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Unraveling the Mystery of Knee Pain #6:

Other Culprits in Knee Dysfunction

Unraveling the Mystery of Knee Pain #6:

Other Culprits in Knee Dysfunction

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Webinar GoalsWebinar Goals

• Explore the assessment and treatment of other culprits in knee dysfunction.

• Explore the assessment and treatment of other culprits in knee dysfunction.

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LogisticsLogistics• Time: 60 minutes

• Schedule:

• Presentation 30-40 minutes

• Questions 15–20 minutes

• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.

• Get a pen and paper please

• Time: 60 minutes

• Schedule:

• Presentation 30-40 minutes

• Questions 15–20 minutes

• Ongoing questions: Use Question box.If I don’t get to your question, ask me on my Dr Ben Benjamin Facebook page after the webinar.

• Get a pen and paper please

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Injuries/Conditions to be CoveredInjuries/Conditions to be Covered

•Bursitis•Cruciate Ligament Sprains•Torn Meniscus •Chondromalacia •Osgood Schlatter’s Disease•Loose Body •Dislocating Patella•Traumatic Arthritis

•Bursitis•Cruciate Ligament Sprains•Torn Meniscus •Chondromalacia •Osgood Schlatter’s Disease•Loose Body •Dislocating Patella•Traumatic Arthritis

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PretestPretest1. Pain when kneeling on the knee usually means that the

patella tendon is injured. True or False?

2. The draw sign refer to an assessment test that stresses the meniscus. True or False?

3. A loose body in the knee joint causes the knee to get stuck in flexion. True or False?

4. Chondromalacia causes knee pain primarily when going upstairs or uphill. True or False?

5. A torn cartilage causes the elderly to be fearful when walking down stairs – the fear is that their leg will lock while straight and they will fall. True or False?

6. You can have a traumatic arthritis in the knee with swelling without a ligament or cartilage injury. True or False?

1. Pain when kneeling on the knee usually means that the patella tendon is injured. True or False?

2. The draw sign refer to an assessment test that stresses the meniscus. True or False?

3. A loose body in the knee joint causes the knee to get stuck in flexion. True or False?

4. Chondromalacia causes knee pain primarily when going upstairs or uphill. True or False?

5. A torn cartilage causes the elderly to be fearful when walking down stairs – the fear is that their leg will lock while straight and they will fall. True or False?

6. You can have a traumatic arthritis in the knee with swelling without a ligament or cartilage injury. True or False?

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Bursas of the KneeBursas of the Knee

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AnatomyBursas of the Knee

AnatomyBursas of the Knee

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• Cushion to reduce friction and allow soft tissue to slide easily

• Lined with synovial cells that secrete fluid to lubricate high friction areas

• 4 important bursas in the knee: • Prepatellar bursa• Suprapatellar bursa• Deep infrapatellar bursa• Pes anserine bursa

• Cushion to reduce friction and allow soft tissue to slide easily

• Lined with synovial cells that secrete fluid to lubricate high friction areas

• 4 important bursas in the knee: • Prepatellar bursa• Suprapatellar bursa• Deep infrapatellar bursa• Pes anserine bursa

Function and Location: Knee Bursas

• Prepatellar bursa – very thin, cushions between patella and skin “B”

Function and Location: Knee Bursas

• Suprapatellar bursa – lies between anterior surface of lower femur and deep surface of quadriceps femoris. “3”

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Function and Location: Knee Bursas

• Deep infrapatellar bursa – lies beneath patella ligament and tendon body “A”.

Function and Location: Knee BursasFunction and Location: Knee Bursas

Pes anserinus – Where the tendons of the Gracilas, Sartorius and Semitendinosis muscles come together to form a common attachment.

• The bursa lies beneath common tendon attachment, cushions between the medial collateral ligament and the Pes anserinus

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How to Touch Bursas of the Knee

How to Touch Bursas of the Knee

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Assessment Tests:Knee Bursas

Assessment Tests:Knee Bursas

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Assessment TestsDeep Infrapatellar Bursa Test 1

Assessment TestsDeep Infrapatellar Bursa Test 2

Kneeling is Painful

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Assessment TestsPrepatellar Bursa Test 1

Assessment TestsPrepatellar Bursa Test 2

Assessment TestsPrepatellar Bursa Test 2

Touch the patella spongy bubble of fluid evident

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Assessment TestsSuprapatellar Bursa Test 1

Assessment TestsSuprapatellar Bursa Test 2

Assessment TestsPes anserine Bursa Test 1

Apply mild pressure to the Pes anserine – it will be warm and painful

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How it HappensHow it Happens

