Friday, January 11, 2008

Orthopedic Problem or Rheumatology Problem?

When is a swollen knee a surgical problem, and when is it a medical problem?

Hey, if it’s my knee, I’d rather not get it scoped unnecessarily.

A large effusion without clear evidence of internal derangement (meniscal tear, bone bruise/fracture, hyaline cartilage damage, or tendon/ligament tear) is like a stop sign.

Stop and think about the possibility of an infectious or inflammatory cause. Possibilities include Lyme disease, crystal arthropathy, and other arthropathies.

A large effusion with a small meniscal tear should still make you do a double take, because small meniscal tears by themselves should not give rise to large effusions.

Here is a patient with a large knee effusion:

The only other finding was a small lateral meniscal tear (not shown). The patient was scoped, confirming the small lateral meniscal tear. There was also extensive crystal disease, which was the real cause of the effusion.

1 comment:

MuchKneadedNYC said...

Great scope pic. I wish my meniscus had looked that pretty. Mine was totally shredded, it looked like the "angel hair" that you put on christmas trees! That was over ten years ago. Had total knee replacement 2 years ago.
Best regards,
Denise Williams