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Knee Exam

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13221. Paediatric Examination

, the child lies very still with flexed knees and shallow breaths. Inspect the anogenital area if appropriate. This is an increasingly difficult examination as children get older and requires sensitive handling. Warm hands and reassurance are needed to palpate the abdomen of an ill child. Neurological and developmental examination: Formal examination is very difficult. Improvisation is often required. Cranial nerves are examined by observation - for example, of behavioural and facial movements. Cranial (...) : Observation is again most important. Peak flow measurement is not reliable until about age 5 years (see separate article ). Gastrointestinal examination: It is often best to examine kneeling down alongside the patient. Children may prefer palpation to be done with their hand underneath the examiner's. Hip and knee examination: Irritable hip and other hip conditions can occur at this age and require assessment. Normal genu varus (physiological in the toddler) and valgus (physiological in the pre-school

2008 Mentor

13222. Can the presence of equinus contracture be established by physical exam alone? (Abstract)

Can the presence of equinus contracture be established by physical exam alone? The condition in which ankle dorsiflexion is restricted is known as equinus contracture (EC). Equinus contracture is purported to be associated with a number of clinical conditions. However, there are no data to support or refute a clinician's ability to diagnose EC by clinical exam. We prospectively evaluated the maximum ankle dorsiflexion with the knee fully extended in 68 people (34 patients with isolated fore (...) - or midfoot pain and 34 asymptomatic subjects) both by clinical exam and by a custom-designed ankle goniometer. We compared the likelihood of agreement of the clinical impression (equinus, no equinus) to the maximum ankle dorsiflexion measured with the instrument at two different numerical definitions of EC (< or =5 degrees and < or =10 degrees of maximum dorsiflexion). When all subjects were included and equinus defined as < or =5 degrees of ankle dorsiflexion, a clinician's ability to detect the equinus

2001 Journal of rehabilitation research and development Controlled trial quality: uncertain

13223. Exploring the use of videotaped objective structured clinical examination in the assessment of joint examination skills of medical students. (Abstract)

at Freeman Hospital, Newcastle (UK). Student performance on OSCE stations for shoulder or knee examinations was assessed by experienced rheumatologists. The stations were also videotaped and scored by a rheumatologist independently. The examinations consisted of a 14-item checklist and a global rating scale (GRS).Mean values for the shoulder OSCE checklist were 17.9 by live assessment and 17.4 by video (n = 50), and 20.9 and 20.0 for live and video knee assessment, respectively (n = 45). Intraclass (...) correlation coefficients for shoulder and knee checklists were 0.55 and 0.58, respectively, indicating moderate reliability between live and video scores for the OSCE checklists. GRS scores were less reliable than checklist scores. There was 84% agreement in the classification of examination grades between live and video checklist scores for the shoulder and 87% agreement for the knee (kappa = 0.43 and 0.51, respectively; P < 0.001).Video OSCE has the potential to be reliable and offers some advantages

2007 Arthritis and rheumatism Controlled trial quality: uncertain

13224. Exercise-induced knee joint laxity in distance runners. Full Text available with Trip Pro

, axial tibial rotation and anterior-posterior tibial displacement were simultaneously recorded, while the runners underwent tests of static as well as dynamic knee joint laxity. At 30 degrees of knee flexion, a maximum increase of 16 per cent in mean total anterior-posterior laxity post-exercise was found. At the examination 30 minutes post-exercise, laxity at 30 degrees of knee flexion was still increased. However, laxity at 90 degrees of knee flexion had decreased to pre-exercise levels or below (...) Exercise-induced knee joint laxity in distance runners. The objectives of this study were to evaluate the effect of exercise on knee joint laxity. If exercise induced laxity is physiological, incorporation of this quality into a ligament replacement material would be indicated. Twenty recreational long distance runners average age 41 (range 24 to 50 yr) were tested before and immediately after 30 minutes of running. Using a computerized goniometer type instrument (Acufex KSS), knee flexion

1989 British Journal of Sports Medicine

13225. Arthrography and arthrotomy of the knee in sports injuries. Full Text available with Trip Pro

Arthrography and arthrotomy of the knee in sports injuries. A total of 266 patients with injuries to the knee sustained during sports activities were managed by arthroscopy and/or arthrotomy. All of them received systemic examination and a standard battery of knee stability tests. Fifty-three were examined by arthrography and all underwent arthrotomy for surgical correction of the lesion diagnosed by both clinical examination and arthrography. Our study showed that clinical examination could (...) give an accurate clinical diagnosis in 88.35% of cases and arthrography in 76.89%. No complication from arthrography was found. Injury occurred most commonly between 21 and 30 years of age and was more common to the right knee than the left. The sport in which most injuries occurred was football.

