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great. Yeah, so yeah. Thanks, Kelly, for organizing this on. Invite me over to talk to ob. Now I'm teaching a screen share, and I can actually see any of you, but this is gonna be quite interactive on, but I'm hoping kill is gonna help me pick people out. Answer some questions just to make sure that we keep things taking over. Really? So we're all set This up is And I thought about what I've missed with orthopedics on Got the things I found difficult. And I've tried to kind of address all all them points and keep it really simple just for medical student audience. All this is going to be just very basic stuff that I think you need to know. As a medical student on hope, it'll be helpful for your exams as well. But just some interest points that will throw in along the way. But as I say, I I'm hoping this is very informal on very interactive. So any questions, just interrupt any point through the presentation, and we can discuss anything further, so we're going to start off here. Uh, one thing I will say is the question start really easy. on, then they get trickier. So if anybody wants to jump in on day, label these for me. I realize it's very easy, but if you get in their early, you might have to pick up some more tricky ones send. You want to just run through this first? This is an AP in a lateral knee, actually, so you guys can either unusable. Pop it in the chat and I will just read out what you, uh, what? You've written some tea. So if we don't get any volunteers, she would start picking. People aren't Kelly. Well, someone is typing, so we'll see. It's always less daunting, I guess. Isn't it for people just to type something rather than from you? And speaking the exactly so we've got one is the femur, and then someone's go on the full. The full hog femur, patella tibia, good stuff. So it's really useful toe to get used to CVS Keys when you I don't know what what years of people can have got mixed between from first of fifth that way. Yeah, so it could be anything. We've posted it. The link on some chats with the foundation years, so it's a foundation, you said aimed at final years. So it should be final years and anyone below. So I think we've got someone from Saint John's ambulance. I know. So coming in anyone he's interested is there is the final year on the chat that wants to have a got describing the X ray. It's good, Oskar practice if anybody is coming up to or skis. Yes, not not myself, but definitely ask you season. Anybody there that wants to have a girl or should I just tell you, um, tell you what? Know who's on the line? That's the final year with you? No. So if no people surprise that, I'll talk you through it. So if you ever get given an extra in your ski, um, you often be given the name on the ages. Well, um, and so the way to approach and extra Yassky is always to say so. For example, we're looking at the left hand image. To start off with is always to say this is an AP film over knee off John Smith, who's a 31 year old male. Um, why I can see from this X ray is you talk about the joint will go through things that you can pick up about the joint. But if there's any abnormalities, you mention the abnormalities you can see. So if you'd stop by that joint, said grossly the joint Marge, the joint space looks okay. There's no obvious fractures on the otherwise looks like a normal, actually, due to see him for the lateral is well, eh, So just this little extra of John Smith is a seven year old man. So our approach every X ray in that same where don't jump straight into it always go through the basics first. And so this is just to say that, um, we always talk about the knee joint as though it's one joint and it's actually very often spoken about as three joints. So when people talk about an arthritic joint left and talk about tricompartmental arthritis, and what they mean by that is that you've electoral tibiofemoral joint. So that's the articulation between the tibia, the femur on the lateral side, on the medial side. You've got a tip your federal joint, and then you've also got the patella femoral. So that's how the patella articulates with the femur. Um, so got some examples. Have how each joint or each kind of part of the knee can be affected. Um, so Kelly gonna pick somebody out to describe the extra what they can see. Yeah, sure. Um Let's see. Uh, maybe Natasha, do you wanna describe what you can see? Uh, okay. This is gonna be fun. Um, uh, I think you got nothing to lose more more. So, people on this chart you probably never seen or heard for you'll never see again. So don't screw this history. Okay? So on the left hand side that we see the joint space, it seems fine. But on the left inside, the joint space do is basically non existent on very compressed. So I would say there's some sort of issue going on. Um, and the joint space on the right hand side, which next compressed is obviously I think, posterior um, the jelly. I don't see any fractures. I would say that there's something probably going on that's not so good. But I don't know what. Yeah, good. Good. I think I think you picked it up. So what? We can refine What? What year? You know, Tasha, see if but haven't on Ortho yet. Okay, good. So we can we Can we find that little bit of that? So one thing to a zero saying earlier is always always going with kind of a pea knee. I haven't given you any more details, but what you can see, it's an adult knee, and it's an air P. That's what you can see from there. And when you're talking about anything in orthopedics, really try to use kind of terms like medial and natural, even if you're looking at a next year and it's tempting, said left and right, isn't it? And do you know which side is media? Which is lateral Natasha on that? Um so I think, I mean, I'm going to guess So I think on the left hand side it's media, you're on and the right hand side is lateral good. Yeah, so just like what? It's just like you said really s. So it's on the lateral side and you've got lots of the joint space on. Got some sclerosis on off the joint margin. So what do you think that might be as a what do things going on in that knee? What's wrong with it. Are you asking me or generally use? That's okay. Have guess what? What? What commonly goes along with joints off off syrup, right? Is for rheumatoid arthritis. That arthritis? Yeah. Tastic. Well done. The Tasha. I'll let you have a break. Perfect. Thank you so