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• Lack of or improper warm-up • Repetitive bending of the knee• Fatigue • Lack of flexibility • Biomechanical alignment• Poor technique in a sport• Overuse or traumatic injury during

athletics• Repetitive kneeling

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Theory: Knee BursasTheory: Knee Bursas

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Irritation of the Bursa

• Cause unknown

Speculation is:

• Infection

• Trauma to the area

• Misalignment causing stress

• Lack of flexibility and movement

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Treatment: Knee BursasTreatment: Knee Bursas

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• Rest• Ice• Injection Therapy

Massage is contraindicated

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Cruciate Ligament SprainsCruciate Ligament Sprains

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Anatomy:Cruciate Ligament Sprains

Anatomy:Cruciate Ligament Sprains

• Hold the knee together

• Limit anterior and posterior movement of the tibia, in relation to the femur

• Hold the knee together

• Limit anterior and posterior movement of the tibia, in relation to the femur

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Anatomy:Anterior Cruciate Ligament

Anatomy:Anterior Cruciate Ligament

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• One of the most common knee ligament injuries in athletes

• Abbreviated ACL• Common in women• Forceful lateral rotational

movements are primary cause

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Anatomy:Posterior Cruciate Ligament

Anatomy:Posterior Cruciate Ligament

• Abbreviated PCL

• The knee’s most important stabilizer

• Common causes are sports, car accidents, or industrial accidents

• Abbreviated PCL

• The knee’s most important stabilizer

• Common causes are sports, car accidents, or industrial accidents

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Assessment Tests:Cruciate Ligament Sprains

Assessment Tests:Cruciate Ligament Sprains

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Draw SignDraw Sign

Assessment Tests:

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Assessment Tests:Anterior Pull

Posterior PushPosterior Push

Assessment Tests:

Assessment Tests:Push Pull Laxity Test

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Assessment Tests:Resisted Flexion of the Knee

Resisted Extension of the Knee

Assessment Test

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Theory: Cruciate LigamentsTheory: Cruciate Ligaments

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• Anterior Cruciate Ligament MI: anterior pull test

• Resisted Extension of the knee (very weak and/or causing pain deep within the knee)

• Posterior Cruciate Ligament MI: posterior push test

• Resisted flexion of the knee (very weak and/or causing pain deep within the knee)

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Treatment: Cruciate LigamentsTreatment: Cruciate Ligaments

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• Ice and Exercise

• Anti-Inflammatory and Proliferants Injection therapy

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Meniscal TearMeniscal Tear

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Anatomy:Meniscal Tear (Torn Cartilage)

Anatomy:Meniscal Tear (Torn Cartilage)

• From Greek meniskos, “crescent”

• Cartilaginous discs in the knee

• Two menisci of the knee joint: lateral and medial

• Lateral meniscus is attached to the ACL

• From Greek meniskos, “crescent”

• Cartilaginous discs in the knee

• Two menisci of the knee joint: lateral and medial

• Lateral meniscus is attached to the ACL

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Function:Meniscal Tear

Function:Meniscal Tear

• Disperse weight of the body

• Reduce friction of femur on the tibia

• Act as shock absorbers

• Disperse weight of the body

• Reduce friction of femur on the tibia

• Act as shock absorbers

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How and WhyHow and Why

• Minor Tears: weakness, clicking when you bend, sometimes knee collapses

• Major Tears: consistent weakness, frequent and unpredictable collapses

• Minor Tears: weakness, clicking when you bend, sometimes knee collapses

• Major Tears: consistent weakness, frequent and unpredictable collapses

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How and WhyHow and Why

• Torn cartilage moves to a part of the knee with no space for it

• Joint movement stops

• Thigh muscles contract to protect

• Torn cartilage moves to a part of the knee with no space for it

• Joint movement stops

• Thigh muscles contract to protect

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Assessment Tests: Meniscal TearAssessment Tests: Meniscal Tear

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Mostly in the History:

• Giving way and collapsing

• Locking in flexion

• Swelling after a locking or collapsing incident for several weeks

• 30 degree clicking

• Pain is deep

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Theory:Meniscal Tear

Theory:Meniscal Tear

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Treatment: Meniscal TearTreatment: Meniscal Tear

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Surgery, or live with it.

