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and that should be working. Yeah. Okay. Eso Welcome to the musculoskeletal examination Lecture, part of the search sock Junior Anatomy. Siris. My name is Chelsea. I'm a third year medical student at Imperial, and I'm very excited to be giving this lecture to you guys. I've heard that you haven't had a faculty ask a teaching as yet, so hopefully this convey Essentially, like some predating so that when you come to do it, um, normally, you'll be familiar. So going over contents What? I need to go over today. The quick recap of me anatomy. Basics of the exam. So what are you expected to do in this exam? Look, he'll move and then special tests. So we're going to go through those each in turn. Um, and then we're going to do some practice questions for the Viagra because, as you know, thesis a station it's put into two parts with five minutes for examinations and two minutes for a little while. I've, uh, on any clinical implications of your findings were going to do a bit on radiographic images and then presentation of certain apologies. If you're ready, I'm happy to start. So this is Sally Okay, So Sally is a 24 year old graduate medical student who is in the hospital for any issue. Your register, our own placement tells you that she's got signs, so you should conduct a musculoskeletal examination on her. Have you got the skills necessary to pick up on the signs? So CPK is about making sure you have those skills so that when you have a patient and you're doing an examination on them, um, you'll be using the right technique in order to pick up on the signs. You don't have the right technique. You'll miss the sides. So that's why I see today is important. So the structure of the examination is in six parts, essentially, so physician and exposure. Look, Bill move special tests and then the Bible. So that's the order in which will be going through in this lecture. They're gonna do a quick recap of the anatomy. Um, we're gonna look at the bones and ligaments, the muscles and the neurovascular chur. And just to preface this lecture, this is not a full musculoskeletal examination lecture. This is essentially the intermediate version and specifically what you need to know for your exams at Imperial. Okay, this is by no means a complete resource. I just thought I'd let you know. Um, right, they have a bones of the knee. So the knee joint itself is formed by three bones. The femur, the tibia, I have to tell. Also present is February. So if we look at the anatomy here, Okay, you just get my laser pointer up. We look at the anatomy here, you have your femur at the top, your tibia and then your patella, and then down here, you have your fibula. But in terms of the actual knee joints, you're just looking at these three bones. Remember that the patella is a sesamoid bone, so it doesn't necessarily, um, connect to the rest of the skeleton. It's encased with bend the patellar ligaments, him ligaments, important ligaments. The collateral ligaments. So the medial and lateral collateral ligaments, which you find on the size so the fibula is on the lateral size. So here you find the lateral collateral ligament and the medial collateral ligaments on the opposite side. Then you have the crucial ligaments. So anterior and posterior and note that the anterior and posterior referred to their attachments on the tibia rather than the fever. And remember that there is a question on it a bit later on, looking at muscles of the knee. Okay, so we have the relevant muscles of the knee joint. Of course, you have all the muscles that you need to know for your and that in this spot. Er but in terms of this examination, these are the muscles they want your focus on. So the quadriceps before muscles, the same tendinosis muscle semimembranosus, gastrocnemius, popliteus and then an important tendon is the patella tendon. Yes, if we just have a looking back here. Okay, so we have the brother sets muscle. Here we have the pleasure sex tendon, the patella that the teller tendon, which is inserted on the on the tibia on tibial tuberosity. Articulated. Here we have the fibula. Then we have your hamstring muscles. So you're semi tendinosis and semimembranosus is okay. You're not spilling sugar, irrelevance, necks, tubular common fibula or the paraneal nerve relevance artery popliteal artery. And then other vasculature. So your popliteal vein this round of practice questions. I'm looking at the shop. The first question what type of bone is the patella answer in the job. Okay, We have one sesamoid. We have two sets. And Lord guys more. You put into the lecture, the more you get out of it, so Okay, good. Sesamoidal attacks more sesamoids in the job. Good. Okay. I'll wait for one war and then move on. Perfect. Thank you guys. Okay, Sesamoid. Right. Next question. Name all the four quadriceps muscles. This is a bit of revision of your anatomy, but it is perfectly acceptable to ask for these in your CPK. Is