much. Um, so, um, Kelly. Jonah, pick something else to go through this one? Yep. Um, how about Z? Sorry if I'm saying any of the names wrong? No. See the left. So I know you're scared of work. Uh, okay. Uh, maybe Oliver, if you're able to come on, a liver still is down. Well, anyone else? Okay, I'll go through this one on. Then we'll we'll see if there's a network. We'll try and find something else for the other one. So I guess another ap of any, um Andi, it's showing joints best now on the medial side this time, Um, you can also see some osteophytes formation. Um, sclerosis again on that medial side loss of joint space. Um, so pay attention to the terms I'm using to describe this. Going to get somebody to give me a little bit of a north of you at the end of this of what osteoarthritis is. Um, these are little clues that you're hearing, um, actually won't be me, and I'll go through this one as well. So this is this is the patella femoral joint on base is called a skyline view. So this's with the knee flexed on the top of that picture is is kind of at the surface of the kneecap on as you the bottom. That picture is the femur. That's what you can see. There is. That is loss of joint space between the patella and the femur on Got some osteophytes. There was, well, some sclerosis. So that's osteoarthritis off the patella femoral joint. Um, so now it will be through them three. Um, Kelly, can you see if there's anybody else that once this week on, I'll ask him another question. Yep. I can try. Ravi, do you wanna give it a go? Yeah, I'm here. I can give it a go. Good luck driving Walton. So rapid What? You are you Oh, fifth year going on. Good. So if you'd be listening to them Three descriptions off them three. Actually, then they should be fairly straightforward, But what are the hallmarks off osteoarthritis of a mixture. I think we use the acronym loss to get loss of joint space. Osteo, osteo like formation said. Contraception is that's a control score. Is this from an on examination? Only you can get a mild to moderate, uh, joint effusion. And you do an AP an electoral off the knee joint. Like I said, you'll do a skyline blue of the knee and inflection. See if there's any patella femoral fractures. Fantastic world ordinary that's born. I've not heard of off remembering that using acronyms loss before. That's really good. Remember in it, but absolutely wilder. Um, so Kelly not robbery down as a attentional victim becoming questions because he knows what he's talking about. I will do. Thank you. Very. Uh, so, um, we started to get a little bit more difficult. Now, Um, if people want to put this in the chap more than welcome. If anybody's brave enough to speak, um, we can go through this in person. Um, so yeah, and yeah, fire. We're sticking in the chart. What? You think 123 and four are on defending? Buddy wants to chance to it. Then tell us what you think They're got some people. Ravi straight in there. ACL PCL, MCL else healed interest. What was that? I missed that last week. That that is Ah, my boyfriend change, uh, that this this person obviously interested in all the cedar all he's got? Finals? No, I'm interested in Phoenix. I think I'm at Kelly. Uh, we're in a conference in Adam, bro. And we're in the same group. So interest in orthopedics? Yes. Don't ask me anything. That, uh I tell you the truth, I've got my finals next week on Monday, so I've just been revised for the knee joints. Obviously one that we like to be tested on medical school. Say you have to get kind of inside out. What medical school is that? Um, it's Helen York Medical school. Make it very good. Yeah. No, don't worry. I have not forgotten. I was thinking that Kelly shouldn't be left out of some of this questioning, but i'll, uh, I'll sable for for later. Um, So, um, this is another representation. Um, off the ACL in the peace. Yell on the reason I put this operates because one thing that I really found difficult medical school was trying to remember all the special tests and what was for what? And on. I don't think it was ever for me linked to the affected to the anatomy. Very well on dial. Stopped seeing this. Makes it easier to remember what test does. What? Um, so gravity. I might just stick with you for now for this bit. And then we'll move on to somebody else for the next pit. Yeah, go for it. So, on them pictures there, what's what's green and red? So I think green would be the A CEO. Yeah. Um um the red is the PCL. Good. Um, it's like a crucifix. It's hard to describe, but on the lateral gives it away. I think it's like, but when you see it in theater, it's like a crucifix. Yeah, I'm going on. Whether crossover is a lot higher 80 oh, across the PC, a lot higher up the new. And you think on the nights. Right? And that and that explains the name is well, doesn't. So that's why it's called a cruciate ligament. So you got the anterior cruciate, the posterior cruciate, and that's that's where the name came from because they cross over and make that cross like that. Um, So what does the ACL do that I'm uncertain of, You know, both for just for kind of knee joints. Stability. Yeah. So if you look at that diagram on that lateral view robbery that green, can you see that? If I was to move the tibia? Well, all of the all that can you see from that diagram, which, where the green line would stop it moving. If you must know it fixed in some that can't get any longer, so be it would prevent it. Me then. Uh, backwards. Is that right? Oh, it's forwards. Okay. Yeah. Um, and and So how would you test the ACL now that you know that I think you do. I think, in special test. Is it? Ah, Is it like that? They call it like, is it like, um, on this test? Good. Good. Oh, you basically have the knee and flexion on you. Yeah, you did the until post area. This is gonna be the best. Yeah. Good. So exactly what you said. This is not perfect. So let's Let's show me what you mean by so the like men's is is probably slightly more advanced than a bit more difficult to do. So let's try or just over these aware, this is what anti redraw test is, and this is what you would be doing for testing your ACL. So this is what your ACL does. Us yell, prevents and Terry Translation off your tibia on the femur on go. That's what you're doing. You're you're pulling forward your thumbs Normally, if you stick with the tibial tuberosity, it makes life a little bit easier on day to show you that again. So you're set sitting on the foot here and you're