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