there relevance? Muscles? I'll give you a clue. So the first one is rectus femoris. Okay, so we have rectus femoris baskets. Lateral is fastest medialis and passes callous. Good. So semitendinosus and sending member no cysts are part of the hamstring muscles. Gastrocnemius, um is part of the muscles of the cops popliteus muscle eyes at the back of the knee, but it's not considered a quadriceps. Muscle was trying to question. So what important artery passes through the Popliteal fossa? And there's a clue in the name popliteal are amazing. Okay, Okay. So which nerves near to the fibula is at risk of damage? Yeah. Common fibula or common paraneal nerve. Perfect. unless I go through these a bit quicker in the later sections. But what ligament prevents the tibia from sliding backwards? Okay, pc else of posterior cruciate ligament, right? And how that works is the posterior cruciate ligament attach is from the anterior section of the femur, which is on top to the posterior section of the tibia, which is that one. So it prevents the tibia from moving posteriorly. I'm looking on the position and exposure is gonna be really quick. So how are you positioned? You're lying on the couch. When you go into your CPS station, the patient will likely be positioned at 45 degrees. But if they aren't, you do need to say, um okay, So, ideally, I would like this patient to be positioned at 45 degrees. Would you mind if I just move the couch? Then you lift up the couch of your lying down exposure. So this is in the examination. You need to be able to see the knee joint on the quadriceps and the calf muscles. That's going to be really important when you come to do your inspection because you kind of get wasting of the quarter sets for example, so your patient will likely be wearing shorts, moving on to look. So what are we looking for? Three main things. So scars, muscle wasting and need for MITI's. So a bit of that activity for you guys. So what can you see By looking at the knee, All that rhymes. I didn't mean for that. But what can you see by looking at the knee, we'll give you an example. He might see scars. You're going to your station on this patient. Might have a midline spar. What other things might you see? That's not good. Swelling prednisome. Yeah. Okay. Also must muscle wasting. These aren't in any particular order, but yeah, we get some more coming in. Okay, So color, shape, temperature, and any star good bruising or wounds? Yep. Infection signs of infection. Like swelling or redness. Okay. Oh, he said swelling. Gee, you baron. So, in layman's terms, uh, this is being bowlegged and then gene of album. But just to help you remember Jean Barrel, which is below like it. And you know, Valium, which is not need You couldn't remember. Rum makes your knees spread apart. So it's like having a rumble in between your knees and you're trying to hold the wrong bottle there, and gum makes you need stick together. So it's like having gum, and it's been you to me, so they kind of like stay for Is this tender? So God makes them You stick together, Gene. Well, gum rum makes your knee spread apart. Gee, you marum just to let you know you don't need to know about Q angles for your CPA. But there is normally an angle to the knee joint when you get genu. Valium and Januvia are, um, is when that angle is excessive, essentially, But you don't need to know that you're seeing is just so that you know that there is an angle there, just anatomically feel. Okay, so when we're feeling, we're looking at, um, joint lines, bones and back spaces. Essentially, you always remember to gel your house in your CPK examination. You won't be allowed to proceed unless you do gel your hands. So remember to do that. Remember feeling the knee joint? It's important to feel for the temperature first. That's an important sign that something is going on, likely an infection. So we assess above and below the joint line. Well, we feel in six different areas around the patella around the medial joint line, the lateral joint line, the tibial tuberosity ahead of the fibula on the popliteal fossa. So, ideally, I would have a video for this, and I was under the impression that you will have gotten teaching from faculty on this. Um, but totally. The summary at the beginning helps you to orientate yourself. Um, has to really is far. But you do need to feel in six different areas for your CPK. If you're asked to palpate the knee joint, they're expecting you to feel in these six different areas effusions. Okay, So how did the test for a fusions? So we have two different methods. Essentially, we have a sweet method, which is for small effusions. And then we have the top method, which is for large infusions. And how I remembered it was sweet and small. Start with us. So sleep method, smaller fusions. Um then the other one is just for a large effusion. So top method for large infusions. And you can see here what infusion might look like. So, on the normal side, you see these