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Imperial College London Surgical Society Junior Anatomy Series CPA SUMMARY GUIDE Musculoskeletal Examination Chelsea A. Stubbs JAS Leads Defne Artun (CPA Lead) CPAAnya Nanch hal (Phase 1a Lead)9@ic.ac.uk) PhaAndrea Per z Navarro (Phase 1b Lead).ac.uk) Phase 1b Lead: Ananya Jain (aj620@ic.ac.uk) Imperial College London Surgical Society Junior Anatomy Series Summary of significance of findings Positionand Exposure Look Likelyindication Scars Downthe middle Knee replacement surgery Other Other surgery Traumato joint (eg fall) Muscleatrophy Due to disuse Arthritis(patienthas antalgicgait) Due to LowerMotor Maybe peripheral NeuronInjury neuropathyor other lesion Knee Deformity Genu Valgum Usuallygenetic Genu Varum Osteomalacia Feel LikelyIndication Warmkneejoint Septicarthritis Flare up of osteoarthritis or rheumatoidarthritis Painduringpalpation Meniscaldamage Swellingin PoplitealFossa Baker’sCyst Effusionpresent Small or Large Arthritis Damageto internal structureeg meniscus Mohamad Abou-Eid (CPA Lead) Chelsea A. Stubbs Imperial College London Surgical Society Junior Anatomy Series Summary of Significant Findings Move Likely indication PainduringFlexion and Active Damageto meniscusor Extension fracture Passive Damageto meniscusor fracture ReducedRange of Motion Arthritis Inabilityto straightleg Damageto knee raise extensors Unilateralhyperextension (more than10 degrees) Damageto internal structures Bilateralhyperextension (more than10 degrees) Damageto internal structures Bilateralhyperextension (lessthan10 degrees) Normal SpecialTests LikelyIndication PosteriorSag Sign PosteriorCruciate LigamentTear AnteriorDraw>1.5 cm (in absenceof posterior AnteriorCruciate sag sign) LigamentRupture AnteriorDraw>1.5cm (in presenceof posterior ClinicallyInconclusive sag sign) Open MedialJointLine MedialCollateral LigamentLaxity/Rupture Open LateralJointLine LateralCollateral LigamentLaxity/Rupture Mohamad Abou-Eid (CPA Lead) Chelsea A. Stubbs Imperial College London Surgical Society Junior Anatomy Series Interpreting Radiology of the Knee X-rays • Will tell you about bones and their integrity • Looking at bone outlines will allow you to pick up fractures. If it’s discontinuous, it’s a fracture. • Will allow you to see joint spaces, which are reduced in osteoarthritis MRIs • Will allow you to see soft tissues • Are typically sagittal, but may be coronal sections • Normal menisci will appear black • Bone appears grey In general • Locating the fibula will allow you to deduce which knee is being imaged • In a Coronal Section, the lateral side of the tibia is thinner • The ACL and PCL are named according to their attachment to the tibia bone rather than the femur Chelsea A. Stubbs Mohamad Abou-Eid (CPA Lead) Imperial College London Surgical Society Junior Anatomy Series Common Clinical Presentations Osteoarthritis • Reduced Range of Motion • Pain worse on movement, better on rest • History of Trauma • Middle to old age • X-ray shows LOSS (loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts) • Possible muscle atrophy due to antalgic gait • In flare up, may detect warm temperature Septic arthritis • Warm temperature • Effusion • Tenderness • Reduced Range of Motion Rheumatoid arthritis • Female • Pain better with movement • May have other features such as ulnar deviation of hands • History of autoimmune disease Chelsea A. Stubbs Mohamad Abou-Eid (CPA Lead) Imperial College London Surgical Society Junior Anatomy Series Common Clinical Presentations Torn ACL • Positive Anterior Draw (without posterior sag) • Pain on passive and active flexion and extension • Plays sports such as rugby or football Chelsea A. Stubbs Mohamad Abou-Eid (CPA Lead) Imperial College London Surgical Society Junior Anatomy Series WE HOPE YOU ARE ENJOYING OUR SERIES! Feedback Please fill out the following feedback form. Let us know if there is anything we can improve on: ✓ Are we missing anything? ✓ Want to see more of something? ✓ What are we doing well? ✓ Finding anything confusing? https://forms.office. com/r/qeWUERrB2V Chelsea A. Stubbs cs1119@ic.ac.uk MohamadAbou-Eid (CPA Lead) ma2219@ic.ac.uk Sree Kanakala(Phase 1a Lead) sk1821@ic.ac.uk Ananya Jain (Phase 1b Lead) aj620@ic.ac.uk