pulling that tibia forward, and this is the like men's test. Salomon's is a little bit more difficult just because it can be difficult to kind of get your hand around the females. You need 100 under the thigh and 100 on the tibia, and you're you're basically trying to do the same movement, but you can do it in a more kind of controlled way. If that is difficult when you've got small hands, one thing that you can do is you can stick your knee in underneath their knee here on. It makes it slightly easier for them to draw that TV afford. Essentially, the movement is still the same. You're drawing that tibia forward on the, uh, on the femur on your testing the ACL here on dope. I hope that's a bit clear right now that you can actually see in that diagram that that green line there will prevent that tibia from moving until you really, um, just really quickly. Robbie. So what does the pcldy? So that's in the back of the knee. Yeah, I'm guessing. I think that one's associated with kind of sports injuries. And ruby players, uh, kind of the sudden jolt, I think they call it or are kind of the hair audible kind of pop or sudden joke. I think he's It's not to prevent the to be a moving backwards. Yeah, yeah, absolutely. Really. Opposite to the base here. Absolutely. So we'll go through the injection is, um, in a little bit, eh? So I think you've got slightly mixed up just because I think you talked about the ACL injury there, but we'll go through. It's not. Don't worry about that for now. We'll go through that in a minute, but yeah, I hope you can see from that diagram, that red line, they almost forms a sling around the back of the tibia and prevents that tibia for moving posteriorly or backwards on the femur. Onda again, we'll quickly show you that as well on this is gonna be so. This is the prostate control test on day, and it's very similar to the anterior draw. So you want to be sitting on the patient's foot or supporting it somehow and again? Thumbs on the tibial tuberosity. They're on digest trying to see if you can push that tibia back on that FEMA. Um, and that's a normal test there where it doesn't move. So, um, all right, let's go back to Yep. So we don't know. Um Okay, So, um, Kelly, if you can find another volunteer who wants to chat about things and if you can, I'm going to ask you, uh, okay. I think this came up in my second year exam, so I haven't done it for three years. Um, but if anyone wants to type it in the chat, if you don't want to speak otherwise I'll pick someone Anyway. Um, so we I'm going to give it a try. If you don't, it's okay. You don't have to leave. You don't want Teo. Maybe if you If there's a non zoom, you can turn yourself green or red. Count you if you want to interact or no, um, I mean, you can put your hand up. There's a rays hand function if anyone wants to raise their hand because they want to answer it. But, um, not sure if there's no one's putting anything in the chat. Okay. All right, fine. I I I'm happy to just we've got a problem. We've got Kelly. That's really to unstressed for the rest of the presentation. What? Looks okay to learn some things. Um, right. I'm looking at any of us. A good start. The question is, um I'm looking at it from the top or the bottom. Okay, fine. I'm just gonna guess at this point, I think one is Oh, no. Rabbits, help me out. He's put p c l a c l m z o L c o lateral meniscus and medial meniscus. Uh, I was going to say one was the ACL, but I have no orientated at all. Yeah, Okay. So yeah, Let's Let's Let's go through that. So So you. So you I right, that's number one is the A C. I, like pc up on. Do what you can look out for. So this is looking at from the tops is an axial slice. You look at the tibial plateau from the top Unease e giveaway is the tibial tuberosity can see the tibial tuberosity on the foot from of the picture. Can you see my guess you can see it. Yeah. So that's the tibial tuberosity. That's to give away off all the interior to yourself, anterior, um, pasta area. And just this kind of funny look on the back of the tibia groups is also another thing is gonna be where is also also giveaway of where you are, Um, and then in terms of orientated yourself, can immediate little actual. And do you What would you look for? How how do you know which is meeting the natural? Um, I am not sure, to be honest. I mean, if I had saw the bones, like off the off the legs, like the tibia and fibula you tell. But from the from this, I'm not quite sure how you would know. Okay, What about you? Probably. Do you know how you tell is the medial side the meniscus? A lot thicker than the the lateral side. So I'm guessing six would be the medial meniscus is It's a lot thicker. Um, there's no the Yeah, it's hard to tell how your e intake did. Yeah, but my thinking is the medial side. The Medio meniscus would be a lot thicker than the the natural side. Um, but yeah, it's hard to It's hard. Start getting your intentions. Well, yeah. Yeah. So? So, by the way, if anybody else wants to join it and this is gonna end up being a conversation to me, Kelly and Robbie, if anybody else wants to join in, who's listening? Stick your name in the chat. Tell Kelly that you want to join in. And then and then we'll include. You've not been. Yeah. Just feel free to listen. It's fine. Not a problem. So, yeah. So the way to tell is there's a couple of tell tales, so the lateral meniscus meniscus is more circular on the medial meniscus. Meniscus is more see shipped, which I hope this diagram doesn't make up. It's not easy on this diagram, but that that's generally what it is. And if you see all the diagrams, it'll look better. Also, the medial meniscus is more firmly adhere to the medial capsule a swell as well as the MCL. So you can see here that this medial meniscus could come draw out to the edge and has joined on to the MCL, which is here. Where's on the lateral side? There's no attachment between the LCL on the lateral meniscus. So that's the easiest give away. So the shape of it on also the attachment to the kind of structures on either on the medial on the lateral side. Yeah. Good. Yeah. So, yeah. Please. I hope that's quite easy. Um, Russia said that she would be happy to join, but she won't be excellent, which I think is not true, given her previous answers won't be any worse than me. No, no, I forgot. Sorry. Natasha forgot you answered excellently. That was really good at Natasha. So want warm test that we haven't spoken