1993 British Journal of Sports Medicine

13226. A modified repair for the anterior cruciate ligament deficient knee. Full Text available with Trip Pro

A modified repair for the anterior cruciate ligament deficient knee. A retrospective analysis of 48 sportsmen and women from an original series of 76 consecutive patients who had undergone a modified McIntosh repair was carried out to establish whether or not the procedure could provide a satisfactory recovery and return to previous ability. The type and level of sport before injury was compared with that after operation. Symptoms of pain and giving way, and examination findings of pivot shift (...) , and Lachman's test were compared before and after operation. Of the 48 patients assessed, 28 (58%) returned to full sporting capacity; 17 (35%) patients were participating in different sports or lower levels of their previous sports, and three patients did not participate in any sport. The more severely symptomatic knees did not perform so well after operation. The degree of preoperative anterior draw and Lachman's test did not influence the final result and the pivot shift, present in all before operation

1992 British Journal of Sports Medicine

13227. Knee pain in sports people--a prospective study. Full Text available with Trip Pro

Knee pain in sports people--a prospective study. Knee pain caused by sport is a common cause of rheumatic symptoms. Clinical diagnosis is frequently difficult and an attempt was therefore made to determine whether particular symptoms and signs were sufficiently characteristic in 129 patients to enable easier recognition of knee disorders. Strict criteria for arthrography and arthroscopy included classical features of internal derangement or disabling pain. Arthrograms were performed in 39 (...) and arthroscopy in 30, revealing good concordance for meniscal tears but none for cruciate tears. Classical histories and signs were often absent from patients with meniscal and cruciate tears. Patellar pain was a prominent symptom of 58 (45%). Questionnaires one year after assessment were returned by 91 (70%). Many patients had persistent symptoms or were unable to resume their sports. The unreliability of clinical diagnosis suggests that more frequent arthroscopic examinations could have increased

1987 British Journal of Sports Medicine

13228. Arthroscopy of the knee. Ten-day pain profiles and corticosteroids. (Abstract)

Arthroscopy of the knee. Ten-day pain profiles and corticosteroids. A prospective study was conducted to determine 10-day pain and analgesic use profiles of outpatients after arthroscopic surgery of the knee and to examine the effects of oral corticosteroid use on analgesic intake, perceived pain, and functional outcomes. Sixty-two patients who underwent a variety of arthroscopic procedures of the knee were matched on level of injury and surgical repair, and were assigned to two groups (...) patients who have undergone arthroscopic surgery of the knee perceive pain at low levels, use limited amounts of analgesics, and return to work within a week. The addition of oral corticosteroids does not influence this profile.

1993 American Journal of Sports Medicine

13229. Comparison of an optical catheter office arthroscope with a standard rigid rod-lens arthroscope in the evaluation of the knee. (Abstract)

-four patients were included in the data analysis, three were eliminated because we were unable to perform an adequate examination with the catheter scope secondary to intraarticular adhesions or excessive bleeding. A comparison of the two systems revealed an overall underestimation and underrecognition of intraarticular knee pathologic changes. Anterior cruciate ligament tears were missed in 3 of 21 knees; no posterior cruciate ligament tears were detected by the rod-lens arthroscope in 44 knees (...) Comparison of an optical catheter office arthroscope with a standard rigid rod-lens arthroscope in the evaluation of the knee. In a prospective, randomized study, 47 patients underwent arthroscopic evaluation of the knee in an operating room setting with both a standard rod-lens arthroscope and a newer flexible optical catheter fiberoptic system. The goal of the study was to assess the diagnostic accuracy of the newer catheter system, which is recommended for use in the office setting. Forty

1997 American Journal of Sports Medicine Controlled trial quality: uncertain

13230. Instrumented evaluation of knee laxity: a comparison of five arthrometers. (Abstract)

Instrumented evaluation of knee laxity: a comparison of five arthrometers. We performed a prospective study on 50 subjects with normal knees and 50 patients with chronic unilateral disruption of the anterior cruciate ligament. In a randomized testing sequence, both groups were examined with five arthrometers: the MEDmetric KT-1000, the Stryker Knee Laxity Tester, the Acufex Knee Signature System, the Dyonics Dynamic Cruciate Tester, and the Genucom Knee Analysis System. Each examination (...) was performed according to protocol with the knee at 30 degrees of flexion. The total anterior laxity measurements of the normal subjects using the Dyonics Dynamic Cruciate Tester and Acufex Knee Signature System were approximately half of the KT-1000, Stryker, and Genucom values. A comparison of the side-to-side measurements revealed no statistically significant difference in the values of the five arthrometers. However, the Genucom showed an unacceptably high number of normal subjects with laxity values

