Post on 16-Apr-2017
Dr. Abdallah El-Sayed AllamMSc of Physical Medicine, Rheumatology and Rehabilitation .
Faculty of Medicine. Tanta University. EgyptMSK US fellowship. National Taiwan University Hospital. Taiwan
Case Presentation
*Female *53years * BMI: 35.53 kg/m2
* Chronic, Bilateral Asymmetric (LT>RT)
mechanical Knee Pain
*X-Ray: L-K G2
*Bilateral Knee OA
*α-D-glucosamine 500mg cap twice daily
+ NSAIDS
Lt knee Pain 8/10
more on lateral side 10/10
With painful limitation of flexion not > 90
degrees actively
MRI LEFT KNEE
-MILD Effusion and synovitis,
-Osteophytes,
-Cartilage defects at both femoral condyles
and post patellar surface,
-Intact menisci and cruciate ligaments .
Clinically
-Effusion (moderate)
-Tenderness along joint line more over
lateral femoral condyle
- Crepitus
- -ve Ant. & Post. drawer , McMurray and
Apley's Compression and Distraction Tests
Ultrasound study
Static scan
Main findings :
1- Suprapatellar pouch and 2 recesses :
Moderate effusion + Synovial thickening and
folding
2- Osteophytes
3- Meniscal subluxation (Med. meniscus)
TTT
1-US guided Aspiration and IA steroids + HA
injection at the same session 1 week 2nd US
guided IA HA injection 1 week 3rd US guided IA
HA injection
Complete Relief of the diffuse knee pain, but
persistent lateral knee pain and Limitation of
flexion > 90 degrees
Ultrasound study
Static scan
Dynamic scan
Diagnosis
Iliotibial band impingement (between 2 osteophytes at lateral femoral condyle)
TTT
1 -Shock wave therapyOr
2 -Surgery
Discussion
Anatomy
Biomechanics
Thank you