about? Actually, at the moment is you know how you would test for a meniscal damage? Think you're pressing down on the knee and you're listening for like any crackling or like movements against, I think. But I don't quite remember to be honest. No Crepitus. Yeah. Have you heard off? It's It's a beard of the name of a test that they often tell you not to do in Europe. Ski, um, for the knee. Do you remember anything like that? No, not a clue. Like I know. I don't know. Well, McMurray's Yeah, yeah, somewhat more. So don't wait until after I think. I don't think I knew that was a second year. Either thing that's that's comes up later when you start in your skills. But just something for you to start thinking about now. So, yeah, absolutely. Movies test even in clinical practice. To be honest, our our never done much more ease in clinical practice. But they like you to know about it for the exams. So this is gonna be in the PT. So they called the pivot shift. Testa's Well, um, yeah, so you can do the periods shift test. But what's the pivot shift test for? I think it's for just a minuscule injury where you get the patient to stand on one leg and get them to try and twist on on one like I don't know. I've just I've just been it been done before? I never I've never known. I'm just assuming that it's for ah meniscal injury. Yes s It's enough. So the reason there is a test called period of Test, but it's actually a C L injuries. Onda, it is, is often done in in kind of anything ties patients because it's quite difficult to do. It can be sometimes quite difficult to do in patients where a wick on it can be quite uncomfortable is. Well, I would be very impressed if you spoke about pivot shift in your final. You're scared. I don't think you're expected to know it, Um, but it's essentially to do with the i t. Be banned. Um, Andi, if you have an ACL injury the'yre in the movement, you do for the pivot shift test. The I T bun them flicks from being until it's posterior on, gives you this characteristic kind of giving on that. That kind of sensation isn't really pleasant patient, which is why they ask you not to do it. But it's something to be aware of. It's another test. You can use for ACL injury. So you got the lack mons the anterior drawn the pivot shift test? Yeah, that's good. Um, one thing I forgot to ask, Actually, it was actually, um, on this'll see how I can make this, but easier, actually. Go back to here. Um, he's from this view, actually. Um, let's go in the Tasha, um, again, don't words you don't know the answers to this is it's it's so it's still useful to talk about it. And hopefully I'll try and explain in a simple where that will mean that you remember it for later. So remember we talked about three and four MCL on LCL, right? Yeah. What do you think? Let's start with the MCL. What? What do you think the MCL does? It stops the knee turning inwards like medially and keeps it like held. So it's not going to go to Medio on. Obviously. Then your ligaments going to stop it from going too lateral from during actual movement. Yeah, I I think I'm good. If you like lemons turn. What do you mean about your knee going medially? How would you describe somebody? Who who's knees? Look at the we really medial. Uh, like it's gonna show of my hands, But I can't do that. Um, where you have, like, the little knees are turned inwards. Like they were just very in words. And then, like the lower legs, gonna probably start to then bend towards a little bit. Yeah. Yeah. Good. Good. So knock kneed, right? Yeah. Um, on D What? What's the name off off the stress that you could apply to the knee. So that would make the knee go into that can knock kneed position, which were Do I need to move that tibia to make it go into the not need position? Oh, um, who delivered that way towards the fibula or the other? Way away from the fibula, I think. Go, um, away from the fibula. So if you moved it kind of that way towards the fibula, then can you see how number three the MCL would be being stretched? Ah, yeah, yeah, of course. Yeah, yeah. Yeah. That makes sense. And then so that that's called a valgus stress. And then the actual complete opposite is for number four. Sometime before would be if you were born like it and your knees were kind of pointing outwards. Yeah, and that would be called a very stress. So this is this is how you do that. So this is how you test for the MCL? Um, And now that you've seen the diagram, you understand the knee sort of the thenar. So essentially, you take the, uh, lower leg. So 100 the inside of the lower leg and the other hand on the outside of the thigh on what you'll see him do here is he's trying to do exactly that movement that you were just talking about. He's trying to move that tibia in laterally on push medially with that femur. So he's trying to stress that medial collateral ligament. So that's how you trust test for the MCL. And then this next one, um, is the exact opposite Bit more difficult because you can't have to get yourself inside in this video. Um, but essentially, you're doing the same thing. So what he's doing, he's got his hand on the inside off the femur this time, and it is tender on the outside of the lower leg, and he's trying to move that lower leg inwards and stressing that lateral collateral ligament this time. Does that make sense? Yep. Yeah. Um, I just had a quick question. How would you do these tests if the patients in pain, So if they have, like, tornado ACL, MCL, etcetera. Surely doing these would cause a lot with pain. Absolutely. Great question. Really? Good thing. Answer is you would have, um So if I saw somebody, um, well, two things to say so it from an exam point of view, then you won't get something with an acute issue injury. It will likely be chronic or they'll have a normal knee, and you just be has to examine them. So I don't need to worry too much about it from an examination point of view. But it's always something something to think about when you're examining a patient to ask them if anything hurts before you go into examining them. And if it doesn't use, just avoid it. And always remember that for your skis in really life, if somebody presents with an acute injury and they've got a big swelling, it's really painful. Then you essentially will arrange for them to have some investigations and MRI scan on. Then you'll send them away. You send them away just to rest. Um, have some physiotherapy. Have the MRI scan and then come