DISORDERS

Tears of the menisci
Cysts of the menisci
Discoid lateral meniscus
Osteochondritis dissecans
Intra-articular loose bodies
Recurrent dislocation of the patella
Habitual dislocation of the patella

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http://www.carletonsportsmed.com/Libraria_medicus/PF_patella_dislocation.JPG
Patellar dislocation