Common Musculoskeletal Problems in the Ambulatory Setting , An Issue of Medical Clinics, E-Book (eBook)

Common Musculoskeletal Problems in the Ambulatory Setting , An Issue of Medical Clinics, E-Book

Matthew L. Silvis (Autor)

eBook Download: PDF | EPUB

2014 | 1. Auflage
100 Seiten
Elsevier Health Sciences (Verlag)
978-0-323-31184-7 (ISBN)

Infos

This issue of the Medical Clinics of North America, edited by Matthew Silvis, MD, is devoted to Common Musculoskeletal Problems in the Ambulatory Setting. Articles in this issue include: Anterior knee pain; The acutely injured knee; Approach to adult hip pain; Evaluation and management of adult shoulder pain; Acute and chorinc low back pain; Neck pain and cervical radiculopathy; Common adult hand and wrist disorders; Fragility fractures; Elbow tendinopathy; The injured runner; The physical therapy prescription; Durable medical equipment: types and indications; and MSK Imaging: types and indications.

---

This issue of the Medical Clinics of North America, edited by Matthew Silvis, MD, is devoted to Common Musculoskeletal Problems in the Ambulatory Setting. Articles in this issue include: Anterior knee pain; The acutely injured knee; Approach to adult hip pain; Evaluation and management of adult shoulder pain; Acute and chronic low back pain; Neck pain and cervical radiculopathy; Common adult hand and wrist disorders; Fragility fractures; Elbow tendinopathy; The injured runner; The physical therapy prescription; Durable medical equipment: types and indications; and MSK Imaging: types and indications.

Textauszug

Evaluating Anterior Knee Pain

Engene Hong, MD, CAQSM, FAAFP∗[e-mail] and Michael C. Kraft, MD,     Division of Sports Medicine, Drexel University College of Medicine, 10 Shurs Lane, Ste 301, Philadelphia, PA 19127, USA

∗Corresponding author.

Musculoskeletal complaints account for about 20% to 30% of all primary care office visits; of these visits, discomfort in the knee, shoulder, and back are the most prevalent musculoskeletal symptoms. Having pain or dysfunction in the front part of the knee is a common presentation and reason for a patient to see a health care provider. There are a number of pathophysiological etiologies to anterior knee pain. This article describes some of the common and less common causes, and includes sections on diagnosis and treatment for each condition as well as key points.

Keywords

Anterior knee pain

Bursitis

Patellar pain

Patellar fractures

Patellar tendinopathy

Patellofemoral pain syndrome

Patellar subluxation

Chondromalacia

Osgood Schlatter’s disease

Key points

• Patellofemoral osteoarthritis and chondromalacia are common causes of anterior knee pain and may be overlooked as the etiology (especially if the radiology report reads “normal”).

• Quadriceps and patellar tendinopathy often occur in patients where there is repetitive stress placed on the anterior knee, such as in jumping and running sports.

• Patellar dislocation and subluxation is a common problem with incidence of 5.8 per 100,000 persons and increasing to 29 per 100,000 persons in the age range of 10 to 17 years old.

• Bursitis of the knee commonly occurs in the pre-patellar bursa or the pes anserine bursa.

• Patellofemoral pain syndrome can be described as patellar tracking dysfunction, and is a common cause of anterior knee pain.

• A bipartite patella is the result of a secondary ossification center that did not completely fuse to the primary site.

• Osgood-Schlatter is a condition that typically presents at the beginning of a growth spurt.

• Sinding-Larsen-Johannson syndrome is a traction apophysitis of the inferior pole of the patella.

• Osteochondritis dissecans is an uncommon but important cause of anterior knee pain in adolescents.

• Plicae are remnants of embryologic tissue.

• Patellar fractures can account for up to 1% of all fractures seen.

• Fat pad impingement syndrome can be an unusual cause of anterior knee pain.

Introduction

Musculoskeletal complaints account for about 20% to 30% of all primary care office visits; of these visits, discomfort in the knee, shoulder, and back are the most prevalent musculoskeletal symptoms. Having pain or dysfunction in the front part of the knee is a common presentation and reason for a patient to see a health care provider.

A good history and thorough physical examination are essential to an accurate diagnosis of the cause of anterior knee symptoms. In turn, an accurate diagnosis is essential to optimal management and best possible outcome for the patient. As with other musculoskeletal conditions, the overall goals in management of anterior knee pain are to improve comfort, restore function, maximize function, and to preserve function.

There are a number of pathophysiological etiologies to anterior knee pain. This article describes some of the common and less common causes, and includes sections on diagnosis and treatment for each condition, as well as key points.

