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  #1  
Old 07-09-2011
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Rheumatology/Orthopedics Gymnastic Student with Intra-articular Loose Bodies!

A 19 y old gymnastic student presents with knee pain on anteromedial aspect of knee. Which has restricted his activity and pain increases on his routine classes. Occasionally he felt catching up of his knee joint. He denies any trauma in past history. On examination you find joint effusion. CBC and synovial fluid analysis are normal. X ray shows normal meniscal, arthrosis, intr-articular loose bodies. What could be the diagnosis?
1. Meniscal tear
2. Osteochondrial fracture
3. Septic arthritis
4. Gouty arthritis
5. Osteochondritis dissecans

Last edited by Ace3; 07-10-2011 at 08:50 AM. Reason: spelling correction
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Old 07-09-2011
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1. Meniscal tear
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5) osteochondral dessicans

i got this answer by the process of elimination
1) menisccal tear= xray shows normal meniscal
2)Osteochondrial fracture- denies any trauma in past history
3 & 4 )septic arthrities & Gouty arthrities = CBC and synovial fluid analysis are normal

that just leaves 5
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Old 07-10-2011
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answer is menisceal tear, occasional catching up of the joint is key here.
Also, menisci are not clear on x-ray and need mri for visualization. In this case the medial meniscus is most likely injured cuz the pain is medial.
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Quote:
Originally Posted by confident View Post
A 19 y old gymnastic student presents with knee pain on anteromedial aspect of knee. Which has restricted his activity and pain increases on his routine classes. Occasionall he felt catching up of his knee joint. He denies any trauma in past history.On examination you find joint effusion. CBC and synovial fluid analysis are normal. xray shows normal meniscal, arthrosis, intr-articular loose bodies. What could be the diagnosis?
1. Meniscal tear
2. Osteochondrial fracture
3. septic arthrities
4. Gouty arthrities
5. osteochondritis dissecans
Answer is 5. Osteochondrities dissecans: Heavy activity usually like sports, gymnastic etc profession seen, mainly involve knee, elbow, ankle joint, locking and catching up of joint seen, restricts movement.

Option 1. Meniscal tear mostly needs history of trauma, usually knee involve and pain on flexion seen, knee swelling, crepitations are seen , MRI needs for diagnosis.
2. trauma histry,any sudden activity or any active activity like while playing or running it happened etc is required for diagnosis, knee twisting, osteochondrial fragment detachment seen on xry or MRI.

4. trauma, inceased wbc, ESR, infection is seen
5. morning stiffness, histry of alcohol, seafood, aspirin, meat consuming present, uric acid level increased, attacks are usually acute.
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  #6  
Old 07-11-2011
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Correct Answer

1. Meniscal tear.

Catching up.. And inra articular loose bodies are imp points..
Altho in knee injuries it is imp to gt an mri fo proper visualization
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although confidant has given answer of the question but don't know why, i still stand at meniscal tear
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Quote:
Originally Posted by dryogi View Post
although confidant has given answer of the question but don't know why, i still stand at meniscal tear
May i know your reasoning behined for considering meniscal tear??

I thought answer to be appropriate since for meniscal tear question frame should have:
1. it should have pain on deep flexion, and mainly on posterior aspect of knee
2.Restriction of movement to flexion and extention
3.H/o trauma present.

compaired to question it mentioned pain on anteromedial aspect and compltete restriction to movements and pain increases on performing activity, h/o trauma not necessery but some time condition resulting decreased bloodsupply will be given..because it occurs mostly due to decreased blood supply.
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Old 07-11-2011
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Help

@confident: isn't catching up same as lock knee?? I thot so..
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Quote:
Originally Posted by docmd11 View Post
@confident: isn't catching up same as lock knee?? I thot so..

Yes catching up and locking up are same. It means that person cannot straight up leg. But it is seen in many number of conditions like where ever u find: there is damage to knee structure like cartilage, ligment, meniscus, twisting, patella dislocation.

But in above scenario we find or may not in meniscul tear and osteochondritis dissecans(twisting of femur and tibia).
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Orthopedics-, Rheumatology-, Step-2-Questions, Surgery-

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