Summer 2002 Course

Case # 7 - Knee Pain

(click here for a printable version of this case study)

Presentation: A 35 year old "weekend warrior" is referred to you for examination after injuring his knee in a touch football game. He stated that the field was wet and his foot was "caught" after he caught a pass and turned to run. At that moment, an opposing player collided with the lateral aspect of your patient's knee, forcing the lateral portion of the knee to buckle inwards. His knee was swollen and was very tender on the medial side. He was able to move his knee but complained of sharp pain and there was a pronounced "clicking" noise as his knee went into extension. The pain was evident during both active and passive movements of his knee. Despite being able to move his knee, he described the joint as feeling "unsteady" when he walked on the affected limb.

Activities:

I. Describe the bony and ligamentous anatomy of the knee joint.

1. Which components of the knee are palpable?
2. How can you determine the location of the knee joint cavity?

II. Discuss the attachments and functions of the major ligaments of the knee using diagrams or models.

1. Name the major ligaments that support the knee.
2. What is the primary function of each ligament?
3. Be able to demonstrate on the "patient" how you would go about testing the integrity of each major ligament.

III. Discuss the location and functions of the menisci.

1. Be able to differentiate between both menisci with respect to shape, mobility, and functions.
2. What symptoms indicate the involvement of the menisci in this injury?
3. Demonstrate on your "patient" a test to determine is the menisci were injured.

IV. Examine the knee of your "patient".

1. Consider the direction of the blow that caused the injury. Does this give you a clue as to which structures are damaged?
2. Determine which of the structures of the knee were damaged.
3. Determine if there was any neurological damage. Check for range of motion using active and passive movements. Describe the movements and the prime mover(s) for each movement.
4. Why was the knee swollen? Define the term bursa and discuss the bursa of the knee.

V. Describe the extent of the patient's injury and the structures involved. Why were these particular structures damaged?