1
osteoarthritis
Ordinary (> 50 years old)
knee pain
Early stage: pain at the beginning of the activity, theater sign, pain when going up and down stairs, pain when squatting, and rest can be relieved;
Middle and late stage: pain due to heavy load, walking and night pain.
Short term morning stiffness (
There may be acute attack of synovitis, tenderness of joint space and decreased activity.
Joint rubbing sound, mild to moderate joint effusion
X-ray film: the anterior and posterior position, lateral position and tangent position of patellofemoral joint under load.
2
Pain of anterior knee joint
Chondromalacia patellae is a general term for anterior knee pain. However, patellofemoral syndrome is often accompanied by anterior knee pain. At present, the commonly used diagnosis is the term anterior knee pain.
differential diagnosis
Symptomatic knee joint folding caused by chondromalacia patellae
Uneven fat pad syndrome of patella (Hoffa's disease)
Abnormal patellar movement infrapatellar/anterior patellar bursitis
Patella tendinitis foot goose bursitis
Hypertonic retinaculum neuroma of iliotibial tract
The lateral retinaculum of meniscus injury has high tension.
Postoperative pain of bilateral patellar neuroma
Blunt contusion and hip fracture can cause pain.
Radiation pain of lumbosacral spine due to osteochondritis of patella
Cindy-Larsen-Johnson disease.
three
patellar-tendinitis
It is more common in the tendon-bone junction of the lower pole of patella after the bone matures. After going downstairs or running, the pain in front of the knee is aggravated, and the patellar ligament in the lower pole of the patella is tender, but the tenderness often disappears during the straight leg elevation test, indicating that the lesion is located in the deep layer of the patellar ligament. When the straight leg is raised, the superficial fibers of patellar ligament are tense, which protects the deep fibers and resists the pain when stretching the knee. No joint effusion. X-rays are negative.
four
Goose foot bursitis
Tendons of sartorius muscle, gracilis muscle and semitendinosus muscle form joint stops on the medial surface of proximal tibia-goose foot. Excessive use or direct contusion can cause inflammation of synovial bursa of goose foot, which is easily confused with medial collateral ligament injury or pain of medial osteoarthritis. The pain of the medial joint of the knee joint can be aggravated by repeated knee flexion and extension, and it is tender below the medial joint line.
No intra-articular effusion, slight swelling at the anchorage of medial tendon, valgus stress test or knee flexion can all cause pain. ? X-rays generally have nothing unusual to look at.
five
Ligament injury
Injury of collateral ligament
Injury of medial collateral ligament
Injury of lateral collateral ligament (lateral ligament complex)
anterior cruciate ligament injury
Anterior cruciate ligament injury
Posterior cruciate ligament injury
Ligament compound injury
six
meniscus injury
It happens when the knee joint suddenly rotates, such as the runner suddenly changes direction, or in the process of chronic degeneration, especially when the knee joint is unstable, the pain of the knee joint is aggravated when it is locked repeatedly. Squatting or knee joint rotation can cause locking, mild edema, joint line tenderness and medial femoral muscular atrophy. Mcmurry test positive? X-rays are negative.
Magnetic resonance imaging: matters needing attention in diagnosis of meniscus injury
There is no obvious continuity interruption on the meniscus surface, so it is impossible to diagnose meniscus tear.
Abnormal signals extending to the meniscus surface at only one level cannot be used as a decisive factor in diagnosis, and the probability of meniscus tear is only 50%. ?
When two or more levels of abnormal signals extend to the meniscus surface, the specificity of diagnosing meniscus tear is 90%. Clinical symptoms should be considered rather than MRI results.
