#98 Knee Pain: History, exam, bracing, x-rays, and injectables
Jun 4, 2018
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Dr. Ted Parks, an orthopedic surgeon and clinical professor, shares his expertise on managing knee pain. He breaks down the four buckets of knee pain and teaches a quick 30-second knee exam that's a game-changer for practitioners. Discussions include choosing the right knee brace, identifying red flags in history taking, and insights into effective injections like cortisone and PRP. Dr. Parks emphasizes the importance of thorough assessments and innovative approaches to treatment, making knee pain a less daunting challenge.
Understanding the categories of knee pain, such as ligament injuries and arthritis, aids in effective diagnosis and management.
A 30-second knee exam focuses on gait assessment and specific tests to identify key underlying issues efficiently.
Incorporating evidence-based practices is crucial when considering emerging therapies like PRP and stem cell treatments for knee osteoarthritis.
Deep dives
Introduction to Expert Insights on Knee Pain
The podcast features a discussion on knee pain, joined by orthopedic surgeon Dr. Ted Parks, who shares practical insights for evaluating and managing knee issues. A primary takeaway is understanding the importance of history-taking and recognizing red flags in patients presenting with knee pain. Key points in gathering patient history include identifying bilateral symptoms, acute events such as falls, and specific pain triggers like ascending or descending stairs. Dr. Parks emphasizes framing the patient’s condition within emergency and non-emergency categories to prioritize further examination and treatment.
Framework for Diagnosing Knee Conditions
Dr. Parks introduces a framework using 'buckets' to categorize knee conditions, including ligament injuries, meniscus tears, arthritis, and patellofemoral problems. He discusses the significance of ruling out emergency conditions like infections while assessing the chronicity and nature of knee pain. For patients over 60, degenerative processes like osteoarthritis typically emerge as common causes. A structured approach to categorizing knee issues aids practitioners in determining subsequent evaluation steps and treatment options.
Approaching the Physical Examination of the Knee
The physical examination of the knee can be conducted efficiently, focusing on key elements that reveal critical information about the underlying issues. Dr. Parks advises practitioners to first observe the patient's gait to identify any limping or abnormalities. Following that, a series of movements checks for crepitus, range of motion, and mechanical symptoms, all important for diagnosing meniscus and ligament injuries. Incorporating specific tests such as the McMurray's test for meniscus tears and Lachman's test for ACL stability can provide valuable diagnostic clarity.
Understanding Imaging and Treatment Options
When imaging knee conditions, Dr. Parks stresses the need to utilize specific x-ray views, such as weight-bearing and sunrise views, to assess for arthritis accurately. He highlights the limitations of standard three-view series x-rays, primarily aimed at detecting fractures. Additionally, he discusses treatment options ranging from conservative approaches like oral anti-inflammatory medications and cortisone injections to more invasive measures if necessary. Understanding these treatment pathways helps practitioners guide patients in managing knee pain effectively.
Evaluating Emerging Therapies: PRP and Stem Cells
In discussing emerging therapies, Dr. Parks addresses the use of platelet-rich plasma (PRP) and stem cell treatments for knee osteoarthritis. While PRP has gained popularity for its potential to promote healing, rigorous clinical evidence supporting its effectiveness is still lacking. Similarly, stem cells hold promise due to their regenerative capabilities, yet practical applications in knees remain unproven and rife with uncertainty. Overall, maintaining a critical eye and emphasizing evidence-based practice are essential when evaluating new treatment modalities.
Knee pain is easy with practical tips from Orthopedist, medical educator, car-builder, and inventor extraordinaire Dr. Ted Parks. He teaches us the four buckets of knee pain, how to perform a 30-second knee exam, choose a knee brace, order x-rays, and the red flags to look for in a history and physical that should have you shouting for your closest neighborhood orthopedic surgeon. This episode is brought to you in partnership with the American College of Physicians. ACP members can claim free CME-MOC credit at acponline.org/curbsiders. Check out our video of the Parks-Approved 30-second knee exam!
Credits:
Written by: Nora Taranto BA, Matthew Watto MD
Produced by: Chris Chiu MD and Nora Taranto BA
Edited by: Matthew Watto MD.
Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD.
Guest: Ted Parks MD.
Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.
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