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9.14 Knee Sprain


Presentation

An athlete may have planted the foot while decelerating, torn the anterior cruciate ligament allowing the tibia to dislocate anteriorly, fallen to the ground where it spontaneously relocated, and not been able to get up. Alternatively, he may have been clipped on the lateral knee, causing a valgus deformity which tore the medical collateral ligament and perhaps the medial meniscus and anterior cruciate as well. An adolescent girl may have dislocated her patella laterally, tearing the medial retinaculum. These sorts of injury tend to come to the ED within an hour or two, in pain, holding the knee flexed ten to twenty degrees, with a tense joint effusion and quadriceps spasm which prevents detailed diagnosis by physical examination.

What to do:

Discussion

Chronic injuries can also be treated with NSAIDS, immobilization, and crutches. Examples include meniscal tears and joint mice, which may present with a history of the knee catching or giving way, and even flareups of osteoarthritis, degenerative joint disease, and pseudogout.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD