TRAUMA TEJIDOS BLANDOS RODILLA

ANATOMIA

HISTORIA CLINICA Localización

HISTORIA CLINICA Mecanismo del Trauma Rodilla extendida + Rotación Externa Rión interoilla extendida LCA + MENISCOS Rotación interna de la tibia con la rodilla extendi

HISTORIA CLINICA Mecanismo del Trauma Rodilla flexionada + Rotacion Interna LCA + LCM

HISTORIA CLINICA Mecanismo del Trauma Valgo + Rotación Externa LCA + LCM + MENISCO MEDIAL

HISTORIA CLINICA Mecanismo del Trauma Hiperextensión Capsula posterior + LCP

HISTORIA CLINICA Lesion contra el tablero del carro LCP

HISTORIA CLINICA DOLOR INESTABILIDAD BLOQUEOS HEMARTROSIS TRAQUIDO

RADIOLOGIA Fractura avulsiva tendón del bíceps de cabeza fibular SIGNO ARCUATO

RADIOLOGIA Avulsión cápsula lateral del platillo tibial lateral FRACTURA DE SEGOND

ESGUINCES Grado I: Elongación Grado II: Parcial Grado III: Total Soft tissue injuries are graded into four classifications and are merely numbered 1 through 4. A grade 1 soft tissue injury is where there is less than 25% disruption of the tissues and a grade 4 soft tissue injury is where there is 100% tear through the soft tissues. Grade 1 soft tissue injuries are self-healing. In other words within a matter of a few days to a week or so they will heal all by themselves. On the other hand, grade 4 injuries usually require surgery. By far the most common degrees of soft tissue injury are grade 2 and 3, especially of the neck, back, shoulder and knee.

ESGUINCES

DESGARROS

DESGARROS

TRATAMIENTO

BURSITIS TRAUMATICA

BURSITIS TRAUMATICA

LCA Util en lesión aguda Prueba mas sensible Comparativa LACHMAN The Lachman test can be useful if the knee is swollen and painful. The patient is placed supine on the examining table with the involved extremity to the examiner's side (Fig. 43-52). The involved extremity is positioned in slight external rotation and the knee between full extension and 15 degrees of flexion; the femur is stabilized with one hand, and firm pressure is applied to the posterior aspect of the proximal tibia, which is lifted forward in an attempt to translate it anteriorly. The position of the examiner's hands is important in doing the test properly. One hand should firmly stabilize the femur while the other grips the proximal tibia in such a manner that the thumb lies on the anteromedial joint margin. When an anteriorly directed lifting force is applied by the palm and the fingers, anterior translation of the tibia in relation to the femur can be palpated by the thumb. Anterior translation of the tibia associated with a soft or a mushy end point indicates a positive test result. When viewed from the lateral aspect, a silhouette of the inferior pole of the patella, patellar tendon, and proximal tibia shows slight concavity. With disruption of the anterior cruciate ligament, anterior translation of the tibia obliterates the patellar tendon slope.

LCA Cajon Anterior Menos sensible Mas útil en lesiones crónicas With the patient supine on the examining table, the hip is flexed to 45 degrees and the knee to 90 degrees, with the foot placed on the tabletop. The dorsum of the patient's foot is sat on to stabilize it, and both hands are placed behind the knee to feel for relaxation of the hamstring muscles (Fig. 43-48). The proximal part of the leg then is gently and repeatedly pulled and pushed anteriorly and posteriorly, noting the movement of the tibia on the femur. The test is done in three positions of rotation, initially with the tibia in neutral rotation and then in 30 degrees of external rotation. Internal rotation to 30 degrees may tighten the posterior cruciate enough to obliterate an otherwise positive anterior drawer test result (Figs. 43-49 and 43-50). The degree of displacement in each position of rotation is recorded and compared with the normal knee.

LCA Pivot Shift With the patient supine on the examining table, the hip is flexed to 45 degrees and the knee to 90 degrees, with the foot placed on the tabletop. The dorsum of the patient's foot is sat on to stabilize it, and both hands are placed behind the knee to feel for relaxation of the hamstring muscles (Fig. 43-48). The proximal part of the leg then is gently and repeatedly pulled and pushed anteriorly and posteriorly, noting the movement of the tibia on the femur. The test is done in three positions of rotation, initially with the tibia in neutral rotation and then in 30 degrees of external rotation. Internal rotation to 30 degrees may tighten the posterior cruciate enough to obliterate an otherwise positive anterior drawer test result (Figs. 43-49 and 43-50). The degree of displacement in each position of rotation is recorded and compared with the normal knee.

LCP Batea Lachman reverso

LCP Cajon Posterior

LCL Bostezo Lateral Más específico con 30° Flexión Extensión : cápsula y cruzados Evaluación neurológica

ESQUINA POSTEROLATERAL LCL TENDON POPLITEO BANDA ILIOTIBIAL BICEPS FEMORAL

ESQUINA POSTEROLATERAL Dial Test Diferencia > 10° - 15° 30°: Esquina posterolateral 30° y 90°: EPL + LCP 90°: LCP

LCM Bostezo Medial 30° Flexión: lesión del LCM Extensión completa: Cápsula medial, LCA, LCM y semimembranoso.

MENISCOS

MENISCOS

MENISCOS MACMURRAY The McMurray test (Fig. 43-37) is probably best known and is carried out as follows. With the patient supine and the knee acutely and forcibly flexed, the examiner can check the medial meniscus by palpating the posteromedial margin of the joint with one hand while grasping the foot with the other hand. Keeping the knee completely flexed, the leg is externally rotated as far as possible and then the knee is slowly extended. As the femur passes over a tear in the meniscus, a click may be heard or felt. The lateral meniscus is checked by palpating the posterolateral margin of the joint, internally rotating the leg as far as possible, and slowly extending the knee while listening and feeling for a click. A click produced by the McMurray test usually is caused by a posterior peripheral tear of the meniscus and occurs between complete flexion of the knee and 90 degrees. Popping, which occurs with greater degrees of extension when it is definitely localized to the joint line, suggests a tear of the middle and anterior portions of the meniscus. The position of the knee when the click occurs thus may help locate the lesion. A McMurray click localized to the joint line is additional evidence that the meniscus is torn; a negative result of the McMurray test does not rule out a tear.

MENISCOS APPLEY The grinding test, as described by Apley, is carried out as follows. With the patient prone, the knee is flexed to 90 degrees and the anterior thigh is fixed against the examining table. The foot and leg are then pulled upward to distract the joint and rotated to place rotational strain on the ligaments (Fig. 43-38A); when ligaments have been torn, this part of the test usually is painful. Next, with the knee in the same position, the foot and leg are pressed downward and rotated as the joint is slowly flexed and extended (Fig. 43-38B); when a meniscus has been torn, popping and pain localized to the joint line may be noted. Although the McMurray, Apley, and other tests cannot be considered diagnostic, they are useful enough to be included in the routine examination of the knee.

MENISCOS Dolor interlinea articular

MENISCOS Prueba de Thessaly

RUPTURA TENDON PATELAR Y CUADRICEPS Edad 2 cm Tendón Patológico Comorbilidades 25% sin diagnóstico

MECANISMO DE LESION Fuerza violenta súbita por contracción excéntrica refleja del cuádriceps con la rodilla parcialmente flexionada

CLINICA Dolor Brecha Patela baja

CLINICA Patela alta Limitación extensión Extensores auxiliares

RADIOLOGIA