dimpling factions around the knee. This is where your patella would be. And this patient is supervising the just laying down on the couch. Where? Along the affected side. You have loss of this kind of white. The states didn't place. You can see that there would be swelling in this portion here. And, um, yeah, I understand that this would make more sense if you had seen the video on this week. Method of the time method. But hopefully again. As I said, this would help to prime you for what's coming. Okay, your practice questions. I'll go with this weekly. So what is the correct exposure for an M S K examination of the knee? So, what are you? Um What? What do you need to see in order to properly inspect and palpate in the patient's see? Yeah, I And like, essentially Good. Next question. What is the medical term for knock kneed? I'll go. Good Genome Algom. That makes your new stick together. Good. Right. Okay. So I might skip this question because you haven't seen the video. But on which side do you sleep upwards when performing the sleep test for smaller fusions? Um, I'll just highlight here. This is important for your CPK because they will be looking to see which side you begin on on or small effusions. You start from the medial side and sweet up and then sweep downwards. You'll see it in the video, But that is something that you do need to take note up and make sure you're doing correctly or your CK Okay, so moving on to move. So movement. We look for active movements and passive movement, though in active movements were essentially doing flexion and extension of the knee election is brought about by in the past ring muscles. So the biceps for Morris, seven tendinosis and member noses into an extent crystal is extension is brought about by the extensive operated. So essentially your quadriceps muscle pushes tended patellar tendon and that attaches to the tibial tuberosity. With these movements, What you're looking for essentially is pain on movements and range of movement. Why, as important, is because a lot of patients, particularly in Western society, have osteoarthritis, so they might have pain on movements due to be wearing a way of the cartilage between there and knee bones and then range of movement might also be reduced. So that's essentially what you're looking for. Passive movements. So this is the patient's turn. Teo, move their own lives. The patient must be sorry. This is your turn to move the patients like active movement. They're moving against resistance. Passive movements. Um, you are simply moving their lives, so the patient's lives must be relaxed. So you begin your CPK by saying okay for this examination, I need you to completely relax. Um, and you were physically flex and extend their legs. What you're looking for with possible movement is hyper extension. It's in the video. What would happen is the patient would be lying on the couch. Um, they have their life straight and you with pain to raise their leg by the Achilles tendon around about and you're just raising it straight up. So you're looking for men, that is, Does it bend or is it straight? If it bends, then there might be hyper extension. Now, some people have a hyperextension just normally, but up to 10 degrees is normal only if it's bilateral. Okay, if it's not bilateral back indicate pathology and one of the knees. I'm very sleepy. Uh, you also do need to know the range of motion. So you might be asked in the five a section. Okay, please assess the passive movement of this patient's knee and comment on the range of motion. Now the normal range. And you can only assess this if you know what the normal range is. The normal range is between zero and 1 35 and if it's reduced for some reason cause they're in pain, for example, or they have a certain pathology, then you can estimate what that reduced ranges. But it is normal. Likewise, they can ask you what the range of motion isn't just saying. It's being 01 35. Oh, practice questions. Where must be petitioners hand be placed with assessing hyperextension if you are doing your CPA and you were asked to assess for your patients um, assess for hyperstatic Hyperextension your patients. Where you going to please your head? Yeah, essentially. So at the ankle to hold the Achilles tendon and moving upwards. Okay, arthritis will cause it increased or decreased range of motion increase. Good. What is the normal range of motion? Pretty. Yeah. Good. What about if you're patient? Has hyper extension. What would you say the range is? Oh, okay. So I see. There you have 0 to 1. 