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NP/CNM/PA Professional Practice Group City & County of San Francisco April 21, 2011 Conference

NP/CNM/PA Professional Practice Group City & County of San Francisco April 21, 2011 Conference. Dan Bertheau, NP, MPH Orthopaedic Trauma Institute SFGH/UCSF. Knee Examination. Disclosure. I have no relevant financial disclosures related to topics in this lecture. Knee Exam- Topics. Anatomy

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NP/CNM/PA Professional Practice Group City & County of San Francisco April 21, 2011 Conference

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  1. NP/CNM/PAProfessional Practice GroupCity & County of San FranciscoApril 21, 2011 Conference Dan Bertheau, NP, MPH Orthopaedic Trauma Institute SFGH/UCSF Knee Examination

  2. Disclosure I have no relevant financial disclosures related to topics in this lecture

  3. Knee Exam- Topics • Anatomy • Three Typical Conditions • History • Physical Exam Tests • Diagnostics • Red Flag/Emergent/Urgent • Referrals • Physical Exam

  4. Knee Anatomy www.aclsolutions.com

  5. Knee Anatomy www.aclsolutions.com

  6. Three Typical Conditions • DJD • Ligament Injury (ACL- most common) • Meniscus Injury

  7. History • Edema • Neurovascular • Sensation • Motor • Previous Treatment (success/failure) • Assistive Devices • Mechanism of Injury • Duration • Walking Tolerance (# blocks) • Range of Motion (~0-140) • Locking? (unable to fully extend- r/o Bucket Handle)

  8. Pain • Anterior- Patella & Associated Soft Tissues • Medial- Meniscus, OA • Lateral- Iliotibial Band Friction, Meniscus, OA • Posterior- Meniscus, Baker’s Cyst

  9. Knee DJD

  10. Lachman- ACL Snider, R.

  11. Anterior Drawer- ACL Snider, R.

  12. MRI – Normal ACL – sagittal view Helms, C. A.

  13. MRI – ACL rupture – sagittal view

  14. Varus Stress- LCLValgus Stress- MCL www.aafp.org

  15. Posterior Sag- PCL Snider, R.

  16. McMurray Test- Meniscus

  17. MRI – Meniscal Tear – sagittal view

  18. Meniscus Tear www.leadingmd.com

  19. X-Ray Imaging ***WEIGHT BEARING*** • AP • Tibiofemoral Joint • LAT • Patellofemoral Joint • Rosenberg (Bent Knee PA) • Tibiofemoral Joint • Sunrise (Merchant, Axial) • Patellofemoral Joint

  20. MRI Imaging • Order Plain X-Rays First • R/O Soft Tissue Injury • Do Not Order In Patient With Known DJD

  21. Lab • CBC with Differential • ESR • CRP

  22. Red Flag/Emergent/Urgent • Knee Dislocation • Septic Knee • Acute Fractures • Bucket Handle Tear of Meniscus

  23. Referral- less than ideal “knee pain”

  24. Referral- ideal “64 year old male with several years of progressive right knee pain; less than 2 block walking tolerance for last 6 months; failed NSAIDs; started PT 3 months ago; Jan 2011 WB x-rays = arthritic changes; interested in op & non-op options”

  25. Patient Handouts • PCP “Bridge” to Physical Therapy • Online (in the future)

  26. Atlas of Human Anatomy, 2nd Edition, Netter, Frank, 2003, Icon Learning Systems Essentials of Musculoskeletal Care, Snider, Robert K., Ed.,2003, American Academy of Orthopedic Surgeons Fundamentals of Skeletal Radiology, 2nd Ed., Helms, Clyde A., 1995, W. B. Saunders Orthopaedist’s Guide to Plain Film Imaging, Pavlov, H., Burke, M., Giesa, M., Seager, K.R., White, E.T.,1999, Thieme Medical Publishers Orthopedic Physical Assessment, 4th Ed., Magee, David J., 2002, Elsevier Sciences Physical Examination of the Spine & Extremities, Hoppenfeld, Stanley, 1976, Appleton-Century-Crofts References

  27. Thank You!

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