Patellofemoral osteoarthritis and chondromalacia

Key points for patellofemoral osteoarthritis (OA) and chondromalacia

1. Patellofemoral OA and chondromalacia are common causes of anterior knee pain and may be overlooked as the etiology (especially if the radiology report reads “normal”).

2. Physical examination findings may largely be nonspecific, but an important finding is tenderness over the lateral or medial patella facet.

3. Radiologic evaluations can be very helpful aides in diagnosing this condition. The Merchant or skyline view is helpful when evaluating isolated patellofemoral OA.

4. Nonoperative management may include ideal body weight maintenance, physical therapy, oral medication and supplements, corticosteroid and viscosupplementation injections, and bracing.

5. The overall goal of treatment is to improve and maximize patient comfort and function.

Introduction

Isolated patellofemoral OA is not an uncommon disease process; it can be an etiology of anterior knee pain or simply an incidental finding on radiographs without clinical significance. In a study conducted by Davies and colleagues,1 of 206 knees of patients older than 60 presenting with symptomatic knee pain, 15.4% of men and 13.6% of women had isolated patellofemoral osteoarthritis. In another study, of 240 asymptomatic knees of patients 55 years and older, 19% of men and 34% of women had radiologic evidence of isolated patellofemoral osteoarthritis.2 Patellofemoral osteoarthritis, defined as a loss of the cartilage in the trochlear groove and retro-patella surface, is found in approximately half of patients who are diagnosed with degenerative arthritis of the knee.3 Chondromalacia is a softening of the patellofemoral cartilage, and may be a precursor to degenerative joint disease in this compartment of the knee. For the purposes of this article, both chondromalacia and OA can be the cause of anterior knee pain related to the cartilage in this knee compartment.

Diagnosis

Patients with patellofemoral OA or chondromalacia will typically present with anterior knee pain. There is no one single defining symptom that is characteristic of patellofemoral OA. The presenting anterior knee discomfort may be exacerbated by kneeling or squatting, walking up or down hills or inclines, climbing or descending stairs, rising from a seated position, or being in one position for too long (typically sitting).3 There may be crepitus or a cracking sensation. Often, patients will complain of stiffness in the knee, especially in the morning on first waking; occasionally there may be a sensation of locking (which is really a pseudo locking) or catching, secondary to irritation between the patella and trochlea groove when friction occurs between the bones.3 Iwano and colleagues4 tried to assess a patient’s activities of daily living (ADLs) to further support a diagnosis of patellofemoral OA. In this scale, the highest attainable score was 14 points. Iwano and colleagues4 had found that a score of 4.1 was more predictive of patellofemoral OA combined with femorotibial OA; however, a score of 9.4 was more predictive of isolated patellofemoral OA. Iwano and colleagues4 used the following 7 items to help predict the presence and type of OA: (1) Clarke test (positive when patients complained of pain during knee extension with patella compression), (2) limitation of patellar mobility, (3) pain on compression of the patella, (4) peripatellar tenderness, (5) crepitation during knee movement, (6) crepitation on grinding of the patella, and (7) pain on grinding the patella. Each item was given a score of 0 to 2 points. Two points equaled maneuvers completed without any problem, 1 point equaled maneuvers completed with some difficultly, and 0 equaled maneuvers completed with great difficulty.

Evaluating a patient with suspected patellofemoral OA or chondromalacia may be challenging for the busy primary care provider. The physical examination may often have nonspecific findings. Leslie and Bentley5 found retro patellar crepitus, effusion, and quadriceps wasting greater than 2 cm as the most important findings for detection of chondromalacia of the patella. According to Grelsamer,6 the most important sign for patellofemoral OA is tenderness over the medial or lateral patellar facet. Often radiographic evidence can largely aid in diagnosis. One of the most important views that should be obtained is the Merchant or skyline view (45° angle). Radiographically, patellofemoral joint arthritis can be classified into 4 stages of severity. The stages are as follows: stage 1, mild with more than 3 mm of joint space preserved; stage 2, moderate with less than 3 mm of joint space preserved but no bony contacts; stage 3, severe with the bony surfaces in contact with less than one-quarter of the joint surface; and stage 4, very severe with bony contact throughout the entirety of the joint.7

Treatment

In patients who have symptomatic...

Produkt-Details

• Erscheint lt. Verlag: 8.9.2014
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Notfallmedizin
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Orthopädie
• ISBN-10: 0-323-31184-9 / 0323311849
• ISBN-13: 978-0-323-31184-7 / 9780323311847