45. Um, technically, you you go into the negatives. So if it's hyper extended, if it's past zero in the opposite direction, it becomes negative. So 0 to 1 40 if they don't have hyper extension bilaterally and minus 10 to 1 40. If they have hypersensitive bilaterally up to 10 degrees of it's if it's, um, past mine was 10 degrees, then that's a normal. That's a apology. But if it's normal hyper extension that you would say minus 10 to about 135 140 degrees, the special tests. So two special tests you want to do so the anterior draw and the posterior said, and then checking your medial and lateral collateral ligaments, which you can think of as like, um, looking at the bridging points. So in posterior side how you want your patient position. Knees flexed, be flat on the couch and you're looking from the side. So in your CPA, you really need to sell yourself, um, and make it very clear to the Examiner what you're doing. So with posterior side, you'd say. Okay, Can I ask you to place your feet flat on the couch? Okay. And when you go to assessment posterior side, you physically bent and look at the knees from the side. So this is what it would look like if it's normal, right? And just a highlight here? Not really. You have a little bit. In this space years you have your bony prominence, your annual to Ross. It e. And then I'm natural. Did hear what posterior side looks like. Is this Okay, so you have your knee joint, and then this step here is actually much more exaggerated. Can anyone suggest what has happened here? It's the guess. Yeah. So PCL rupture because that tibia has moved posteriorly. Okay, so you have that exaggerating it, which is what you're looking or when you're looking at post in your side, and it's it's really quite exaggerated. Okay, this is normal, right? You'll see that normally from the side of the couch. But they do have that posterior side. It will be quite a dramatic tip. So we'll see. Your sack sign is what you call it, and it indicates the presence of a posterior cruciate ligament tear No anterior draw. Okay. And there's a reason why we went over. Poster Your cycles, anterior draw is actually less useful. So for this examination, you're in the same position. You have your knees flexed, your feet flat on the couch. You place your thumbs on the tibial tuberosity. So if this waas me, for example, you place your thumbs on the tibial to we're all see, and then you wrap your fingers behind the knee until they're in the popliteal fossa. But you're going to do this, pull gently, okay? And actually pulling gently because this could be quite painful for patients. So the anterior draw test looks to see um, what the integrity of the anterior cruciate ligaments is because, remember, the anterior cruciate ligament prevents the tibia for moving. I'm teary early. Those is essentially what you're doing for your CPA, though, you will be talked to place filthy and bounds straight on the tibial tuberosity rather than cross how this practitioner is doing it again, that the fingers are reaching into the pool with you. Also, the positive anterior draw test indicates presence of anterior cruciate ligament tear now crucial bit that you need to know for your CPA and something that trips up lots of candidates is that a positive anterior draw in the presence of a positive posterior side sign is clinically inconclusive. Does anyone want to suggest why it's clinically Please? The patient has a positive posterior side. Why would a positive anterior draw be inconclusive? The latest already posterior So pulling cool room, they return to original position. Exactly. So you don't know if the degree to which you're moving in anteriorly is due to the posterior sag or determine a seal rupture? It's just, um it's two, um, ambiguous in that case. So you need to have an MRI to confirm Yes, you're wrong. And looking at the collateral ligaments, the really collateral ligament examinations knees slightly flexed. So again, you please put your feet flat on the couch. You place your hands above and below the knee on the medial and lateral size. So if this is our me, for example, um, you have your video side have real actual side one goes above one goes below. But what you're doing is you're applying in valgus and embarrassed stress. So what we mean by that is, if This is the medial side. So this would be the patient's, uh, left knee. Right? So this is the medial side that place my top end here on my bottom hand here, and I apply a stress in this direction. I am applying a valgus stress because I'm trying to bring the knees together. And if I swapped the position of my hands and I a part of pressure, then I'm applying embarrassed stress because I'm trying to pull the knees apart or open. That's Q angle again. This will make more sense once you've had the faculty teaching on it. But essentially, this is what you weren't doing the examination. Okay, so we have the medial joint line, you have actual joint line here. Okay? If this opens up, the more it shouldn't right. But if it opens up that more that Q angle is larger than it should be, then you might have a collateral ligament, laxity or rupture, and likewise on the lateral side. That's not normal, right? Um, it's not like hyper extension. These ligaments are not meant to allow your need to open That is pathological and needs intervention. Okay, So for your cpk opening of the medial joint lines of just damage to medial collateral ligament and opening of the lateral joint lines. Just damage to the lateral collateral. Pretty straight over there. 