Injury + Management
AC Joint separation / sprain
Most managed conservatively
- 48 hours immobilisation with sling, rice
- physio for strengthening program
- anaglesia
2-6 weeks generally to return normal function
Review if symptoms persisting - increase chance of OA
ICS can be beneficial if conservative not helping
Likely diagnosis?
Trevor Habif, aged 69 years, has a tender, stiff and swollen right knee. His knee is tender when he puts weight onto it and he finds it difficult to fully straighten the knee. It sometimes feels like his knee “gets stuck’. He cannot recall any injury to the knee. The onset of pain has been gradual. Trevor points to the medial joint line as the site of maximum tenderness.
Degenerative meniscal tear
Most common injury to knee joint
After 40yo degenerative pathology without clear mechanism common
History of insidious symptom onset and an inability to remember a precise moment of injury
knee pain (especially with extremes of motion, such as deep knee flexion)
mechanical symptoms (such as locking, popping, catching, or buckling)
persistent focal joint line tenderness
recurrent effusion after activity.
Features mensical tear
History of insidious symptom onset and an inability to remember a precise moment of injury
knee pain (especially with extremes of motion, such as deep knee flexion)
mechanical symptoms (such as locking, popping, catching, or buckling)
persistent focal joint line tenderness
recurrent effusion after activity.
Positive thessaly test + McMurray test
Management meniscal tears
Most degenerative respond well to conservative
Intensive physio
Review after a month
> 50yo MRI not that helpful and no longer rebatable by GP
Arthroscopy only if younger or if severe symptoms not improving with conservative
Features of patellofemoral syndrome
History of insidious symptom onset and an inability to remember a precise moment of injury
knee pain (especially with extremes of motion, such as deep knee flexion)
mechanical symptoms (such as locking, popping, catching, or buckling)
persistent focal joint line tenderness
recurrent effusion after activity.
Patella tilt test + patella femoral grind test positive
Diagnosis?
Ashley McDonald, aged 32 years, presents with dull aching pain and stiffness in the front of her right kneecap. The onset of the pain has been gradual and is worse when she walks, runs or squats. She has pain and a grinding sensation in the knee when she climbs up stairs or when standing up after sitting down at her desk. The symptoms began recently after she completed her first marathon following months of training. She has not been able to run because of the pain.
Patellofemoral syndrome
Management patellofemoral syndrome
Initially rest and RICE
NSAID
Physio
Features of greater trochanteric pain syndrome
defined as localised lateral hip pain with focal point tenderness on palpation over the greater trochanter with the patient lying on their side
It is most common in women over 40 years and represents approximately 10-20% of hip presentations in primary care
Positive
Jump test
trendelenberg
single leg stance test
Pain in Active resisted hip abduction and in internal rotation
Diagnosis?
Lori Johnson, aged 52 years, presents with left hip pain and tenderness. She works at a desk job on the fourth floor and occasionally uses the stairs. She had an initial sharp and intense pain while walking up the stairs last week, but the pain is now more of a general deep pain in the hip area. There was no snapping, popping or locking of the hip joint. The pain is at the point of the left hip, extending to the outside left thigh and lower back. It is worse at night lying on her left side, or when she is active. It is causing her to limp. Lori has no past history of back pain or injury, or pain/deformity in any other joints. She has a BMI of 24 kg/m2.
greater trochanteric pain syndrome
Management greater trochanteric pain syndrome
Conservative
Relative rest, ice packs & sleep with pillow between legs on unaffected side.
NSAIDs
Physio - gluteal strengthening, extra-corporeal shock wave therapy
ICS
Diagnosis?
Angela Yeo, aged 66 years, presents with left hip stiffness and pain. The pain is deep in her left hip and worse in the morning. She has pain with weight bearing and is reluctant to walk very far as her hip feels weak and unable to take her weight. Angela is retired and the symptoms are affecting her social life. She cannot help with her grandchildren or get out and meet with family and friends. Angela has a BMI of 27 kg/m2. She is currently on ramipril (5mg daily) for hypertension and paracetamol (1g, 4 times a day as needed) for pain.
On examination, Angela has pain in the anterior left hip and groin on internal rotation of the left hip.
Hip OA
Management Hip OA
Topical NSAID or capsaicin
Oral paracetamol or NSAID
ICS but may accelerate cartilage loss
Duloxetine
Weight management
Physio
Surgery if persistent/fail conservative
