Long Case 2 PCL Injury

                                    Long Case 2

PCL Injury

Introduction

Exposure

General Examination

Apparently Healthing looking ,

Conscious

Well oriented to time place and person

Co-operative

Not in distrees due to pain

………

Moderately built up

Jaundice Pallor Lymph Node Cyanosis  Clubbing Oedema Dyspnoea

Vitals                           BP                    P                      T                      RR

Skin     Hair Distribution                      HEENT

Systemic Examination

Chest

CVS

P/A

Musculoskeletal Examination

Upper Extremity

Spine – C – spine and L-spine

            Head at centre

            Shoulder and Pelvis Leveled

            Normal overlying skin without any dimpling/swelling on the back

            Normal Movement of C-spine ,

Ask patient to stand up

            Thoracic and lumbar spine movements tested

Lower Extremity –

Gait     - Varus / Valgus thrust or walks slowly on a plodding manner loading knees on lateral compartment

Squating – Painful  , One side heel higher than the other

Alignment

           

Pelvis Leveled

            Both patella facing forward ,

Genu Valgum deformity on Right side

            Upper Extremity overlying Greater Trochanter

No flexion contracture at knee

Archs at feet normal

Posterior

( Measure Genu Valgum once you see this and continue downward ..)

Attitude not any partcular on lower extremities

Sitting again

Local Examination of Knee

Look               Skin

                        Swelling – effusion , fluid shift , Patellar floating sign , transillumination ,

                        Discharge

                        Posterior Sag sign

                       

Feel                 Temperature

                        Tenderness

                        Osteophytes

                       

Movements     Flexion / Extension

                        Crepitations

Stability

                        Varus / Valgus Stress Tests

                        Anterior Drawer,Posterior Drawer,Lachman’s ,End points

                        Mc Murray’s

Special Tests

Card on front of knee

 Subtle concavity present with a gap between card and front of knee

Step off sign

Tibial pleateau flush with medial femoral condyle suggesting PCL Disruption

Quadriceps Active drawer Test +

            PCL disruption –tibia moves anteriorly when Quadriceps contracted actively , extending knee from a flexed position against resistance .

           

Distal Circulation

Distal Sensation

Examination – Hip / Ankle / Foot

Neurology – Sensation / power / Tone / Reflexes

Management

Life Style Modification

            Decrease wight with calorie cut down , avoid participating in strenuous exercises

Physiotherapy

            Quadriceps Strengthening exercises

            Braces

            Drugs – Pain Management-  Opoids , NSAIDs , Steroids – Oral or Percutaneous

                        Hyaluronate Injections weekly 3 shots

           

 Discussion

Examine main ligaments

Posterior Sag – See tangentially anterior knee ,

PCL Deficiency – Quadriceps Active test

If PCL injured , what else to examine ?

            Dial test at 30 and 90 degrees

Management Plan ?

            After  Patellectomy and PCL deficiecy ?

            Posterior Stabilized TKR

What do you examine a patient with ACL and MCL injury ?

            Medial joint line

            O’Donoghue’s triad

 Treatment 

 Conservative 

PCL Reconstruction