Common Knee Complaints

by Tyler Cymet, DO, FACOFP

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    00:01 Common knee complaints The biggest complaint we hear is the knee hurts.

    00:06 and usually it hurts with more activity.

    00:09 Sometimes it's secondary to hip problems, sometimes it's secondary to ankle problems but paying attention and ruling out intrinsic knee issues, structural knee issues of the bone, muscles or ligaments are critical in knowing what you can do or what you can't do in treating the knee.

    00:29 You'll also hear stiffness, locking, clicking, and other difficulties with using the knee People say they feel unsteady or unstable, and with increased muscle use, the risk of injury may increase or decrease, depending on how the surrounding muscles are being strengthened We know with fatiguing of muscles, such as climbing a lot of steps, you're more likely to trigger knee pain If you do a lot of exercises that use the knee, you're more likely to have issues in other areas as well because you can't effectively stabilize the knee or use it properly So swelling or other common knee complaints - difficulty walking, standing, I think the issue that people come to DO's for the most are usually locking, clicking, or motion-related issues with the knee Knee complaints can be due to a sprain or strain of the knee, you have multiple ligaments that can get pulled out of place that can get pushed out of place by a bursa and may need to be monitored and of course osteopathic manipulation is one technique that can be used to treat it, but so can removal of fluid from the bursa or other manipulations that aren't just musculoskeletal in nature.

    01:45 Bursas and tendons are two areas that tend to get treated a lot in knee complaints, tendonitis either with manipulation, moving, understanding which part of the tendon is involved.

    02:00 Fractures are something you need to be aware of, whether they are microfractures, major fractures and whether fractures that could be noted on x-ray or need further imaging.

    02:10 On occasion, you will notice dislocation particularly of the patella where it falls outside the femur's grooves and needs to be put back into place and they need to be monitored for a muscle tear as well or other issues, and meniscial injuries.

    02:29 Meniscial injuries are different than muscle injuries or tendon injuries, if you tear a tendon, you'll have swelling up right away, if you injure a meniscus, the swelling will usually be delayed by 8-12 hours so you'll be able to function right away but develop the symptoms later on.

    02:47 That's all part of the history that will focus you on what area of the musculoskeletal system you need to work on.

    02:55 Things to think about, with knee pain, what where they doing? Was it sports-related? Was it a contact sport or a non-contact sport? Did the person hear a pop? or a click? or a tear? People tend to know when they break something, they know when they tear something and they'll tell you.

    03:14 So if they had a contact sport, if they were playing soccer, or football and they hear a pop, you are gonna worry about the MCL or LCL, sure could be the meniscus, meniscus you're less likely to hear a pop although it is possible.

    03:29 A fracture - they hear a crack different than a pop.

    03:35 If the person has acute swelling, they swell up right away.

    03:39 We worry about the ACL or PCL, the anterior cruciate or the posterior cruciate.

    03:45 You will notice some laxity and freeing of motion on exam.

    03:50 Were they hit on the side? you worry about the MCL If they had a blow to the inside of their knee, you worry about the lateral collateral ligament but if the knee gave out or buckles, you're worried about an ACL tear, a patellar dysfunction, dislocation, or a meniscal injury, An old meniscal injury, we have a piece of meniscus getting caught, will increase the likelihood of a knee locking, buckling or giving out And again, you lose some stability when you bend your knee, so if somebody falls hard on a flexed knee, like while playing sports, you worry about a PCL tear which often occurs with injuries to other structures in the knee as well, because you no longer have the stability of muscles protecting the knee.

    04:38 This is an important issue particularly for test which is O'Donoghue's triad, because it gets people to think - you think about the mechanism of injury, you think about what could be going on, O'Donoghue's triad is the ACL, MCL and the meniscus that are involved So check that out.

    05:00 So O'Donoghue's triad is the "blow knee" and it's tested a lot because it gets you to think about how the injury occured - is it the posterior cruciate? Is it the anterior cruciate? Is it the lateral meniscus? and what's happening to the other areas well.

    05:17 So think about O'Donoghue's triad.

    05:22 One of the things I do when I examine the knee is I always get a good sense of how bad it's been injured, and how bad t's been used or misused over time.

    05:33 So I look at all areas of motion, I look to see if the patella is ballotable, How much fluid is below it? How much motion? how much give? What is the range of motion you have? We all know if you play with your own knee, you can get to outside the groove very easily, particularly if you bend it a little bit.

    05:52 If you put your thumb on the superor portion of the patella, and push it over, you'll get the most motion, Inferior portion doesn't move as well If you contract your quadriceps, you'll be able to see that you can move your patella up so examining the patella even though we don't have good normals and we accept it as just sitting there, in a simple hinge joint, with some modifications, check it out, I think you can tell with the person, what's possible, what's doable, where their comfort will be and what you may need to do to help them be more comfortable.

    06:28 In feeling the knee to see where there's pain, where there's discomfort, and you'll see if the pain comes with motion and how much the quadriceps contribute and how much the ligaments contribute.

    06:42 And again, just cause we don't have all these information fully worked out, it's still a very common issue and patients are gonna do this themselves so guiding them through it is going to be important, a lot of what we do with knee injuries is witness and share what we know predicting the future for people because if they get in the emergency room, they may get an x-ray X-rays are not very helpful, they'll tell you if something is broken, they'll give you severe injury If you want to get a good sense of small internal cracks or dislocations or there's an accessory sesamoid bone developing, it's important to get a CAT scan or an MRI, they'll give you a much better sense.

    07:25 If you don't see a break on a CAT scan or an MRI, but the pain is still there and it still seems like it's broken, or there are some separation, that's when you need a bone scan.

    07:36 In heavy duty athletes, high achievers who push themselves, often the CT and the MRI are not gonna be enough, and you are gonna need to go do a bone scan to figure out what's really going on.

    07:49 But because of the difficulty getting one because of the cost, it tends to be pushed off until the third or the fourth visit.

    07:57 We also do some blood work, looking for other abnormalities, looking for autoimmune issues, looking for signs of a break, so when somebody does have chronic knee injuries and chronic knee pain, we will get a CBC and ESR and a C-reactive protein.

    About the Lecture

    The lecture Common Knee Complaints by Tyler Cymet, DO, FACOFP is from the course Osteopathic Diagnosis of the Knee Region. It contains the following chapters:

    • Common Knee Complaints
    • O'Donoghue`s Triad
    • Patellofemoral Grind Test

    Included Quiz Questions

    1. Medial collateral ligament (MCL) tear
    2. Lateral collateral ligament (LCL) tear
    3. Anterior cruciate ligament (ACL) tear
    4. Posterior cruciate ligament (PCL) tear
    5. Knee dislocation
    1. Injury to the anterior cruciate ligament, medial collateral ligament, and medial meniscus
    2. Injury to the posterior cruciate ligament, medial collateral ligament, and medial meniscus
    3. Injury to the anterior cruciate ligament, lateral collateral ligament, and medial meniscus
    4. Injury to the posterior cruciate ligament, lateral collateral ligament, and medial meniscus

    Author of lecture Common Knee Complaints

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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