After partial meniscectomy, due to the repair mechanism of fibrocartilage, irregular high signal is generated along the incision surface, so it is difficult to distinguish residual meniscus from new tear on MRI. .
seven
Epiphysitis of tibial tubercle
More common in teenage boys? (especially 13, 14-year-old boys or 10,10-year-old girls in the fast-growing period), the pain is confined to the tibial tubercle, and the pain is aggravated when squatting, kneeling, going up and down stairs or the quadriceps muscle is strongly contracted, and the condition is aggravated when jumping and hurdling. Local swelling, fever and tenderness of tibial tubercle can cause pain when resisting active knee extension or passive knee crossing, and there is no joint effusion. X-ray film can be negative, or calcification shadow can be seen at tibial tubercle, patellar ligament? Thickening and swelling of soft tissue before tibial tubercle. Occasionally, avulsion-like changes of tibial tubercle can be seen? (It must be differentiated from avulsion fracture).
eight
osteochondritis dissecans
Intra-articular osteochondrosis, with unknown etiology, degeneration and recalcification of articular cartilage and subchondral bone, is more common in femoral condyle, vague pain in knee joint, morning stiffness and repeated intra-articular effusion (mild). If there are free bodies, there may be chain symptoms. The quadriceps femoris muscle atrophy, and the affected femoral condylar articular cartilage tenderness.
X-ray plain film shows osteochondrosis or intra-articular loose bodies. If exfoliative osteochondritis is suspected, the radiograph should include anteroposterior position, posterior anterior tunnel position, lateral position and patellofemoral joint tangent position.
nine
Patellofemoral joint pain syndrome
It belongs to overuse syndrome, and the typical pathological changes are chondromalacia patellae, mild and moderate pain in knee joint and vague positioning, which often appear after sedentary ("theater sign-theater?" Sign) Women are more common. There may be mild effusion, patellofemoral joint friction when knee joint moves, and squeezing the front of patella can cause pain. The quadriceps resistance test is positive, and there may be tenderness on the articular surface of patella. X-rays generally have nothing unusual to look at. Manifestation of early degeneration.
10
Medial slip membrane plica syndrome
It is easy to miss the diagnosis and belongs to overuse syndrome. Synovial plica in patellofemoral joint is inflamed and edematous due to excessive activity of knee joint. After excessive exercise, the pain in the medial side of the knee joint is acute. Tenderness and movable nodules or cord-like tissues can be touched inside the knee joint and in front of the joint line. Generally, there is no joint effusion, and the X-ray is negative. CT or MRI can show synovial folds.
1 1
Tendinitis of iliotibial tract
Excessive friction between iliotibial tract and lateral condyle of femur will cause tendinitis of iliotibial tract, which is also an overuse syndrome. Common to runners and cyclists. Tension of iliotibial tract, excessive foot pronation, genu varus and tibial rotation are all susceptible factors, and the pain on the lateral side of knee joint can be aggravated, especially when running downhill and climbing stairs. Tenderness of lateral epicondyle of femur (about 3mm on the joint line).
? Noble's Testing? (+): The patient lies on his back, and the examiner puts his thumb on the lateral epicondyle of the patient's femur, and the knee joint flexes repeatedly. The pain is usually the most obvious when the knee flexion is 30. There may be soft tissue swelling and fricative sounds. No joint effusion, X-ray negative.
12
Hoffa's disease
The etiology is unknown, which may be related to the injury of infrapatellar fat pad. After injury, bleeding, inflammatory cell infiltration, swelling and organization may lead to chronic inflammation, fibrosis and hypertrophy, which is due to repeated minor injuries. Some patients have a large fat pad, which protrudes from both sides of the patellar ligament when the knee joint is straightened, and is easy to be squeezed, causing inflammation and fibrosis. The symptoms are pain in front of the knee, tenderness near the patellar ligament and patellofemoral joint, and rough calcification shadow on the infrapatellar fat pad on X-ray film.
13
Split (bisect) patella
Common in children, mostly bilateral. ? It is generally believed that it is a variation of normal ossification, and adolescents can fuse.
Symptoms: pain during or after exercise, pain when kneeling, pain when kneeling, pain when going up and down stairs, pain when walking, and pain when cold.
Splitting pain: it can induce symptomatic splitting patella pain, and the asymptomatic one is negative. Local bony uplift of fractured bone fragments. ? Muscle atrophy of quadriceps femoris, patellar fricative sound, joint effusion, limping and limited joint activity. Sometimes it needs to be differentiated from fracture.
14
infect
It can occur at any age, especially in patients with weakened immune system: cancer, diabetes, alcoholism, AIDS, steroid therapy and so on. No history of trauma, pain, swelling, increased skin temperature, obvious tenderness, and even slight activity may cause severe pain.
Joint cavity puncture
See turbid joint fluid.