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ChondromalaciaChondromalacia

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Anatomy:Chondromalacia

Anatomy:Chondromalacia

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Under surface of the patellaGliding surface on the femur

The Patella:• Protects the knee joint• Increases the functional strength

of the quadriceps by 40%

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Assessment Tests: Chondromalacia

Assessment Tests: Chondromalacia

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Deep Knee BendDeep Knee Bend

Assessment Tests:

Patella PressPatella Press

Assessment Tests:

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Theory: ChondromalaciaTheory: Chondromalacia

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• Down stairs or downhill

• High barometric pressure makes it worse

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Treatment: ChondromalaciaTreatment: Chondromalacia

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• Sinvisc injections

• Surgery

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Osgood Schlatter’s DiseaseOsgood Schlatter’s Disease

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Anatomy:Osgood Schlatter’s Disease

Anatomy:Osgood Schlatter’s Disease

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Rupture of the growth plate at the tibial tuberosity with strain of the tendon attachment

• Injury and pain is at the junction of the patella ligament and the bone

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Assessment Tests: Osgood Schlatter’s Disease

Assessment Tests: Osgood Schlatter’s Disease

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Resisted Extension of the KneeResisted Extension of the Knee

Assessment Tests:

PalpationPalpation

Assessment Tests:

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Theory: Osgood Schlatter’s Disease

Theory: Osgood Schlatter’s Disease

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Treatment: Osgood Schlatter’s Disease

Treatment: Osgood Schlatter’s Disease

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• Proliferant injection – growth plate

• Friction therapy – tendon strain

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Loose BodyLoose Body

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Anatomy:Loose BodyAnatomy:

Loose Body

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• Loose floating fragment of cartilage or bone

• Pain is felt deep in the knee

• Pain usually when the knee is straight

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Anatomy:Loose BodyAnatomy:

Loose Body

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• Knee locks

• Shake leg to dislodge

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How it HappensHow it Happens

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Direct cause is often unknown• A fall• Arthritis

Smaller chips are sometimes created through bone rubbing

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Diagnostic VerificationDiagnostic Verification

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X-rays can only pick up bone, not cartilage

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Assessment Tests: Loose Body

Assessment Tests: Loose Body

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• In the history

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Treatment: Loose BodyTreatment: Loose Body

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1. Manipulation

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Treatment: Loose BodyTreatment: Loose Body

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2. Knee Wash

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Treatment: Loose BodyTreatment: Loose Body

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3. Surgery

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Dislocating PatellaDislocating Patella

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Anatomy:Dislocating Patella

Anatomy:Dislocating Patella

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• Kneecap moves laterally to outside of knee

• Pain concentrated at the front and outside of knee

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How it HappensHow it Happens

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• Running

• Sharp turn while walking

• Patella too small or not firmly anchored

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Diagnostic VerificationDiagnostic Verification

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Sometimes confused with torn cartilage

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Assessment Test: Dislocating PatellaAssessment Test: Dislocating Patella

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• Gently push kneecap laterally

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Treatment: Dislocating Patella

Treatment: Dislocating Patella

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• Forceful straightening

• Passage of time

• Quadriceps exercises

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Traumatic ArthritisTraumatic Arthritis

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Anatomy:Traumatic Arthritis

Anatomy:Traumatic Arthritis

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• Usually accompanies other injuries

• Also called “Water on the Knee”

• Irritates lining of knee joint

• Lining overproduces fluid

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How it HappensHow it Happens

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• A fall or jolt

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Diagnostic VerificationDiagnostic Verification

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• Compare both knees• If pain is general, arthritis is primary• If pain is specific, check for ligament injuries

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Assessment Tests: Traumatic ArthritisAssessment Tests: Traumatic Arthritis

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HeatHeat

Assessment Tests:

Knee FlexionKnee Flexion

Assessment Tests:

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Knee ExtensionKnee Extension

Assessment Tests:

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Treatment: Traumatic Arthritis

Treatment: Traumatic Arthritis

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• Self-Treatment

• Medical Treatment

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QuestionsQuestions

Facebook.com/DrBenBenjaminFacebook.com/DrBenBenjamin

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Post-testPost-test1. Pain when kneeling on the knee usually means that the

patella tendon is injured. True or False?

2. The draw sign refer to an assessment test that stresses the meniscus. True or False?

3. A loose body in the knee joint causes the knee to get stuck in flexion. True or False?

4. Chondromalacia causes knee pain primarily when going upstairs or uphill. True or False?

5. A torn cartilage causes the elderly to be fearful when walking down stairs – the fear is that their leg will lock while straight and they will fall. True or False?

6. You can have a traumatic arthritis in the knee with swelling without a ligament or cartilage injury. True or False?

1. Pain when kneeling on the knee usually means that the patella tendon is injured. True or False?

2. The draw sign refer to an assessment test that stresses the meniscus. True or False?

3. A loose body in the knee joint causes the knee to get stuck in flexion. True or False?

4. Chondromalacia causes knee pain primarily when going upstairs or uphill. True or False?

5. A torn cartilage causes the elderly to be fearful when walking down stairs – the fear is that their leg will lock while straight and they will fall. True or False?

6. You can have a traumatic arthritis in the knee with swelling without a ligament or cartilage injury. True or False?

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