back and see you. And then you review them again in a few weeks' time. When everything's settled down, the pain's more under control. The swelling is all gone down. Then you can make a more clinical assessment, um, to kind of establish and call it what you can see on the MRI scan. Um, see, a great question. And the answer is, don't thank you. Yours? Um, on. Then this is This is about movies test. This is gonna be a video on. So it's It's quite simple, really. You essentially are turning the foot either in or out tibia immediately, whether you want to test the medial a lateral meniscus so you can see he has turned the foot in. And he's just flexing up the knee through different kind of degrees of flexion to see if it catches on. A positive test is either that kind of catching sensation, all the patient being impaired. Um, and so this time is looking looking at the lateral meniscus by turning the foot out, um, and then again flexing me on because you're trying to elicit pain. It's why it's not recommended for you to do it in a Noski. Um, because something may have an undiagnosed meniscal tear. Um, on you may cause the pain and you drop marks for having calls the patient pain. So it's something you would talk about say I could do more test and and then they'll police there. You don't. Um okay, So any questions on any of that examination so far? No, thank you. Nothing, Jack. It just let me know if there is like that. Put anything in any point or just a pipe up and took me on. But you can talk about stuff. So now I'm insect. A step back on. We're gonna talk about the rest of the exam. So, actually, we've done this slightly backwards, but I think it just floors better in my mind to talk about special tests with the anatomy because it's just easier to understand why you're doing something on board kind of run through the rest of the exam. So every often examination is really easy because it's always look, feel, move, um, on D. So the first thing you do for any examinations. Say you get the patient to stand first, watch them walk on. Then you're looking at them standing on line down And things were looking for muscle bulk symmetry and what their alignment is. So as we've discussed blackness actual describing earlier, you could be knock kneed. You can be bored. Leg. It s a verus. Valgus are neutral alignment. Uh, I went to school in, so that's normal. That's the describe it is neutral on. And then you're also looking for scars, swellings and things like that on bees are knee replacement scars. If you see a scar that's kind of dead center down the knee there and that's usually a sign that something's have new placement, Um, and then feel say, apart feel is, um, feeling around the joint lines. So you want to feel kind of medial natural joint line. Um, and where where the kind of meniscus it's essentially. And then you wanna pulpit along the medial onda lateral collateral ligaments azelas the quadriceps and the patella tendon to see if there's any pain anywhere on around the back of the knees. Well, but this is an important thing. Um ah, Kallis, you know what they're testing for in these two tests. Um, is it like a Dema? So if there's like, what's the what? A nephew shin? So you're seeing if there's any fluid in the around the joint? I think, Yeah, so absolutely eso you looking for in infusion? So that's that's fluid within the joint within the capsule on why is the two tests? What's the What's the difference between these two tests? I honestly have no idea. Uh, Natasha robbery or anybody else. You know why there's two tests? Is it the compartment which the fluid lives? Not quite. So it's all going to be within the knee. Um, capsule asshole. Tasha. Any guesses, maybe to determine were the effusion might be in a new Let me not to see something is what Robby said. Like not on a clue. Okay, so So the the test. Essentially big. A few big effusion on dzemal effusions. Really? So if you have a this is going to be a video, you know, kind of lords and loads of food in the knee. Then your patella tap will be positive. So what you're doing here? So you're milking down on do you kind of compressing on that super patella pouch, which is part the capsule. This but he's doing in this hand I don't do. It's not strictly necessary. You basically mark down with this hand, has his right hand, and you can use your left hand just to see if you can push that patella into the infusion on. If you have a really big effusion, the patella will kind of almost feel like it's floating on something and bouncing. Whereas normally that patella would just hit the femur on, you wouldn't get feel that kind of bouncing type sensation got this guy. If you want to test for a smaller effusion, then you do this wipe test. And so he sent you. All you do is you sweep everything out of the medial side first, then the medial got a Q. See that. There's like a little different he can see here, and that's because the medial got to. It's completely empty on. Then you sleep down the lateral side and he hasn't gotten infusion. But if he did, I don't have any fusion. You'll see a little bulge in this area as that fluid and comes back and pushes out against it. So that's for testing for a smaller effusion. So patella tap big effusion on, then the brush stroke or bulls test whatever you want to call it, that's for a smaller effusion. Right? That's next. And then you, um you just looking at, um, finally active and passive movement in this video online, which, er, the Tasha. Which order would you normally do your Activia passive movement in And why, um, passive and then active. And why do you Why, honestly, I don't know. I just feel like that would make more sense. I don't quite know what my thinking it's Yeah, I know. I also that was all. Honestly, I was always think that you it's passive. So it's less than active is more so. You do it more. I completely scent. Probably. Kelly, what do you think? Um, I think that you do the active first. Why did you do that? Um, I don't know. My boyfriend said that, so I wouldn't said pacifist. And here's that know it's active, so I don't know. Um, so let's get let's see. Let's just rob, you know, off on our kind of she off sketchy cheeks like around I say active, then passes. Uh, but I'm not too sure. I just think it's because it's That's what's written out and friend that that's the way that would been tall. But no one's ever explained why Kelly's your boyfriend given you any more clues, is