Janice’s Painful Knee

Anatomy of knee joint
1. Bones
  1. Femur, tibia, and patella
2. Ligaments
  1. Extra- capsular
    1. LCL, MCL, Oblique popliteal
  2. Intra-capsular
    1. ACL, PCL, Transverse, Posterior meniscofemoral
3. Menisci
  1. Medial and lateral
4. Blood supply
  1. Anastomosis of the Knee joint
    1. Formed by 10 branches
5. Bursa
Structure of cartilage
1. Cells
  1. Chondroblasts + Chondrocytes
2. Matrix
  1. Ground substance + elastic and collagen fibres
3. Types
  1. Hyaline cartilage
    1. collagen and elastic fibres are present in equal amounts
      1. Supports and reinforces
        Found in: fatal skeleton, articular surfaces, costal cartilage, and cartilage of nose, trachea, and larynx
  2. Elastic cartilage
    1. elastic fibres are present in large amounts
      1. maintains shape and allows flexibility
        Found in: external ear and epiglottis
  3. Fibrocartilage
    1. collagen fibres are present in large amounts
      1. strength and ability to absorb compressive shock
        Found in: Intervertebral discs Pubic symphysis Menisci
Osteoarthritis
1. Risk factors
  1. Age/sex, disease, genetics, occupation, injury, weight, and muscle weakness
2. Clinical presentation
  1. pain, stiffness, swelling, tenderness, and crepitus
3. Pathogenesis
  1. trauma of genetic factors
    1. damage to articular cartilage or failure of abnormal cartilage under normal joint loading
      1. increase water in joint space
        Erotion
        Eburnation
        Bone cysts, osteophytes, sclerosis, and joint space narrowing
4. Treatment
  1. 1st line:
    1. Therapy: Physical therapy, occupational therapy, Tai chi yoga
  2. 2nd line:
    1. Medications: Acetaminophen, duloxetine, NSAID
      1. Glucosamine
        one of cartilage building blocks
        given as supplementation in osteoarthritis
        Contraindications:
        patients with shellfish allergy, Pregnant women, Cardiovascular disease, Impaired glucose tolerance
  3. 3rd line:
    1. Surgeries: Cortisone injection, Joint replacement, Realigning bones, Lubrication injection
5. Diagnosis
  1. Arthrocentesis, x-ray, blood test, MRI
6. Complications
  1. Reduced mobility, stress fractures, pinched nerve, osteonecrosis, chondrolysis
Types of Arthritis and diagnostic tests
1. Rheumatoid arthritis
  1. rheumatoid factor and anti-CCP antibodies.
2. Fibromyalgia
  1. Blood test (FM/a )
3. Psoriatic arthritis
  1. Close to gout and rheumatoid arthritis
4. Gout
  1. joint fluid analysis for uric acid crystals
5. Septic arthritis
  1. Joint fluid analysis
6. Systemic lupus erythematosus
  1. Erythrocyte sedimentation rate, Kidney and liver assessment or biopsy, Urinalysis,
7. Ankylosing Spondylitis
8. Reactive arthiritis
  1. Joint fluid tests (White blood cell count, Infections)

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Janice’s Painful Knee

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	Created by Noree Alii over 7 years ago