Patella ballot syndrome. Development of the patella, injuries and their consequences

Various diseases and injuries of the knees can often provoke the symptom of balloting the patella. This means that intra-articular fluid accumulates. The kneecap or patella is necessary for normal movement, so it is important to pay attention to the symptoms in time in order to quickly diagnose the problem and fix it.

What does it represent?

Ballotation is commonly called the swinging or oscillation of a dense, movable organ in its environment. When it comes to the knee joint, it means an abnormal increase in the volume of fluid of a different nature in the articulation cavity. It can be blood, purulent impurities, transudate. Ballotion of the patella occurs when, when pressed, the calyx descends inward and then returns to its original position, springing back. With an abnormal increase in fluid over 15 ml, you can hear tapping sounds in the knee joint.

Causes of the patella ballot symptom

Patella ballot syndrome can be triggered by chronic joint diseases or sports and household injuries. The main causes of occurrence include:

• knee osteoarthritis;
• inflammatory processes;
• purulent arthritis;
• acute or chronic injury;
• damage to the entire joint or one structure.

Particular attention should be paid to the symptom of balloting in the diagnosis of injuries. Often he talks about damage to the meniscus, ligaments or shell of the articular bag.

Manifestation of symptoms

Ballotion of the calyx is a symptom for diagnosing other diseases. At the initial stage, it is accompanied by pain during movement, then the pain manifests itself in a calm position. The intensity is determined by the amount of liquid - the more, the more acute the discomfort. Swelling of the knee joint appears - visually it becomes larger than healthy. With a long-term pathological process, dysfunction of the knee mobility is observed, it is difficult or impossible to unbend and straighten the leg.

Treatment Methods

Separate treatment of this symptom is not carried out, but complex therapy is prescribed, depending on the causes of occurrence. For a complete diagnosis, additional studies of the cavity of the knee joint are carried out using MRI, ultrasound or CT. By the nature and type of pathological disorders, a list of ongoing activities is determined:

• fluid removal;
• washing with antiseptic solutions;
• injection of drugs into the joint;
• soft or hard dressing;
• restriction of mobility;
• physiotherapy.

Take preventive measures to prevent re-injury. For this purpose, knee pads or elastic bandages are used. Resuming full load on the knee is allowed after complete tissue regeneration, after consultation with a doctor. You should also return to sports activities after the absolute recovery of the joint and under the guidance of an experienced coach.

A. Acute mechanical injury of the knee joint

B. Chronic meniscus injury

C. Osteoarthritis of the knee

D. Chronic venous insufficiency of the lower limbs

E. Purulent arthritis of the knee joint

The symptom of balloting the patella is a reliable sign

A. Injuries of the anterior cruciate ligament of the knee joint

B. Intra-articular fracture of the condyle of the tibia

C. Hemarthrosis of the knee joint

D. Hydrarthrosis of the knee joint

E. Chronic synovitis of the knee joint

What can indicate the presence of hemarthrosis of the knee joint?

A. .Protrusion of the upper inversion;

B. Patella Ballotion

C. Front drawer symptom.

E. Options A and B only

E. Options A, B and C

Hemarthrosis of the knee joint is characterized by

A. Bursting pain

B. Limitation of knee flexion

C. Baikov's symptom

E. Options A and B only

E. Options A, B and C

Damage to what structures CANNOT cause the development of hemarthrosis of the knee joint

A. Meniskov

B. Cruciate ligaments

C. Collateral peroneal ligament

D. Synovial capsule of the joint

E. Intercondylar eminence of the tibia

35. Fractures of the diaphysis of the tibia heal the worst:

A. In the upper third, since reposition of bone fragments is difficult there

B. In the upper third, since the attached muscles create significant lateral

C. In the middle third, since the attached muscles create significant lateral

and rotational displacement loads

D. In the middle third, since the bone in this area is the worst blood supply

E. In the lower third, since the bone in this area has the worst blood supply

In case of a fracture of the diaphysis of the bones of the lower leg, skeletal traction is applied

A. 5-8 cm distal to the fracture area

B. 3a calcaneus

C. For tibial tuberosity

D. For the epicondyle of the thigh

E. For the supramallear region

When is it best to use an external fixation device for osteosynthesis of a fracture of the diaphysis of the bones of the leg?

A. Unstable helical fracture of the tibia

B. In case of fractures of both bones of the lower leg at the same level

C. With a primary open fracture with infection of the bone wound

D. With multi-comminuted fractures

E. With intra-articular fractures

To clarify the diagnosis, in case of suspected impression fracture of the condyle of a white bone, in addition to R-graphy,

A. Ultrasound examination (ultrasound)

B. Computed tomography (CT)

C. Stress radiographs of the knee joint with lateral loading

E. Options A and B only

E. Options A, B and C

Specify the most probable concomitant injury in a helical fracture of the tibia at the border of the lower and middle thirds with displacement

A. Fracture of the fibula at the same level

B. Fracture of the fibula in the upper third

C. Fracture of the medial malleolus

D. Rupture of the distal tibiofibular syndesmosis

E. Associated injuries are not typical for such a fracture.

What is characteristic of an isolated fracture of the fibula?