it for power? Maybe grading of power or movement? Um, you could do that if you want to do a neurological assessment as well. Um, you could do that. Uh, it's also cause he's a doctor, so it's a bit of cheating, but yeah, I'm good. So, yeah, I think you do active first, because then the patients in control and they know what they can tolerate it. So they're in pain, and you're not gonna move them into position. That's going to really hurt them. Yeah. Great. Absolutely. Yeah, exactly. So it's not so absolutely just s I didn't catch your name was you know, James James? Yeah, just like James said there. If you if you allow the patient to do something themselves first you can see what their conduce comfortably without causing them pain. If they are unable to flex, there need to 90 degrees. Then you take their knee passively and force it up to 90 degrees. You gonna cause the pain, and that's going to look very good. Um, so essentially, you know, we are just making an assessment off what you can and can't do. Um, so what's have done the active moon? Basically, the reason to do it passively is just kind of put in hand over the patella on feel for any crepitus as you go through that reinjure movement. Um, yes, that's that's quite important point. Or was active first and then passive. Um, so we spoke quite. It's a little bit earlier. Ceravi. I'm gonna get you to talk about this. This's a knee X ray from somebody who's been playing football. And they describe that the injury is basically just what you described earlier. So it's non contact twisting, kind of fallen. They felt they heard inaudible pop had swelling immediately on, couldn't play on. I'm kind off the pitch June stop by describing the x ray first. So this is ah, a p X ray of ah, footballer. Um, we don't have an age or down the name. Um, so it just worked for the X ray as ah normal preserved joint space. Um, I didn't say what me is, Did I did it seven years the way that so, uh, you know, be normally be marked if if there was, they told you. Yeah, there's no signs of kind of degenerative changes. Uh, but what you can see here is there's a little fragment that's just, uh, popped off. Excellent. On the I get, that would be the on the lateral side. Yeah, you're on the lateral side. You have better than that. There's no does, no changes. But did you ask for electoral aspirin X ray as well? And it's hard to tell if there's any swelling because you can't really see any You can't see any changes or fluid lines suggestive of like a hemarthrosis at this point in time. Yeah, the main finding is this little, uh, does popped off, Which is associates with the sale. Yeah. Fantastic. Absolutely. Um, and you know what that's called That fracture. It's not, uh Is it social? It's not. That is part of tippy. Oh, plateau, No. Yeah, yeah, yeah, yeah, yeah. Good. Yeah. Just come off the to report on what's it called? It's called name of a gold medal You're so close. Got everything else. So while I'm there, uh, it's not it It begins with that's it's not set. No, it's not set. Morning there. Um, no. I don't know, sir. Gone fracture? Yeah. Yes, that's what it's called. Here. Good. Good. So I was thinking of the one that's associated with the ankle fracture. But it's not that one either. Yeah. Yeah, that's what That's what you know. Excellent. So, yes. So So that's if you see that on an extra. Um, it's part anomic for a S u l. Injury on that history from what you described earlier, anywhere probably that was quite classic. Often ACL injury anywhere on, but something to look out for in a lecture. Good. Um, also Kelly. Few techniques. One, then. Natasha, I'm gonna ask you about this one, the Tasha, So I'll give you a little bit time to, uh, so prepare a little bit as well. Um, actually, can you, uh, can you tell me about this one? Start off with what do you see in that clinical picture? Um, I can see a person with two legs sitting in the flex position on looking at them. Obviously the side by side. The right tibia looks abnormal from the left leg because the tibia looks like it's like sinking into this like a Boeing sort of action going on from a lateral view. Um, And then, given the history the blow to the anterior tibia, it's gonna be a cruciate ligament injury trying to work out in my head. Which one it is. Um, I think it is. Was it a try and think about which one it was that we said that prevents the tibia falling backwards on the femur, falling that quids? That's the area. Yeah. Excellent. So pasta. Okay, A crucial ligament. Absolutely. So I think it's a where that when you were testing it, you'd be pushing the tibia backwards. Wouldn't Yeah. Yeah, And that's what's already happened. Your tibia is fallen backwards. So this patient Absolutely. Just like what you described. That's a That's a peaceful injury. Well, the excellent it's just known as opposed area suck or any chance? Yeah, excellent. Excellent. Yeah, that is exactly so. So what you would do is you would put your thumb so it feel for that tibial plateau. One c. Really? On. You put your thumb over the top. And so you can imagine when you to put your thumb over the top. Here, you can feel tibial plateau kind of sitting kind of kind of common in a boating against the thumb. And if you put your thumb on the top here, you're the tibial plateau doesn't come and sit up against your thumb. It's fallen backwards s So that's why it's called posterior sag. Um, I'm just out of interest. I'll tell you this. This is something I think particularly to know for for finals. But one thing that you always need to be aware off is that if you don't make this assessment from the patient from the side, um, before you start doing your special tests, it can get very confusing, because when you do your until you draw test now to this right knee, that tibia in your hands will feel like it's moved a long way forward. It's the new in your mind, would think, Oh, that seniors moving until really, that must mean the ACL is gone. Actually, all that's happening is that the tibia is moving back to the position where it should be sat. If the PCL was intact. Does that make sense? Yeah. So that's just something you do before ACLU piece your special test, but again, A. That's quite tricky on, but nothing. You'd be expected to know that for your files or anything but something TOB aware off. Just you can get called up by an anterior draw test because of that. Um, right. I think we've got two more injuries, and then