Knee 膝关节运动损伤

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1、MS3SportsMedicineWorkshopFamilyMedicineClerkshipKneeProblemsMS3FamilyMedicineAnatomyReviewFemurMedial&lateralCondylesEpicondylesTrochleargrooveIntercondylarnotchPatellaSuperiorpole(base)Inferiorpole(apex)Medial&lateralfacetsTibiaMedial&lateralCondylesGerdy’stuberclePesanserineareaTibialtuberos

2、ityTibialplateauTibialspinesFibulaHeadNeckAnatomy–MajorLigaments&TendonsQuadricepstendonPatellartendonMedial&lateralpatellarretinaculuaMCLLCLAnatomy–MeniscioftheKneeMedialmeniscusLateralmeniscusMeniscalligamentsFunctionsofthemenisciMeniscalzonesWhite-whiteRed-whiteRed-redKneeExamOverviewInspec

3、tionPalpationRangeofMotionStrengthNeurovascularSpecialTestsCase1–MedialRightKneePain16yoHSsoccerplayer,previouslyhealthyTackledfromrightsidewhilerunningImmediateonsetofmedialjtlinepainDelayedonsetlocalmedialedema,stiffnessAbletobearweightKeyQuestionsintheHistoryMechanismofInjury?AcuteorChronic

4、?Locationandlevelofpain?Abletowalk?MechanicalSymptoms?(Locking,popping,catching?)Associatedinstability?Swelling?Previousinjuriesorsurgeries?Case1-ExamInspection:MildmedialkneeedemaPalpation:+ttpmedialkneeROM:can’tbend>80dStrength:mildlydecreasedNeurovascular:normalSpecialtests:NegLachman,Anter

5、iorDrawer,McMurray,varusstress+mildincreasedgaponvalgusstress(comparedtoleft)withgoodendpointSpecialTests-ACLInjuryLachmanTestSpecialTests-PCLInjuryPosteriorDrawerTestSagSignQuad-ActiveTestVarus/ValgusstressforLCLandMCLInjuryFeaturesthatshouldpromptanxrayafteracutekneeinjuryinclude:Unabletobe

6、arweightCan’tflex>90dPatellaTTPFibularheadTTPAge<18or>55Alloftheabove5OttawaKneeRulesi.e.WhentoorderakneexrayafteracuteinjuryAge>55or<18UnabletowalkTTPonPATELLATTPonFIBULARHEADUnabletoflex90degCase1-ImagingNormal!Case1–DifferentialDiagnosisMoreLikelyLessLikelyMeniscalTearLigamentousInjuryWhich

7、ligament?ACLPCLMCLLCLMuscleStrainFracturePatellofemoralPainPlicaMCLSprainDiagnosis?WhatgradeofsprainislikelypresentoftheMCL?Grade1:nolaxity,buthurtsGrade2:mildlaxity,stillintactGrade3:completetearGrade4:hurtslike*^%*MCLSprainTreatment?R