Case Study 2

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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 *-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 condyleCrepitus -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 folding2- Osteophytes3- 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

15

Dynamic scan

Diagnosis

Iliotibial band impingement (between 2 osteophytes at lateral femoral condyle)

TTT

1- Shock wave therapyOr2- Surgery

Discussion

Anatomy

Biomechanics

Thank you