Saturday, 19 December 2009

Knee injury - Torn Cartilage 1

Knee injuries are common and easy to diagnose. There are a limited number of problems with a knee, these are relatively easy to diagnose and satisfying to treat

This site is helpful Click here - the site sells knee surgery, if their surgeons are as good as their website, you are in safe hands! worth travelling to Yorkshire.  There is a lot of useful information about knee inuries and knee anatomy

Normal Knee function 

The knee does two things - it flexes and straightens and it also rotates, to allow you to twist and turn as you walk and run. It is this rotation that seems to cause the problems, probably because we encase our feet in concrete and walk on flat surfaces most of the time, we rarely turn at the knee, and when we do, it causes problems. Everyone knows they can bend and straighten their knee, but not everyone appreciates that knees can also "rotate". When the rotation goes wrong, you end up with a "twisting injury" of the knee and when extension and flexion go wrong, you have a hyperextension injury or dislocation.

When your knee is straight, it locks in place and cannot rotate but as soon as you start to bend your knee, you can start to turn it. Sit down and bend you knee slightly, move your foot inwards, and outwards - most peoples' knees allow the foot to twist inwards and outwards about 60 degrees (the same amount as a decent sized slice or segment of cake). The knee does not just bend and straighten, it also allows the foot to turn in and out. This movement allows you to walk on rough ground where the surface is uneven and every step is different.

The first step in making a diagnosis is understanding the problem, and if you want to be a doctor, you have to understand the human mind and body. We all have one readily available patient and that is ourselves, learning from ourselves means it sticks in your mind and  you always have a reference point.

Knee injuries

1 - Making a diagnosis.

The Medical History 

The diagnosis is almost always in the history. By understanding what happened and how the patietn felt you  can work out what happened. And once you know what happened, you can work out what has gone wrong, and that is your diagnosis. Knowi what has gone wrong and you can put it right

Occasionally, you cannot find out what has happened, that is, you may  not have a medical history, for example, the patient may have had other major injuries at the same time and just not know what happened to their knee, but this is rare.

It is useful to know whether the injury is a twisting injury, whether the knee hyperextended, or was hit directly.

Today's case is of a man in his late thirties, early forties, not particularly fit, who lost his footing on a path and fell heavily. He landed heavily on his shoulder and hip and twisted his knee. I saw him three months after his original injury. His shoulder was better and his hip was better but his knee had not improved.

And if you are a patient stick to the point - we don't need smart ass patients! The answer to the question "What seems to be the problem?" is not "Well you are the doctor, you tell me" On the other hand saying "It is my cartilage" is equally unhelpful. As a doctor, you want to hear facts and then put the relevant facts together to make a medical history which leads you to the diagnosis.

My patient was helpful, he told me that he had twisted his knee as he fell and that his knee had immediately swollen up a bit, not massively. It was immediately painful and from the time of his accident he could not put weight on that leg without excruciating pain. He saw his GP the next day because he couldn't walk and he didn't want to make a fuss.

The skill in taking a medical history is in being able to tease out what details are medically relevant and which details are just padding.

Accident Prevention

Many people nowadays are extremely unfit, with little sense of balance and even when they do exercise it is in a gym and  not outside in the real world

1 - Keep fit and practice good balance - that means moving around a little more, preferably without keeping your feet in blocks of concrete, otherwise called "Trainers". The weight alone should put you off!
2 - Be more mindful - if you are walking on rough ground - be aware of it!
3 - Make sure you walk straight and your posture is good - this keeps your joints aligned and means when you do fall, you fall "naturally" rather than in a heap and your joints bend where they should and not where you land. When footballer Mike Owen's injured his knee you could see it flapping about before he landed on it and destroyed it. He already had a knee problem and falling on his knee, finished it off.

Injury after minor falls are far too common - I worked with the Fire Service, and because many firefighters are not as fit as they should be, after every major incident there were always injuries. If Hannibal's men had been as unfit as that lot, Hannibal would never have left Carthage, never mind crossed the Alps with a platoon of elephants in the middle of winter and wiped out three Roman armies!

Copyright (c) Dr. Liz

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