Knee

Quadriceps tendon rupture – Jon Sharpe, Consultant MSK Radiologist (@jonsharpe360)

This patient had suffered a fall and developed sudden anterior knee pain and inability to straight leg raise. Interesting just how much you can see on the plain films below and how closely it correlates to the US findings.         Dr Jon Sharpe works at Yorkshire Radiology, who can be found on twitter @YorkshireRad   Further articles of interest Sonography of Partial-Thickness Quadriceps Tendon Tears With Surgical Correlation (2003) Journal of Ultrasound in Medicine, 22:1323–1329 Please do rate and share via the links below and visit the other case studies on this website. If you would like to …

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Patella tendinopathy and non-union of the ossification centres – Dr Matthieu Sailly (@MedecinsDuSport) Sports Medicine Physician, Switzerland

Following on from the recent case I posted on patellar tendinopathy and the role of diagostic MSK Ultrasound, Dr Matthieu Sailly, Sports Medicine Physician at Centre Synergie Medical, Lausanne in Switzerland got in touch and has contributed the following clinical thoughts on patellar tendinopathy and non-union of ossification centres. With a focus on the potential sequel of complaints that may arise  following  non union of the ossification centre. Tibial tuberosity Osgood Schlatter disease (OSD) may lead to chronic symptoms in 5 to 12% of the cases depending the literature (1). Distal patellar tendinopathy is not so frequent. This condition is …

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Patellar tendinopathy and diagnostic ultrasound – Stuart Wildman, Extended Scope Physiotherapist

This is a case study/overview of patellar tendinopathy and diagnostic ultrasound, focussing on summarising the role of ultrasound in the diagnosis. It aims to provide a source of evidence based information for clinicians. The treatment of tendinopathy and the current thoughts on the mechanisms behind it are outside the scope of the aim of this article.Please feel free to comment at the end of the post to discuss this somewhat debateable area of MSK medicine and musculoskeletal ultrasound. This patient in his late 20's presented with an eight month history of right anterior knee pain. This had started insidiously, and …

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Pretibial ganglion following ACL reconstruction – Stuart Wildman (@SWildmanPhysio), Extended Scope Physiotherapist

This interesting case was referred for assessment after the patient had experienced 6 months of anterior knee pain, with a background history of an Anterior Cruciate Ligament repair. The patient was in their 20's and presented with soreness in the region of the tibial tuberosity. They could not recall any recent trauma, and had no initial complications following the surgery. They reported no episodes of locking , giving way or instability. They did recall an occasional smaller area of swelling appearing on the anterior shin over recent months. On examination, there was nothing of note on observation with no wasting, …

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Exertional tibialis anterior muscle hernia – Suresh Sudula, MSK Consultant

This interesting case demonstrates the benefit of linking  musculoskeletal ultrasound with a clinical examination...with great images!. This 18 year old football club academy player had been referred to the ultrasound department with a three year history of a lump which appeared intermittently over the medial aspect of her leg. She had been seen by an Orthopaedic physician and had an ultrasound scan without conclusive findings or diagnosis.  She was also referred to an Orthopaedic surgeon who requested an MRI scan which came back with no lump. The MRI Images can be seen here... When I saw her in the clinic …

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Acute patella tendon impact injury – Niek Vink, Physiotherapist & Ultrasonographer (Dutch National Training Centre for Ultrasound)

Figure 1: Long view of patella tendon 5 weeks following direct impact trauma

Thanks to Niek Vink,Physiotherapist and Ultrasonographer, for contributing this case from his clinic at the Dutch National Training Centre for Ultrasound. It provides an insight into the appearance of tissues with acute trauma. This interesting case gives insight into the sonographic appearance of an acute patella tendon impact injury and the visible changes still present 4 1/2 months after the injury. This patient was in his early 30's and sustained direct trauma from a hockeyball impacting against the distal patella tendon. The patient presented with direct tenderness over the patella tendon. Ultrasound images at five weeks (Figure 1 and 2)  post trauma show …

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Lateral meniscal cyst – Stuart Wildman, Extended Scope Physiotherapist

A recent interesting case presented with lateral knee pain and no response to Physiotherapy. No prior history of trauma, but continued discomfort particularly on knee extension. On examination, there was no effusion and as reported subjectively there was a slight restriction on extension with a hard end feel. Knee flexion was full and pain free. On office based ultrasound, the following was found (Figure 1). A cystic,non-compressible, non-vascular, anaechoic lesion on the lateral joint line, that appeared to communicate with the lateral meniscus and joint line. The initial hypothesis was that this represented a lateral meniscal cyst. A meniscal cyst …

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Ostenil plus injection of the knee – Rob Mast, Extended Scope Physio and MSK Sonographer

This patient had previously suffered several traumas to his left knee. When he was a teenager he had some knee pain which he attributed to playing football. The Orthopaedic surgeon at the time felt it was due to a meniscal tear and recommended complete removal of the menisci in his knee. He agreed and he had open surgery to remove both menisci. When he was older he was also involved in an RTA and fractured this same leg. He recovered well but always had some restriction and intermittent pain in the knee. He was a fairly stoic type of person …

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Distal patella tendon – Dave Baker, Extended Scope Physiotherapist and MSK Sonographer

  Thanks to Dave Baker, Extended Scope Physiotherapist and MSK Sonographer for this case.... This patient presented at the Extended Scope Physiotherapy clinic in their 20's.  They reported receiving a kick to the left knee 10+ yrs earlier, there was a significant amount of pain at the time but they never had any formal investigations. Since then they had been aware of a small lump just adjacent to the tibial tuberosity.  The patient reported training regularly for the last ten years, and the knee has given few problems. Unfortunately, in recent months they reported noticing pain when load had been placed …

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Chondrocalcinosis – Stuart Wildman, Extended Scope Physiotherapist

A commonly encountered referral in many Physiotherapy clinics is 'OA knee...do the needful This was one such referral. An elderly patient with a longstanding history of bilateral knee pain, but a recent exacerbation in her left knee. This was causing significant discomfort and functional limitations. On examination there was a marked effusion , which was noticeably tender proximal to the knee. The effusion also felt slightly firmer than normal. Here is one of the images demonstrating the area of calcification within the effusion.

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