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Imperial College London Surgical Society Junior Anatomy Series CPA SUMMARY GUIDE Musculoskeletal Examination ChelseaA. Stubbs Defne Artun (CPA Lead) Anya Nanchahal (Phase 1a Lead) Andrea Perez Navarro (Phase 1b Lead) Imperial College London SurgicalSociety Junior Anatomy Series Summary of significance of findings Position andExposure Look Likely indication Scars Down the middle Knee replacement surgery Other Other surgery Trauma tojoint (eg fall) Muscle atrophy Due to disuse Arthritis (patient has antalgic gait) Due to LowerMotor May be peripheral Neuron Injury neuropathy or other lesion Knee Deformity Genu Valgum Usually genetic Genu Varum Osteomalacia Feel Likely Indication Warm knee joint Septic arthritis Flare up of osteoarthritis or rheumatoid arthritis Pain during palpation Meniscal damage Swelling in Popliteal Fossa Baker’s Cyst Effusion present Small orLarge Arthritis Damage to internal structure eg meniscus Defne Artun (CPA Lead) Chelsea A. Stubbs Imperial College London SurgicalSociety Junior Anatomy Series Summary of Significant Findings Move Likelyindication Pain during Flexion and Active Damage to meniscus or Extension fracture Passive Damage to meniscus or fracture Reduced Range of Motion Arthritis Inability to straight leg Damage to knee raise extensors Unilateralhyperextension (more than 10 degrees) Damage to internal structures Bilateralhyperextension (more than 10 degrees) Damage to internal structures Bilateralhyperextension (less than 10 degrees) Normal Special Tests Likely Indication PosteriorSag Sign PosteriorCruciate Ligament Tear Anterior Draw>1.5 cm (in absence of posterior Anterior Cruciate sag sign) Ligament Rupture Anterior Draw>1.5cm (in presence of posterior Clinically Inconclusive sag sign) Open Medial JointLine Medial Collateral Ligament Laxity/Rupture Open LateralJointLine LateralCollateral Ligament Laxity/Rupture Defne Artun (CPA Lead) Chelsea A. Stubbs Imperial College London SurgicalSociety 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’sa fracture. • Will allow youto see joint spaces, which are reduced in osteoarthritis MRIs • Will allow youto 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 Defne Artun (CPA Lead) Imperial College London SurgicalSociety 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 Defne Artun (CPA Lead) Imperial College London SurgicalSociety Junior Anatomy Series Common Clinical Presentations Torn ACL • Positive Anterior Draw (without posterior sag) • Pain on passive and active flexion and extension • Playssports such as rugby or football Chelsea A. Stubbs Defne Artun (CPA Lead) ImperialCollege London SurgicalSociety JuniorAnatomySeries WE HOPE YOU ARE ENJOYING OUR SERIES! Feedback Pleasefill outthe followingfeedback form.Letusknowif thereis anything wecanimproveon: ✓ Arewemissinganything? ✓ Wantto seemoreof something? ✓ Whatarewedoing well? https://forms.office. ✓ Finding anythingconfusing? com/r/qeWUERrB2V ChelseaA.Stubbs cs1119@ic.ac.uk DefneArtun(CPALead) da1019@ic.ac.uk AnyaNanchahal(Phase1aLead) sn1119@ic.ac.uk AndreaPerezNavarro(Phase1bLead) ap6418@ic.ac.uk