Knee joint
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Injuries
Fractures
The Ottawa knee rule, a clinical prediction rule, can guide need for an x-ray:[1]
- age 55 years or older
- "isolated tenderness of patella (no bone tenderness of knee other than patella)"
- "tenderness at head of fibula"
- "inability to flex 90 degrees"
- "inability to bear weight both immediately and in the emergency department for 4 steps (unable to transfer weight twice onto each lower limb regardless of limping)"
Torn meniscus or ligament
Many tests have been proposed to improve the physical examination. Examples are: Meniscal injuries:
- Apley compression, McMurray's, and medial-lateral grind tests
Cruciate ligaments injuries:
- Anterior drawer, posterior drawer, lateral pivot shift, and Lachman tests
Injuries to the cruciate ligaments can be accuractly diagnosed with physical examination by orthopedic physicians; meniscal injuries are more difficult to detect.[2] No sign on the physical examination (McMurray's, Apley's, and joint line tenderness) is more than 70% sensitive for meniscal injuries.[3]
The presence of a hemarthrosis indicates likely injury to a meniscus or ligament, usually of the anterior cruciate ligament with high specificity.[4]
References
- ↑ Bachmann LM, Haberzeth S, Steurer J, ter Riet G (January 2004). "The accuracy of the Ottawa knee rule to rule out knee fractures: a systematic review". Ann. Intern. Med. 140 (2): 121–4. PMID 14734335. [e]
- ↑ Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL (October 2001). "The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination". JAMA 286 (13): 1610–20. PMID 11585485. [e]
- ↑ Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC (September 2007). "Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis". J Orthop Sports Phys Ther 37 (9): 541–50. PMID 17939613. [e]
- ↑ Hardaker WT, Garrett WE, Bassett FH (June 1990). "Evaluation of acute traumatic hemarthrosis of the knee joint". South. Med. J. 83 (6): 640–4. PMID 2356496. [e]