50 questions just to get a cell on the same page again. The went providing embarrass stress to the knee. Which ligament is being tested? Watch your black stool agreements. Good. Yeah. Next question. Where are the thumbs of the position placed when performed the anterior draw test? I'm a go guys to be able to cross it. Good. In what position? Most the patient's legs be when looking for posterior sac. Sign good. 90 degrees. So you ask them, Please place your feet flat on the couch. Just check that they're on these events. Atlanta degrees. Okay, So, by the questions, um, we're going to go over radiographic images, and I'm going to do presentations of some common for apologies. Um, I'm over halfway through. The lecture had spent about happen hour. So I think this might be a good time for a break. Okay, so let's just have maybe a two minute break, and then you can resume. But feel free to put any questions on the chat in that time, so we'll start again at 6. 38. Any questions? You agree to something in your job ends If you have time after the selection for you can get a head start on your faculty teaching by looking at the geeky medics video on a mask examination. It's very similar. But obviously, for your cpk, make sure you follow the techniques. Um, better put forward by imperial. That's how we'll be marking you. Okay, 6 38. I don't see any question, so I'm happy to continue. Okay. So basics of need energy, um, or your c p a m s k station. Um, this will likely be an MRI. Usually get a Nemo. Ryan, The knee, um, was trying to think about why. Okay, So the first question I want to ask you guys is What does it X ray allow you to see? You can put out in the shop bones. Good. Anything else mainly goes, Is it bones and other things are just bones. My oh, hemarthrosis. Interesting. Okay, I haven't come across that any bone fractures or abnormality fractures, bone soft tissues. Okay. Interesting. So, in terms of your CPA, um, X rays allow you to see bones. Um, that's That's essentially what they want you, Teo be able to identify. And when we're talking about pathologies of the knee, we're usually talking about a policy is that that involved a soft tissue. So, um, the ligaments and cartilage of the tendons. What will that MRI allow us to see? And it was Liver makes muscles, soft tissues, regiments, some tissue bones to shoot muscles. Good. So the first thing, unless you to see is bones, right, The bones, cartilage, ligaments, vessels that that well conceived fact on the MRI Just remember, um, the patella when you're palpating the patella. Hopefully you will have done your anatomy attention on this already. Um, when you're getting around the patella, your palpating the fat, um, which kind of cushions that the MRI is really good for that. And like I said, um, pathologies of the knee usually involved with salt issues. So, basics of imaging the meat, um X ray is standard, right? You might get an X ray if you want to have just a quick look, but, um okay, so you might want to get an X ray if you want just to have a quick look. But X ray is particularly useful when the patient has osteoarthritis, for example, So medication has osteoarthritis or suspected of having osteoarthritis, you might get a standing pills. So when the patient is standing rather than supine, Um, and the reason why I want them to be standing is because when you are looking for osteoarthritis, you're looking specifically or loss of joint space. Okay, because the cartilage is being worn down so the bones are coming closer together, and you'd only see that if the patient is standing and they're putting weight on their bones so that that so that the space compresses. You wouldn't see that if it's if the patient has soup. I'm Oh, for your CPA. You need to be able to, uh, name the bones. So your femur, your tibia, your fibula, identify any fractures, how you do that. So you would look at any outlines on the bone. And if there are any, um, inconsistencies in that outline, then you know that that might be a fracture. Every CPA, it should be very obvious and identify any displacement or abnormal spaces the animals faces might be the space in between the joint MRI allows us to see the soft tissue. So you can see in this image you can see a lot of detail about the soft tissue as well as the bones. Um, for the CPA, they don't expect you to be a radiologist, but on the most basic level. Can you identify the bones? Any Wouldn't buy the muscles, can you? Wouldn't are ligaments on them in the sky. Anything further than that is beyond your two levels. I don't worry about it. Um, just focus on these war areas. Essentially. But what? We could do some questions together, okay? And anyone Tell me what me this is. Is it the left or the right knee? And how do you know? Left knee. Good. How do you know it's the left