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Knee HOPS. HISTORY. We estimate that the proper diagnosis can be achieved in 80 - 85% of cases from a properly performed history alone . (Univeristy of Minnesota Sports Medicine) How What sport Contact v. non-contact Non-contact think ACL Valgus force think MCL Varus force think LCL
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HISTORY • We estimate that the proper diagnosis can be achieved in 80 - 85% of cases from a properly performed history alone. (Univeristy of Minnesota Sports Medicine) • How • What sport • Contact v. non-contact • Non-contact think ACL • Valgus force think MCL • Varus force think LCL • Rotational force think meniscus or ACL
Did it feel like it gave out • Did you hear or feel a “pop” • Chronic v. acute onset • Functional limitations • Locks think meniscus • Pain with deep knee bends or stairs think meniscus
OBSERVATION • It is important to observe the symptomatic knee for any deformities, abnormal alignment, surgical scars, lacerations, discoloration and swelling. • Observe the gait • Unable to extend knee fully when walking think ACL • Knee locked when walking think meniscus
Swelling • Intraarticular: swelling inside the joint (capsule) will result in the loss of the normal contour of the extensor mechanism. May see a “fluid wave” think meniscus, ACL or PCL
Extraarticular: swelling oustide of the joint. Localized swelling and a traumatic etiology can indicate either a localized hematoma or a localized joint injury. • Medial aspect of knee think MCL • Lateral aspect of knee think LCL • Anterior aspect think bursitis, tendonitis • Tibial tuberosity think Osgood-Schlatters • Posterior aspect think Baker’s
PALPATION • Bony • Head of fibula – think LCL • Tibial tuberosity –think Osgood Schatter’s • Joint line/tibial plateau- think meniscus • Patella – inferior pole think Lars-Johansen
Muscular • Quadriceps and quadriceps tendon • Hamstrings and tendons • Origin of gastrocnemius • Ligaments • MCL on medial side • LCL on lateral side • Cannot palpate ACL or PCL
Special Tests • ROM– active,passive and resistive knee flexion and extension • Patellar grind test-- chondromalaysia