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The injury is heralded by a tearing or popping sensation followed by severe pain Occasionally, meniscal tears result from seemingly minor trauma In contrast to ligamentous injuries, in which hemorrhage causes immediate swelling, effusions associated with meniscal injuries accumulate over hours and are typically worse the day after the injury Several days after resolution (full or partial), the patient may experience the sensation of joint locking or instability, recurrent swelling with activity, and pain Pseudolocking caused by muscle spasm and swelling is more common than mechanical blockage caused by a fragment of torn meniscus A knee effusion is usually present Tenderness may be localized to the medial joint line, and range of motion in the knee may be restricted In patients without an acutely painful, swollen knee, McMurray s test may suggest the diagnosis This test is performed with the patient supine and the hip and knee in full flexion The examiner has one hand on the involved knee and the other on the ipsilateral foot As the foot is externally rotated, the examiner extends the patient s knee The presence of a snap (palpable or audible) suggests a medial meniscus lesion MRI is the optimal test for confirming the diagnosis if plain films exclude other conditions
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4 Overuse Syndromes of the Knee
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Runners particularly those who overtrain or do not attain the proper level of conditioning before starting a running program may develop a variety of painful overuse syndromes of the knee Most of these conditions are forms of tendinitis or bursitis that can be diagnosed on examination The most common conditions include anserine bursitis, the iliotibial band syndrome, and popliteal and patellar tendinitis
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both because close apposition of the dressing to the skin is critical to control swelling and because direct application of ice is uncomfortable and even deleterious to the skin Referral to a physical therapist may expedite recovery Patients should be informed that symptoms from lateral ankle sprains may take weeks or months to resolve, and that this period will be prolonged by premature attempts to bear weight on the injured ankle Surgical repairs of ruptured lateral ligaments provide excellent outcomes but are usually necessary only in cases of chronically unstable joints
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Beynnon BD et al A prospective, randomized clinical investigation of the treatment of first-time ankle sprains Am J Sports Med 2006 Sep;34(9):1401 12 [PMID: 16801691]
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Treatment
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Initial management is conservative, with elevation of the joint and application of a compression dressing and ice Weight bearing should be minimized for the first few days after the injury but may be resumed slowly thereafter The patient should perform quadriceps-strengthening exercises under the instruction of a physical therapist Surgery is reserved for patients with symptoms that recur upon resumption of normal activities or for patients with irreducible locking caused by mechanical problems
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Jackson JL et al Evaluation of acute knee pain in primary care Ann Intern Med 2003 Oct 7;139(7):575 88 [PMID: 14530229]
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6 Ankle Sprains
Ankle sprains are among the most common of all sports injuries Most sprains involve the lateral ligament complex, particularly the anterior talofibular ligament In more severe injuries, the calcaneofibular ligament may also be involved If both of these ligaments are ruptured, the injury results in significant joint instability and is classified as a grade III (severe) sprain (Grades I and II correspond to mild and moderate injuries, respectively) This section reviews only the type of ankle sprain resulting from inversion (varus) injuries, which account for 85% of all sprains
7 Plantar Fasciitis
The most common cause of foot pain in outpatient medicine is plantar fasciitis, which results from constant strain on the plantar fascia at its insertion into the medial tubercle of the calcaneus Although certain inflammatory disorders such as the seronegative spondyloarthropathies predispose patients to enthesopathies, the majority of cases occur in patients with no associated disease Most occur as the result of excessive standing and improper footwear
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