knee? Yeah. Good. Fibula. Is lateral good. Okay, the top tip. Look at the fibula. Right. That's unless you have a photographic memory and know the exact shape of the bones when they're left or right. Um, you need to look at the fibula to be able to tell if this is the left. The right knee. Okay, So what? Surgical intervention has been performed and by the way. These are radiographic images that you can fully get in your CPA. So, um, do you have a go? Yeah, it's a little knee replacement. Good. Okay. Um so you can see essentially the entirety of the knee has been replaced. Um, you can see parts of the femur as well. A centimeter. I have to join. Space is essentially. You can see that they preserved the condyles. Okay. Okay. Name the structure. What are we looking at here? Just to kind of give you a clue? This here. This line here that you're looking up and also down here. He's a cartilage. Right on. There's something here with in that joint space. What is it? Okay, this medial meniscus. Good. And how do you know it's Medio about tibia? Good. But why's that medial as opposed to lateral? What was our top 10? Good. You can see the fibula is lateral from the lateral side. So this must be the medial side. And this therefore must be the meniscus. Good. The medial meniscus. Amazing. Okay, Another question. One test will be positive if the following structure is tourney. This is what we call a second order question. So In order to answer these kinds of questions, you need to know what the structure is. And then what? Tests will actually be positive with this storm. So let's see how you do on the second order question. Interior draw tests. Good. Okay. So as we said before, the anterior and posterior referred to the attachments of the cruciate ligaments on the tibia, not the theme femur. Right. So the interior, my laser. Okay, so this Christian ligament attaches to the anterior portion of the TV here, which means that it prevents the tibia from moving anteriorly. So when this is torn, you get a positive anterior drop test. That's question Name the structure here and struck me. Me is good. Um, would you like to explain how you figured out that it was gastrocnemius as opposed to Cilias? If you don't know, you can just that you don't know this is a learning point because this is a muscle that you could be asked to identify. No. Superficial. Yeah. You could think about it like that. There is something else. Gastrocnemius is on top of soleus, but intensive. The anatomy struck me. Use attaches to the femur. Okay, so you have your tibia here. Your femur here. Castro Penis comes all the way, um, about across the knee joints and attaches to the femur here, whereas soleus attaches to the to the fibula, which is, um, a lower down so the muscle wouldn't come up this far. Wouldn't cross the knee joint. It would be lower down. That's actually two. Okay, A few more questions. Anyone named this structure and remember to use the top tip lateral collateral ligament. Good. Okay, I think it's Yeah. Good. Amazing. LCL I like that of radiation. Okay, so, again, talk tip. Look at the fibula to decide whether medial natural You can see the fibula here. Right? That means that this, although, you know, it's a collateral ligament, is it's all your crossed. Any joints? It has to be the lateral collateral ligament as opposed to the medial. Okay. Named the vessel from which this vessel arises. If you haven't done the analogy, could you let me know? I might skip this question. Have you guys done the anatomy of of the knee joints? I was only told you haven't done the clinical skills for this is yeah. Yeah. Good femoral artery. Okay, so again, the second order question. So you need to be able to identify what this vessel is. This is being public teal artery. Because it's in the public, he'll fall. So you're just behind the knee joint, which is what you're reaching into when you're doing your anterior drama test. Um, I need arises from the road. It's just orientated. You have your aorta by for case into me. Um, iliac common femoral. You have your superficial in deeply moral but essentially femoral artery. And that becomes a popliteal artery which runs in the popliteal. Also. Okay, if you more questions, name the bones. This one's a bit difficult, but let's see how you get on. I included this question because I wanted to teach you a little trick. So how you go the 50. 50 chance. Any guesses as to what this bone might be? We are still looking at any joint femur. Good. Why do you say that? Okay. Cannot seem fibula. Electro can see patella good anywhere else. New guess is Okay. So this is the femur. Well, it's a highlight here is that the patella is located at the level of the femur. Not until here. Okay, So when you see images like these, So this MRI of the knee, Um, if you see the patella in this cross section of the meat, you're looking at the fever rather than the tibia. So that is a top step. Um, you cannot see the fibula in this section. So you can tell all this this medialis. It's natural. Like, where am I? Obviously if you conceive the fibula, you know you're at the tibial level, but if you can see the patella, you know you're at the femur level, so that's just a little trip to help you to figure out where you are. It's just the highlights about here. You have your femur know tibia, your patella. This was essentially the section we were looking at, and you can see that the patella is only found at the level of humor. Okay, you more questions? Name the pathology shown here. Toujeo. That's a fracture. Okay. Actually, when I searched up this image, I was looking for a particular pathology. But looking at it now, I do see that there might be a fracture here. They may have occurred at the same time. Well spotted but it's not. The pathology was after action, too. Okay, Yeah. Yeah. Okay, fine. There is a fracture to be a guys, because you can see that this, um the line of the cortex of the bone is not smooth. Um, so well spotted. But that's not the, um, not the pathology I was after. Okay, So what is that? What is that sign? Cold. He said, I'll rupture. What is that? Signed? Called. What's your science? I'm good. Okay. Their few more clinical questions were nearly there. Guys. So what pathology does this patient have? So the pain that they have in their knee is worse on movements. There is a history of trauma to the knee on their x ray shows, joint space narrowing and osteo fights. This is a question you can get in the two minute section. They might give you a brief history of a patient and ask you what pathology they might have. So, what do you think about this one? Osteoarthritis. Good. Okay, so next one knee tender and feels hot. Positive top test. Okay. I appreciate you haven't seen the videos, but in a positive top test, that is an indication that there is an infusion. So positive top tests and to reduce the range of motion. So what pathology? Musty first suspect in this patient. And you might know this from the RS. But clinically, um, there is a certain pathology you must not ms Don't need. It was tender. Feels hot. Maybe infection there is an infusion there is reduced during your emotion, So Okay, um, septic arthritis is the pathology that you must dyspeptic. First, you can suspect bursitis as a later differential, but septic arthritis is an emergency. Um, other differentials could be wrapped of arthritis. So it's when you have a pro general period, when you have a viral illness and then later on you can develop an arthritic pathology. Um, you can also get a rheumatoid arthritis flare up that my present in the same way. But you must do investigations to exclude septic arthritis first, which must be something like an aspiration to identifying bucks. Because if you leave the need to long, then you could essentially, who's the joint do just so much time. So this is the first apology you must expect can be bursitis. That's all bursitis in the chopped. Um, but it's not. It's not. Be emergency that you want to rule out first. Okay. Uh, right. So open medial joint line. It's a medial joint line. Positive anterior draw and paying on Platt. Um, girl. Sorry, I'm passing a collection. So name one type of activity that typically damages the's structures. Open medial joint line. We're thinking of the medial collateral ligament posterior a positive interior. Drop tests. Um, you're thinking of the anterior cruciate ligament? I'm paying on. Pass a flexion. Okay. So not sure. Movements in Rhode Deep Good. Yeah. So, essentially any sports. So what, then? What? Your takeaway from your studies of em skc pa is that sports are common causes of injury to the knee. So these kinds of apologies air common in footballers and roping players, Um, their scores that require a lot of activity involved in me. A lot of stress on those ligaments. So you do see these injuries quite commonly. And if you watch sports, I'm sure you know about it. And you have dedicated, uh, doctors for these apologies that arise. Okay, So bonus question. And we're very nearly done. Okay. So why I have these structures been damaged together So we go back just a second, okay? Okay. So the medial collateral ligament, the anterior cruciate ligament on essentially any other ligaments in the space that will cause pain on passive election. But specifically the medial collateral and the anterior cruciate, one of those been damaged together. That's a bonus question that goes back in at me again. If you guys have not done the anatomy for the knee, please let me know, and we can just skip onto the answer. But this is more like a higher level. Last in. More like a distinction, Mr. For instance, stress and trauma that cause this friction. Okay, they're common. Um, common rupture that you see is ruptured to the colo. Or, for example, the needle collection, a ligament. Any idea? In terms of the anatomy, the version would wear down the cartilage That would cause pain on passive question to be and femur pressure. Okay, that's more to do with the cartilage. But thinking about these sports in about how your knee has dio withstand so many twisting horses. Remember, your knee isn't meant to be twisting. It's not meant to be opening Is Q angle? Um, certain structures get damaged together, as the reason for this is the medial collateral ligaments is closely connected to the medial meniscus. Okay, so if you look close to here, you have your last well, collateral ligament. It's out of your knee joint from your femur to your fibula. Okay, this has no relationship to your lateral ministers. Your medial collateral ligament is a bit different and that you have your medial collateral ligaments connecting your femur to your tibia. So it's standing that knee joint, but it also has fiber is running into the medial meniscus. So the medial meniscus, um, often gets ruptured whenever you have a needle, glass related mint rupture, Um, and vice versa. So these are often damage together. Okay, the whole that was clear. Um, it is something that you can get asked, and it would be a higher level question. So, um, if you're aiming for those marks, um, to pay attention to that, the last topic tips. If you are unsure about the answer to a vial question, for example, you can be they okay if they require more specificity in your see pigs and they will problem too. Uh, you can always ask them to repeat a question, but only do so when you finish the exam. So remember, your exam is in two separate parts. You have a five minute part of the two minute part within those five minutes. If you, um, finish all the examinations, you want to do another one over again. Um, he's still you're still in that arm minute window. You can ask to just do that examination again, and it's fine. We'll erase your sport with first attempt. Um, I last talked to is to start practicing today. Okay. CK is a practical exam. Um, you don't get good at it overnight. I appreciate this lecture has come before your teaching from back a little. I don't think that was the intention, but in any case, I hope it's not. This election was useful and help to give you a springboard to, um, doing well on the day. But that only happen if you start practicing the scales. Okay, So I was told that this QR code doesn't work. I'll put a new Lincoln the chopper feedback. The Daphne was not able to be here today, but she's asking to put this in the tractor. You guys so if you wouldn't mind filling in the back, that would be amazing. The lecture is recorded. So if you did find it useful, um, tell your friends they wash their recording as well. All of the, um, questions. The practice questions right there in this lives. I also want to highlight that there is a summary sheet. I'll just walk you through that briefly. But there is a summary sheet this I could cheat sheet for your exams. Um, but literally. I spent a lot of time going through in sandy trying to put together what are the most relevant things you need to know. Um, what are they not so relevant things. So if you work, Teo, have a summary of everything you need to know. For your virus section, it would be in this document. So summary also in findings. Remember, if you don't have the right technique, you will pick up on spines. But if you do pick up on science, um, this is what they mean. It's a big sample. Scars down the middle might indicate knee replacement surgery. Um, anything else could be due to other surgery or trauma. Warm. The joint could be septic arthritis. That's the one you want to rule out. First be a flare up of osteoarthritis or rheumatoid arthritis swelling in the pulpit. She'll also could be due to a baker cyst. You learn about that? Um, one faculty release that information, but yeah, I just wanted to highlight that this resource is available and, um, a lot of time has gone into it, so it is complete, and I have make sure that it is clinically accurate. So I do have a look. Um, and yeah. Thank you so much for tuning in and were engaging with the lecture. Um, yeah. Have a nice rest of your evening. And good luck with your exams. How do we access the change sheets? So it is in the teens folder. So the link that you have for this lecture should take you to the team. Otherwise, I can put the later that in the shot. If that wasn't made clear in the advertising my sister saw, it's lives just a summary. Yeah. Yeah. Okay. Okay. Okay. And then we'll just put this in shock here. You know, during the jazz, seek a grip on teams. You should be able to um, let me see me. If I could put the Linda in this shop. Not sure how this, um, was set up. I'm not sure if you meant to join the same teens as the lectures, but let's see link for these summary sheet, and then I'll give you a link to crowd team. There you go. Yeah. Any questions? Feel free to email, or I'll hang around for a few minutes. You want to speak to me directly involved? Um, second year in general. But I'll stop the recording now. And you can have all but thank you guys. So much for coming.