1992 American Journal of Sports Medicine Controlled trial quality: uncertain

13231. An appreciation of the injured knee. Full Text available with Trip Pro

An appreciation of the injured knee. 6892890 1980 08 15 2018 11 13 0306-3674 14 1 1980 Mar British journal of sports medicine Br J Sports Med An appreciation of the injured knee. 6-12 England J P JP eng Journal Article England Br J Sports Med 0432520 0306-3674 IM Athletic Injuries diagnosis epidemiology England Humans Knee Injuries diagnosis epidemiology Ligaments, Articular injuries Pain etiology Patella injuries Physical Examination Soccer Tibial Meniscus Injuries 1980 3 1 1980 3 1 0 1 1980 3

1980 British Journal of Sports Medicine

13232. Ultrasonographic scan in knee pain in athletes. Full Text available with Trip Pro

Ultrasonographic scan in knee pain in athletes. Fifty-two knees were examined using real-time high-definition ultrasonography with a 7.5 MHz probe. The extra-articular structures were easily visualized and diagnosis of patellar tendon lesions and Baker's cysts formulated. While the meniscal cartilages were shown as a homogeneous triangular structure between the femoral condyle and the tibial plateau, no lesions were detected. Deeper intra-articular structures, such as the cruciate ligaments (...) , were not shown by the scan, thus their evaluation was not possible. Given its low cost, wide availability, non-invasiveness and patients' acceptability of the technique, ultrasonography may play an important role in the diagnosis of soft tissue lesions in and around the knee joint.

1992 British Journal of Sports Medicine

13233. A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group. Full Text available with Trip Pro

for more than 12 months. Forty nine of the subjects had two or more separate episodes of symptoms. Ultrasonography showed a characteristics hypoechoic region at the junction of the inferior pole of the patella and the deep surface of the patellar tendon. Histopathological examination showed separation and disruption of collagen fibres on polarisation light microscopy and an increase in mucoid ground substance consistent with damage of tendon collagen without inflammation.Jumper's knee has the potential (...) A cross sectional study of 100 athletes with jumper's knee managed conservatively and surgically. The Victorian Institute of Sport Tendon Study Group. Jumper's knee causes significant morbidity in athletes of all standards. However, there are few reference data on the clinical course of this condition in a large number of patients, and the aim of this study was to rectify this.A retrospective study of the course of jumper's knee in 100 athletes who presented to a sports medicine clinic over

1997 British Journal of Sports Medicine

13234. An evaluation of pre- and postoperative nonsteroidal antiinflammatory drugs in patients undergoing knee arthroscopy. A prospective, randomized, double-blinded study. (Abstract)

An evaluation of pre- and postoperative nonsteroidal antiinflammatory drugs in patients undergoing knee arthroscopy. A prospective, randomized, double-blinded study. The potential benefits of a nonsteroidal antiinflammatory drug to 67 patients undergoing knee arthroscopy were evaluated in a prospective, randomized, placebo-controlled, double-blinded study. Group A received the drug (diclofenac, 75 mg twice daily) for 3 to 5 days before and for 7 days after surgery. Group B received a placebo (...) preoperatively and the drug postoperatively. Group C received a placebo at both times. Codeine was available postoperatively for all patients if needed. Outcomes reported by the subjects included pain, crutch use, and return to activities. Outcomes assessed by physicians included knee effusion, range of motion, and gait. Knee flexion and extension strengths were measured isokinetically pre- and postoperatively. Pain scores on the 1st postoperative day were higher in Group C than in Group A. Pain scores

1993 American Journal of Sports Medicine Controlled trial quality: uncertain

13235. The effect of glucosamine supplementation on people experiencing regular knee pain. Full Text available with Trip Pro

The effect of glucosamine supplementation on people experiencing regular knee pain. The purpose of this study was to examine the effects of oral glucosamine supplementation on the functional ability and degree of pain felt by individuals who had regular knee pain, most likely due to previous articular cartilage damage, and possibly osteoarthritis.Subjects were randomly supplemented with either glucosamine (G) (n=24) or placebo (P) (lactose) (n=22) for 12 weeks at a dose of 2,000 mg per day (...) . Over this period, four testing sessions were conducted, with changes in knee pain and function assessed by clinical and functional tests, (joint line palpation, a 3 metre "duck walk" and a repeated, walking stair climb), two questionnaires (the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Pain Scale (KPS)) and participant subjective evaluations.The clinical and functional test scores improved with time (main effects: p<0.05, p<0.01) but there were no significant differences