Yeah, that's it. Really? So, Tasha, over to you. Um, clearly, this isn't a teenage girl with, like, a like that, so we can ignore that bit. So this is a very classic history, but the picture doesn't fit, but we'll go with it. What do you think? That picture We're looking at the left leg of a meal of some sort of itch on that The patella. Looks like it's dislocated laterally. Fantastic. Think. Yeah. Yeah, absolutely. Well, don't go at one. Um, yeah, absolutely. And that's that's of a typical kind of history on day for a patella dislocation on Boston. People will even have had any doctors call me and say that there's a knee dislocation now need This location is a is an emergency, and I've genuinely had people piling blue light ambulance and transferred over to where I am because the any senior doctor has said this. The knee dislocation and they've turned up to our I am on except patella. That's dislocated. Clearly, this is not a Nimer ginseng tea, and this is something that most people could deal with. Um, so it's always it's really important to be aware of that distinction between a dislocated knee on a dislocated patella. Um, do you know how you put that back in Tasha? You know what you would do? I feel like saying push it medially is not the right answer. No, it more. It is really more or less so. Normally the patients would would would present you with flexed me on the knee will be flexed on the patella will be fall enough laterally. But yeah, that is literally. All you do is it's a simple as that you extend the knee while pushing the patella immediately on it just really nicely slots back in. Not nice for the patients, but I mean, yeah, it's slots back it quite easily on, but you do need some painkillers on board on. But yeah, that's all you will need to know about patella dislocation, Doctor, you need to know too much more about that. And then last case. What time? Yeah, last case. Then we'll finish up for now without, um, it's This is a bit tricky. Um, Kelly are grabbing between the two of you. Do want to have a look at that. And so this is, um now for oscopy image on by that instrument you can see there is called a probe on that instrument is just probing structure in the knee to assess for any damage. You know, diet. You know what we're looking at or what the description might be off something. Is that the MCL? No, no. Are we looking at the medial meniscus or the lateral meniscus? Fantastic. Yeah. So that's the medial meniscus. Um, excellent. Um, so that's a a medium meniscal tear, and that's that's quite a classic kind of history. So so arthroscopy wise. You'll you'll see a lot more this when you get into orthopedics and see to Martha scri, you can't really see the MCL All the LCL joing on arthroscopy. Um, and it's it's much easier to kind of get an appreciation of them open. But yeah, arthroscopically, it's This's a meniscus. Um, there's lots of different types of meniscal tears on lots of different types of repetitive it wears of repairing them. But essentially that kind of history on examination, somebody with with an effusion on a restricted range of movement think meniscal tear on that diagnosis. You can also make the MRI scan on diffuse. So obviously you want to do something about it, and your arthroscopy would be a choice. There's a question saying, How can you tell that it's medial meniscus versus lateral on the image? Or is it just because it's the image in association with the history that said medial pain? Yeah, yeah, exactly. So in this situation, what I'm expecting from you guys is just to put the history on the image together. There are ways after scopic clear that you can kind of decide if it's medial lateral by phone. That's that's above kind of your level, Um, and it's it's kind of I don't think you'll ever be asked that, but is essentially the um, kind of medial side and electricity have some differences. Eso of example. The popular TIAs Popliteal tendon goes through the lateral meniscus on gets also tends to be a lot more difficult to visualize an arthroscopy s. So there are ways that you can tell when you're actually doing the arthroscopy apart from actually looking where the camera is within the knee. Um, I wouldn't worry too much about that, I think, from from from like, a finals off ski point of view, it's just about putting the history and the clinical picture together, okay? And like a stupid question. But where on the image can you actually like? Where is actually the tear? Because I actually don't quite know what I'm looking at. Yeah, it's really difficult. Um e even restart seeing I thought for the 1st 10 or 15. You see, you can't really already tell yourself. But essentially, this is the apart to the meniscus. And this is the lower part of the meniscus. So that's a tear through the meniscus. That probe is going through. The tear on gets quite freed looking meniscus. All these jagged edges in this little tear go through here is well, so it's It is an older persons degenerate meniscus, but that is potentially symptomatic. So, essentially, if you were treating that you would keep this top surface. And you basically just nibble aware this bottom surface, which is likely kind of flipping into the joint and causing symptoms. Uh, so that's what you're looking at there. Cool thinking. Um, I didn't really have anything else to go through. Um, but I am really happy to take any questions. Talk about anything that people would talk about. Um, and if no, it's a clock. I don't mind on any anybody. Got any question you go. If there's anything burning that you want to know, stick into child. Just moving forward from kind of. Finally. It's rough. 