WBC & gt50000/mm (50? ×? 109L)
Polymorphonuclear cells >: 75%
Protein > 3g/dl (30g/l)
glucose
Bacterial culture? (+): Staphylococcus aureus is very common.
hemogram
Leukocytosis
Increased polymorphonuclear cells (nuclei move to the left)
ESR accelerated (> 50 mm/h) CRP increased.
15
Inflammatory arthropathy caused by crystallization
Acute inflammation, no history of trauma, redness, swelling, fever, pain and limited activity.
Gout: sodium urate crystals; Pseudogout: calcium pyrophosphate crystals.
Joint cavity puncture
The joint fluid is clear or slightly turbid.
White blood cells 2000 ~ 75000/ mm
Protein > 32g/dl (320g/l)
Glucose 75% blood glucose concentration
Polarizing microscope.
Needle crystal with negative birefringence
Pseudobirefringence positive diamond crystal
16
Idiopathic osteonecrosis
Old people? (& gt55 years old), most of them have no inducement. Suddenly, they have severe knee pain, which is obvious at night. Intra-articular injection of glucocorticoid is ineffective, and there is tenderness on the articular surface of femoral condyle, which has little effect on the activity. X-ray film shows the bone defect and transparent layer of femoral medial condyle.
17
Saphenous nerve compression
There are tender points behind the sartorius muscle on the posterior medial side of the knee joint, hypoesthesia in the medial leg and foot, Tinnel sign of compression point, saphenous nerve: femoral nerve? Branch (L2 ~ L4), send 2 branches,? The infrapatellar branch is distributed in the skin in front of the patella, and the medial branch of the calf is distributed in the skin on the inner surface of the calf and the medial edge of the foot.
18
Proximal tibiofibular joint instability
It is common in adolescent women, with symptoms of unstable knee pain and peroneal nerve paralysis, numbness of calf when squatting, habitual dislocation of fibular head, weakness of lateral knee, and click, "girl's knee"? Girl's? Knee.
Multiple, wandering, knee joint is the most common, no organic lesions, no sports injury, no patellar instability. There is tenderness between the goose's foot and the medial joint. Most of them are bilateral and can disappear on their own. Some people think it is related to endocrine factors. ? Some patients were misdiagnosed as meniscus injury or chondromalacia patellae and underwent surgery, but the symptoms remained after operation.
19
Popliteal cyst
Common, popliteal discomfort or mild pain, popliteal fullness or cystic mass, no tenderness or mild tenderness, activity is not affected. Most of them are near the synovial sac of the posterior medial gastrocnemius or the medial head of gastrocnemius. B-ultrasound, CT and MRI.
20
Epiphyseal spondylolisthesis of femoral head
Knee joint pain, children and adolescents, unclear knee joint pain site, no history of knee joint injury, overweight, mild flexion and external rotation of hip joint, passive internal rotation and straightening of hip joint can cause pain, and knee joint examination is normal. The typical X-ray manifestation is epiphyseal displacement of femoral head, but the clinical manifestation is typical, but the negative film can not rule out the diagnosis. At this time, CT scanning is helpful for diagnosis.
Common causes of knee pain
Children, adults and the elderly
Patellar subluxation patellofemoral joint pain syndrome (chondromalacia patellae) osteoarthritis
Inflammatory arthritis caused by crystallization of medial sliding membranous fissure syndrome in tibial epiphysis: gout and pseudogout.
Patellotendinitis goose foot bursitis popliteal cyst
Pain involved: femoral head epiphyseal slippage injury: ligament injury, meniscus injury.
Exfoliative osteochondritis inflammatory arthropathy: rheumatoid arthritis, Reiter's syndrome
Infectious arthritis
Common causes of knee joint pain in different anatomical parts
Anterior knee pain, medial knee pain, lateral knee pain, and posterior knee pain.
Patella subluxation or dislocation medial collateral ligament injury lateral collateral ligament injury popliteal cyst
Cruciate ligament injury after medial meniscus injury and lateral meniscus injury of tibial tubercle epiphysis
Patellar tendinitis goose foot bursitis iliotibial fasciitis
Femoral joint pain syndrome (chondromalacia patellae) medial slip membrane wrinkle syndrome
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