2003 British Journal of Sports Medicine Controlled trial quality: uncertain

13236. Radiographic osteoarthritis of the knee classified by the Ahlbäck and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35-54 years with chronic knee pain Full Text available with Trip Pro

by clinical examination and plain posteroanterior, weight bearing radiographical examination. The Ahlbäck criteria (focusing on joint space narrowing) and the Kellgren & Lawrence classification for knee OA were used for diagnosing tibiofemoral OA.A questionnaire was sent to 2000 randomly selected people aged 35-54 years. The response rate was 92.6%. Fifteen per cent of these people reported chronic knee pain. This group (n = 279) was offered a clinical and radiographic examination of the knee joint (...) Radiographic osteoarthritis of the knee classified by the Ahlbäck and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35-54 years with chronic knee pain To determine the prevalence of tibiofemoral radiographic knee osteoarthritis (OA) in people aged 35-54 years associated with chronic (> 3 months) knee pain using two different radiographic grading systems.Population based postal survey in a random sample of inhabitants in a district in southern Sweden followed

1997 Annals of the Rheumatic Diseases

13237. Knee effusion after total knee replacement. Full Text available with Trip Pro

Knee effusion after total knee replacement. The various causes of effusions in artificial knees can be divided into four groups: implant related, technique related, interface problems, and infection. Diagnosis can be made from the patient's history and a clinical examination. Treatment is usually surgical revision.

1993 Canadian Family Physician

13238. Prosthetic above-knee femoropopliteal bypass grafting: results of a multicenter randomized prospective trial. Above-Knee Femoropopliteal Study Group. (Abstract)

a knitted Dacron polyester graft impregnated with collagen or a thin-wall expanded reenforced PTFE graft to the above-knee popliteal artery, usually from the common femoral artery. They were frequently observed by protocol for as long as 5 years by a physical examination noninvasive hemodynamic study, including duplex scanning in many instances. Continuing patency was noted, as were other potential adverse outcome events. The data were analyzed by the log-rank test for cumulative patency and expressed (...) Prosthetic above-knee femoropopliteal bypass grafting: results of a multicenter randomized prospective trial. Above-Knee Femoropopliteal Study Group. There are excellent arguments in favor of the preferential use of prosthetic grafts above the knee for the treatment of infrainguinal occlusive disease. This approach has been popularized on the basis of the seemingly acceptable results when using polytetrafluoroethylene (PTFE). However, in many centers, knitted Dacron polyester has been used

1997 Journal of vascular surgery Controlled trial quality: uncertain

13239. Randomised, prospective study comparing cemented and cementless total knee replacement: results of press-fit condylar total knee replacement at five years. (Abstract)

total knee replacement and report the results of 139 prostheses at five years. Outcome was assessed both clinically by independent examination using the Nottingham knee score and radiologically using the Knee Society scoring system. Independent statistical analysis of the data showed no significant difference between cemented and cementless fixation for pain, mobility or movement. There was no difference in the radiological alignment at five years, but there was a notable disparity (...) Randomised, prospective study comparing cemented and cementless total knee replacement: results of press-fit condylar total knee replacement at five years. Early implants for total knee replacement were fixed to bone with cement. No firm scientific reason has been given for the introduction of cementless knee replacement and the long-term survivorship of such implants has not shown any advantage over cemented forms. In a randomised, prospective study we have compared cemented and uncemented

1998 The Journal of Bone and Joint Surgery British Volume Controlled trial quality: uncertain

13240. Cartilage and bone macromolecules in knee joint synovial fluid in rheumatoid arthritis: relation to development of knee or hip joint destruction Full Text available with Trip Pro

Cartilage and bone macromolecules in knee joint synovial fluid in rheumatoid arthritis: relation to development of knee or hip joint destruction To examine the hypothesis that aggrecan, cartilage oligomeric matrix protein (COMP), and bone sialoprotein (BSP) concentrations in synovial fluid could provide information on variations of progression of joint destruction in rheumatoid arthritis.Aggrecan, COMP, and BSP were quantified by enzyme linked immunosorbent assays in longitudinally collected (...) knee joint synovial fluid samples of patients rapidly developing destruction in knees or hips, the "'destructive" group, n = 18, and in patients slowly developing destruction, the "non-destructive" group, n = 25.The aggrecan concentrations decreased from initially high levels (P < < 0.001), and the BSP concentrations increased (P < < 0.001) over time in the destructive group, whereas levels of both markers were low and did not change in the non-destructive group. The COMP levels did not change

1997 Annals of the Rheumatic Diseases

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