Examination of Knee Joint in a Child
Nirmal Raj Gopinathan in Clinical Orthopedic Examination of a Child, 2021
Knee cruciates are strong cord-like structures present in the intercondylar region of the tibia and femur, preventing their movements on each other in the anteroposterior direction. The ACL passes backward and outwards from the anterior intercondylar region of the tibia to attach to the posterior medial aspect of the lateral condyle of the femur. The PCL, however, originates from the posterior intercondylar region and adjacent popliteal surface of the tibia and passes inwards and forwards to insert on the anterior aspect of the lateral surface of the medial condyle of the femur. With an acute injury, the child may be in pain and muscle guarding may be present. The knee may be swollen because of hemarthrosis. In such circumstances, the various physical examination tests for anterior and posterior instability may be of less value. These tests have a greater value for chronically deficient knees.
Temporomandibular Joint Dysfunction
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Soft tissue injuries to the TMJs can be the result of direct blows to the mandible. The categories of these injuries are considered the result of “crush” type forces. Because of the nature of the anatomy, there are various soft tissue components (menisci, cartilage, blood vessels, etc.) juxtapositioned between bony surfaces, the condylar head, the superior articulating surface of the bony socket, and the distal and medial aspects of the socket. When a condyle is forced beyond its physiological range either anteriorly or posteriorly, especially in rapid motion, the chance of a crush-type injury exists. The result is a disruption of the joint surfaces and supporting tissues on both a cellular and macrolevel. Hemarthrosis may result, leading not only to an acute situation, but also to a synovitis that contributes to inflammation of the affected surfaced resulting in long-term articular degeneration and possible degenerative joint disease.
Methods for assigning impairment
Ramar Sabapathi Vinayagam in Integrated Evaluation of Disability, 2019
The bleeding/hemorrhage manifests spontaneously or during minor/moderate/severe trauma, and during surgery. The bleeding in hemophilia may be intracranial, hemarthrosis, hematoma in muscles commonly gastrocnemius/iliopsoas/flexor muscles of the arm, and hematuria. If adequate factor replacement is not controlling bleeding, it is necessary to confirm the presence of FVIII or IX antibodies in the blood. The level of coagulation factor serves to classify the severity of hemophilia. Class 1 impairment indicates coagulation factor level of more than 5% and less than 40%, that is, more than 0.05 and less than 0.40 IU/mL and hemorrhage occurs only during major trauma and surgery. Class 2 impairment denotes 1%–5% of normal factor level, that is, 0.01 to 0.05 IU/mL and triggers hemorrhage even with mild to moderate trauma. Class 3 impairment defines less than 1% of normal factor level, that is, less than 0.01 IU/mL and manifests spontaneous hemorrhage and hemarthrosis (124,126).
Applying World Health Organization 2020 guidelines on physical activity and sedentary behavior to people with hemophilia
Published in Expert Review of Hematology, 2021
Hortensia De la Corte-Rodriguez, E. Carlos Rodriguez-Merchan, M. Teresa Alvarez-Roman, Victor Jiménez-Yuste
Thanks to advances in hematological treatments and prophylactic modalities, physical activity has been made possible for PWH, to help maintain their health [3]. Physical activity confers several benefits to the PWH such as improved muscle strength, joint stability and flexibility, decreased pain, increased bone density and prevention of falls, reduced risk of bleeding [4]. Other physical benefits include the prevention of obesity, heart disease, high blood pressure and diabetes. Physical activity also confers several mental health benefits, such as improved emotional regulation, self-efficacy and social interactions [3]. Physical inactivity is more harmful in PWH than in the general population; thus, the WHO recommendations are especially important in hemophilia [3]. Without proper treatment, people with hemophilia will suffer multiple joint and muscle bleeds. Joint bleeding (hemarthrosis) is the most frequent clinical manifestation in hemophilia. Repeated hemarthroses will lead to a process of inflammation and synovial hypertrophy, as well as progressive deterioration of the osteochondral structures, known as hemophilic arthropathy [5]. This arthropathy usually affects several joints, mainly ankles, knees and elbows. The degree of arthropathy will condition the pain, the functional deficit and the detriment in the quality of life of the patients.
Hemophilic arthropathy: a teaching approach devoted to hemophilia treaters in under-development countries
Published in Expert Review of Hematology, 2021
E. Carlos Rodriguez-Merchan
If the joint hemorrhages repeat because they cannot be prevented or fully resolved, the articulations’ synovium will increase in size to eliminate the intra-articular blood (which is detrimental to the chondrocytes of the joint cartilage). This phenomenon is called synovitis, and it is predisposed to re-bleeding, ultimately leading to a dangerous cycle of hemarthrosis-synovitis-hemarthrosis [15]. If we fail to stop that cycle, the joint cartilage will be destroyed due to the death of the chondrocytes, progressing in a few years to hemophilic arthropathy [1] (Figure 1). These circumstances substantially impact the quality of life of these individuals, particularly in cases of severe hemophilia (<1% circulating factor) and in those who present an inhibitor (antibody opposed to the deficient factor infused intravenously).
Incapacitating pain from Tenofovir Induced Hypophosphatemic Osteomalacia in a Hemophilia Patient – A Case Report
Published in Canadian Journal of Pain, 2020
Emma Woo, Dinesh Kumbhare, Paul Winston
Pain is commonplace in patients with hemophilia and often arises as the result of hemarthrosis, joint bleeds that may cause progressive joint damage and have a significant effect on quality of life and mobility.1 However, it cannot be assumed that severe pain is due to hemarthrosis-related joint damage. Clinicians should consider a wide range of etiologies for pain in patients with hemophilia. Acute causes include infection, osteoporotic fractures, bleeds, with chronic causes including arthritis, and osteomalacia. A comprehensive medical history may reveal unanticipated causes, including side effects from medications such as tenofovir, specifically tenofovir disoproxil fumarate. This case demonstrates a rare instance of poorly localized back and hip pain, severe enough to prevent ambulation in a patient with hemophilia A caused by hypophosphatemic osteomalacia due to tenofovir treatment for blood transfusion–acquired human immunodeficiency virus (HIV). In the early 1980s, before blood products were tested or heated, nearly 50% of the U.S. population with hemophilia had become infected with HIV from blood transfusions.2 Among the aging population of people with hemophilia, there is a significant likelihood of an HIV infection.2 Other uses of tenofovir include pre-exposure prophylaxis (PrEP) and treatment of chronic hepatitis B infections.
Related Knowledge Centers
- Anticoagulant
- Arthroplasty
- Bleeding
- Haemophilia
- Warfarin
- Joint
- Magnetic Resonance Imaging
- Injury
- Knee
- Physical Examination