China
Africa
Explore chapters and articles related to this topic
Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The test is performed in supine position. The hip is slightly abducted and flexed. The examiner supports the ankle with one hand and distal thigh with the other. Ensure that the limb is in slight internal rotation while it is being lifted off the table and in an extended position. Subsequently, the knee is flexed, and simultaneous valgus stress is applied with pressure over the upper aspect of the leg. In an ACL-deficient knee, the lateral tibial plateau is posteriorly subluxated over the femur at the initiation of the test (knee flexion 0° to >30°), and subsequently, with an increase in flexion to 30° or beyond, the displaced lateral tibial plateau reduces suddenly, producing a palpable and sometimes audible clunk, indicating a positive pivot shift test. The best site to observe this reduction is at the tubercle of Gerdy. The pivot shift test will be inaccurate if knee extension is not possible because of pain, swelling, or displaced meniscal tear.
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The medial collateral ligament prevents medial widening of the joint space and is stiff with the knee in extension. The leg is externally rotated, keeping the knee flexed, and the probe is placed at the long axis of the medial collateral ligament, in an oblique orientation. The ligament is examined from the medial femoral condyle to the proximal tibial metaphysis. Dynamic assessment of the ligament integrity can be performed during valgus stress [58].
History taking and clinical examination in musculoskeletal disease
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The presence of palpable joint line tenderness is the most sensitive clinical examination test for a meniscal tear. Flex the knee to 90° and palpate the joint line using your thumb and index finger. Note any areas of tenderness. Tests for meniscal damage are not very reliable but, combined with a history of mechanical symptoms, locking, catching and pain, may be helpful. With posterior medial meniscal tears patients suffer pain on high flexion or squatting. The well- known test for meniscal tears is McMurray's test. The patient lies supine with their knee flexed to 45° and hip flexed to 45°. The examiner braces the lower leg: one hand holds the ankle; the other hand holds the knee. For assessment of the medial meniscus, palpate the medial joint line with knee flexed. A ‘click' may be felt suggesting meniscus relocation. A valgus stress is applied to the flexed knee. Externally rotate the leg (toes point outward), and slowly extend the knee while it is still in valgus.
A comparison of the biomechanical and clinical effects of a biaxial ankle-foot orthosis and lateral wedge insole in individuals with medial knee osteoarthritis
Published in Disability and Rehabilitation, 2022
Kourosh Barati, Ismail Ebrahimi Takamjani, Alireza Shamsoddini, Habib Ejraei Dolatabad
The rate of changes in the studied parameters (the first peak KAM, the second peak KAM, KAMI, pain, stiffness, and function) were not influenced by the participants' primary KL grade or BMI. This finding was in contrast to our expectations. According to the study by Bruyère et al. [44], ideal individuals with knee osteoarthritis for bracing are patients with early and mild diseases, not severely obese, with knee malalignment that is reducible by valgus stress maneuvers on physical examination. One possible reason for this finding might be that the participants of our study were composed of individuals in the normal weight range (18.5 kg/m2 and 25 kg/m2) and had moderate disease severity (grades II and III). Therefore, the rate of changes in the studied parameters was not influenced by the disease severity or BMI due to the homogeneity of the participants.
Comparison of outcome between nonoperative and operative treatment of medial epicondyle fractures
Published in Acta Orthopaedica, 2020
Petra Grahn, Tero Hämäläinen, Yrjänä Nietosvaara, Matti Ahonen
This is a comparative study of 81 consecutive children prospectively collected who had sustained a > 2 mm displaced medial epicondyle fracture treated by surgeon’s preference either by immobilization or by ORIF with a high follow-up rate, 81/83. Treatment was not randomized, which may cause a bias. Mean age of patients in the nonoperative group was lower than in the ORIF group. We do not have an obvious explanation for this discrepancy, but in general younger children less often require operative treatment in pediatric orthopedic trauma, which may have had an effect on selecting treatment modality. CTs had not been taken routinely and the exact fracture displacement could not therefore be measured. Regardless of treatment some patients remain symptomatic under valgus stress. This raises the question as to whether our treatment decisions are based on the right parameters, e.g., displacement of the fracture fragment vs. medial collateral ligament injury. In light of the shortcomings of this study we have been granted ethical review board permission to start a randomized control trial conducted as a non-inferiority trial.
Effect of dry needling on cubital tunnel syndrome: Three case reports
Published in Physiotherapy Theory and Practice, 2019
Sudarshan Anandkumar, Murugavel Manivasagam
On observation, no abnormalities were noted in posture, gait, elbow-carrying angle, muscle strength, and range of motion testing. Sensory testing of the ulnar cutaneous nerve distribution revealed reduced sensation to touch, pain, and temperature over the ulnar side of the dorsum of the hand. Valgus stress test for the elbow was negative. Like patient A, concordant symptoms were reproduced 2 cm below the right medial epicondyle over the FCU on sustained pressure. Further, Tinel’s sign was positive at the same site, reproducing the tingling over the ulnar side of the dorsum of the hand. Also, the elbow flexion test (Wojewnik and Bindra, 2009) worsened the symptoms after 5 s. Upper limb neurodynamic testing biasing the ulnar nerve (Nee, Jull, Vicenzino, and Coppieters, 2012) did not reproduce the concordant symptoms.