sheena2005
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an 18 year old girl comes to the physician because of knee pain that has been present for 5 years.the pain is prolongerd by prolonged sitting and by going up and down the stairs.she has 10 degrees of hyperextension of both elbows.she becomes apprehensive when laterally directed pressure is applied to the pattela.X ray film shows no abnormalities.what is the management?
1-anterior cruciate ligament reconstreuction
2-arthroscopic partial menisectomy
3-quadricept strenghtning ecxersies
4-sympathetic blockade
5-total knee preplacement
6-upper tibial osteotomy.
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| ssrpk
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3-quadricept strenghtning ecxersies
i am not an orthopod [atleast not yet  ] but i'll place my bet with 3.
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| study_ing
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well i ve done a similar q somewhere but i just cant recall it  ..the hyperextended elbows are supposed to point to a syndrome..ill go for either 2 or 1...( i think i had guessed 3as a safe answer and gotten it wrong )
apprehension test is positive..one seems invasive so may be 2..but if there's pain on prolonged sitting it wud favor ACL pathology more ( probably )
1 the final guess
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| sheeezooo
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hmm i,ll go for 3 ..but not sure..
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| sarika
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i think its CHONDROMALACIA PATELLA so my answer is 3 quadriceps strengthing exercise
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| sheena2005
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this question is from NBME form 3.i am not sure about the answer myself guys, so pleasee discuss it further because it is a very confusing question. hyperextension of the elbows and knee problems at this young age do seem like pointing towards some syndrome. but i am unable to find any correlations.
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| study_ing
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http://www.physsportsmed.com/issues/2002/10_02/co...
Laxity. General ligamentous laxity should be assessed. Hyperextension greater than 10° in the elbow and knee and 90° in the metacarpophalangeal joints suggests hypermobility syndrome. Because of the lower force required to dislocate the patella, hypermobile patients are less likely to sustain osteochondral injuries and often recover quickly. Patients with extreme ligamentous laxity may also be susceptible to medial subluxation
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| study_ing
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i had this article stored on my comp..and i remember the confusion i had when i read it..it tells u about the mainstay of operative and of non-operative treatment, but it does not mention what the mainstay of treatment is...
in nono-op treatment ..
"Strategies to decrease the recurrence of pain and instability should be discussed with the patient. These include activity modification, maintenance of quadriceps strengthening exercises (eg, straight-leg raises and wall sits), and stretching programs. Prophylactic use of a neoprene patellar brace is controversial,19 although it appears that these sleeves offer some subjective improvement in symptoms for many patients"
but in surgical reduction they mention..
"For skeletally mature patients who have recurrent instability, both proximal soft-tissue and distal bony procedures are routinely performed"
"We recommend medialization for patients who have isolated instability and anteromedialization for patients who have significant patellofemoral pain or concomitant chondral lesions"
so i hope its C coz thats simple and ortho in detail should not be expected of us , but im not sure
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| sheena2005
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Thanks studying. from the above explanation it does lok like C.and I really hope too that they don't expect us to know ortho that much in detail.this is too confusing.
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| webjeee
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sarika is right.
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