14 to Yeah, I have You got kind of a few kind of do the whole process all over again. Have you got any kind of recommendations to strengthen the application process? That will be then kind of towards the start off with two years? You mean into going into call surgical training? Yes. Those crowds. Yeah. Um, yeah, well, so there's quite a lot of things to think about, and I think I wouldn't say that. I would particularly say you should do one thing or the other, but I would definitely say that you need to have an awareness about these things. So if you want to do orthopedics, um, you've got to route into orthopedic surgery. As it stands, you can either go through call surgical training, way to call surgery. One cost every two and then you need to reapply on, then move into S t three. And in them first two years, you need to have done the MRI C s exams. Um, I'll take this often share, and then I could see people is Well, actually, um how do I do that teen? Um, I think you can just click the teams loger. Yeah, so on. Do your thing to be aware off is, um, you can go into kind of run through training s so you can apply to Scotland on Scotland World. Run through from ST one older to to consultancy, so you don't need to apply again. Um, so it's a benefit of that on your thing that you can do is academia, um, on again? This is, you know, kind of. I do some academic stuff now, so I'm not actually academic, clinical fellow, but I'm really late in my career to be doing something like that. And I'm I find academia interesting. I find research interesting on day. I wish I'd probably start it earlier. So I wish I had done, like, an academic foundation program on, then moved through into an SCF, um, kind of ST three level or CT one level s. So if you think that academia might be all think, then definitely look into the academic foundation program was a foundation. Yeah. On then. Also the academic program where it means you get it done through training. So it means you can apply into ct one and get some food into consultancy rather than having to re apply after CT. Well, ct to start something to be aware off. Um, yeah, well, so we're going to say, um, that's about it. Really? In terms, I think the decisions, Really, I could have a program, Um, all of them through training. I think your big two differences. I'm just one. Well, from a How about kind of going about getting your publications? Um, so I mean, I wouldn't stress too much about publications. It's nice to maybe have one or two, um, bit kind of always look out for National Collaborative. They're probably the easiest way off getting yourself of publication. Um, so I've got one coming up. Um, a little plug it. Look out for the people. Axtell P p a k that's looking at antibiotic use in care. Why surgery? Um, essentially, I'll be ruling that out through border as a national collaborative on D. If people recruit 10 or 15 patients on submit their debt on outcomes, um, they get all through, uh, into the paper when it's published. Um, so that's these where you collect patients on D. Once the papers published you, you'll get yourself on on it. Um, I think trying to write a paper for yourself as next one of two is really difficult. If somebody does give you a good idea, I think wrong with it. But I would say if if people are approaching you say and I would want to do this project of that project early on, you need to be asking the questions off. If I do this, what do I get out of it? Um, I going to be on author. Whereabouts on the authorship are going to be 1st 2nd somewhere in the middle on then decide whether it's worth it for you or not. Um, and the only other thing I would actually say on that point is you know, I think you could probably focus on your exams a bit more as nephronex to, um So I had really easy jobs as f one f two. So I did my part ever MRCs in F one part, too. And f two, um, So by the time I went into see ti training that I would have done my mouse. Yes. And side had two years, just a kind of enjoy and on practice surgery and actually be in theater all the time. Rather have to worry about my exam on you already in the morgue of revising after having just, um, finals. And it just seemed really quite seem to floor really well, doing it that way. Um, so, yeah, that's that's your thing. That other recommend, if you're if you got the time and inclination sounds so that yes, thank you. Anything else from anyone? Um, James is asking how you book the m o. C s. And like figuring out. Obviously, you said you had some easy sort of irritation. So that makes sense of one to do it, but yeah, so kind of booking it just through the college websites. You can either go through College of Edinburgh, Welchol just surgeons that are all colleges. Surgeon England eyes intercollegiate. So it means the exam is exactly same. Just difference is whether you found your trip to remember when you graduate trip to London on bills have different venues, Factory sitting in the exam. Um, so So that's where to book. It was a second part, That question, uh, I was going to say about when to take it, but I think that's just something you have to kind of figure out based on your rotations when you get them figuring it up. So, yes, I did. I did. I did party at the end of effort, then part to the end of two on. It just felt night fell nicely for me there. So eso I've posted the feedback link in the chats and guys to make sure you fill in. Otherwise you won't be able to get certificates. And obviously, you know as ah, it's good fraud tutors to be able to have the feedback I've also posted in a Google doc. That is for a study called the Girl First Study or grift study. Yeah, that one s so you know, you can try and get involved that with that as a medical student. So just sign up with your associate. It hospitals, like, really easy data collection that you only have to do in May. So, I mean, I've signed up for my hospital, but just there's there's quite a few. Gotten a moment to keep an eye on If you're all on Twitter, follow border on Twitter. There's lots of collaborative and things going on on things for you to get involved in, and it's very clear what you need to do. What? You got it. So it is really good. We're get involved. Um, but yeah, If that's everything, then, um, thanks very much. Have me. You're welcome. Natasha Amani. I hope it was useful. Tiene hope it's helpful for you exams on do for anyone aspiring to do orthopedics, any questions or anything. I didn't actually put my details on there, but you can look me upon Twitter or email me you'll if you get into your Kelly. She's got my email address and stuff. So gonna do Want to ask anything That's more than welcome. Uh, via Kelly will use, uh, Can I put my email in shop? I've got chart here. I'll just stick it in. Did shot here, and you're the next session is on hip on Monday. So if you need some extra vision if your finals haven't already passed and be sure to be there and we also have a quiz the week after that on a low level. Um so So it's a quick it cool, like, very much. You're welcome. Thank you. Thank you. Kelly is always no way Welcome, Kelly on. Thanks for organizing. That's okay. Thank you. So giving it a good always Good luck with your sessions or anything. Thank you. Bye, everybody, right?