| Popis: |
Examining a knee is often thought of as a mysterious art by many trainees and, it must be said, by a fair number of orthopaedic consultants! Like examining any joint, practice is the key, and to get a feel for the subject, I would urge interested parties to examine as many normal joints as possible. Never forget that God was kind to orthopaedic surgeons and, realising we are simple souls, gave most people a reasonably matching pair of limbs. You will avoid many errors in diagnosis by comparing what you think is a positive sign in one knee, with the opposite leg. Always take a careful history first as this will ‘zero in’ your clinical examination to the appropriate area. Examination then needs to be systematic—examine every knee in the same sequence and you will not miss valuable information. Examination in acute knee injuries may be difficult; this does not mean it should be avoided. Gentle and careful palpation will reveal the exact site or sites of tenderness, and a block to extension is usually obvious. A history of the exact mechanism of injury will usually predict which structures are likely to have been damaged, and significant laxity of individual ligaments is usually detectable. The more severe injuries may be less painful as complete disruption of the capsule may destroy nerve endings and release a haemarthrosis into the soft tissues. MRI may be able to tell you which structures are damaged, but what it cannot tell you is whether those structures have pathological laxity, and hence cannot tell you which structures may need reconstructing. There is only one thing that can assess complex knee laxity, and that is the hands of an experienced examiner. Examination |
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