A. Violation of the support of the limb

B. Soreness with axial load

C. Absolute segment shortening

E. Options A and B only

E. Options A, B and C

Interposition by soft tissues in case of a fracture of the bones of the lower leg is evidenced by

A. Symptom of umbilization;

B. Absence of fragment crepitus at initial examination

C. Pathological mobility in the area of ​​damage;

E. Options A and B only

E. Options A, B and C

42. Reliable signs of rib fractures include:

A. Bone crepitus

B. Development of hemo- or pneumothorax

C. Symptom of interrupted inspiration

E. Options A and B only

E. Options A, B and C

Multiple rib fractures

A. Fracture of one rib in two places

B. Starting with a fracture of two ribs

C. Starting with a fracture of three ribs

D. Starting with a fracture of four ribs

E. Fracture of the ribs in combination with fractures of other bones

44. Paradoxical breathing occurs with fractures of the ribs:

A. Multiple

B. Fenestrated

C. Double-sided

D. Complicated by damage to the pleura

E. The development of paradoxical breathing is not associated with damage to the ribs

45. With paradoxical breathing, the lung on the side of the lesion when inhaling:

A. Randomly collapses and straightens during respiratory movements

B. Starting to straighten out, stops with continued inhalation

C. Does not change volume

D. Straightens out

E. Falls off

Vagosympathetic blockade according to A.V. Vishnevsky is indicated for fractures of the ribs

A. Complicated by lung injury

B. Multiple

C. Fenestrated

E. Options A and B only

C. Options A, B and C

47. What method is not used to reduce pain caused by rib fractures?

A. Intercostal nerve block

B. Paravertebral blockade

C. Epidural anesthesia

D. Vagosympathetic blockade

G. Chest bandage

48. In the treatment of uncomplicated rib fractures, one should use:

A. Bed rest, semi-sitting position

B. Breathing exercises from the first day

C. Immobilization of lesions (compression bandage) for several days

E. Options A and B only

E. Options A, B and C

In case of violation of the frame of the chest against the background of fractures of the ribs, apply

A. External fixation rails

B. Permanent traction

C. Tygoe chest bandage

E. Options A and B only

G. Options A, B and C

50. With a closed fracture of the rib,:

A. Subcutaneous emphysema

B. Tension pneumothorax

C. Closed pneumothorax

E. Options A and B only

E . Options A, B and C

For "floating" fractures of the ribs, it is characteristic

A. Severe dyspnea

B. Paradoxical breathing

C. Dislocation of mediastinal organs

E. Options A and B only

E. Options A, B and C

The most common complication of a sternum fracture is

A. Traumatic asphyxia syndrome

B. Lung injury

C. Contusion of the heart

E. Options A and B only

E. Options A, B and C

What instrumental studies are indicated for suspected sternum fracture?

A. Radiography

C. Scintigraphy

E. Options A and B only

E. Options A, B and C

54. Neck vagosympathetic blockade is indicated for:

A. Multiple rib fractures

B. Burns of the upper respiratory tract

C. Penetrating stab wound to the chest

E. Options A and B only

E. Options A, B and C

55. In children, unlike adults:

A. The periosteum is thicker, the bones are stronger and grow together better

B. The periosteum is thinner, but the bones are stronger and fuse better

C. The periosteum is thicker, the bones are less strong, but they fuse better

D. The periosteum is thicker, the bones are less strong and grow together worse

E. The periosteum is thinner, the bones are less strong and grow together worse

56. For the growth of which bones in a child, according to the Digby scheme, the proximal epiphyseal zone is of the greatest importance?

B. Shoulder

C. Forearms

E. Options A and B only

E. Options A, B and C

57. Epiphysiolysis is called:

A. Melting of the bone in the area of ​​the epiphysis due to a purulent process

B. Destruction of the epiphyseal zone against the background of osteoporosis

C. Cystic bone degeneration in the area of ​​the epiphysis against the background of osteoarthritis

E. Traumatic destruction of the growth epiphyseal cartilage in children

E. Periarticular fracture in children with transition to the growth zone

58. Fractures are characteristic of childhood:

A. Impression

B. Subperiosteal

C. Multisplintered

E. Options A and B only

E. Options A, B and C

With epiphysiolysis with a displacement, the optimal treatment tactic in a child is

B. Closed manual reposition with cast fixation

C. Skeletal traction

E. Open reduction and submerged fixation

E. Imposition of a spoke or rod apparatus

60. A sharp pull of the child by the outstretched arm (prevention from falling) often leads to:

A. To the epiphyseolysis of the distal radius

B. To a fracture of the olecranon

C. To subluxation of the head of the radius

D. To external dislocation of the forearm

Hemarthrosis of the knee joint, the treatment of which is prescribed by a doctor, can develop as a complication after a knee injury. The knee joint is one of the most vulnerable. It accounts for most of the load when walking. Hemarthrosis is the accumulation of blood in a joint. This pathology does not pose a particular danger, but only if hemarthrosis refers to an uncomplicated form. Usually, blood enters the joint from a damaged vessel as a result of an injury. Hemarthrosis of the ankle joint is much less common.

Why does knee hemarthrosis develop?

In the knee joint there is a special sterile cavity, the surfaces of the femur and tibia go into it. In this space there is a small amount of fluid, which is necessary to reduce friction between the articular surfaces. The volume of liquid in the normal state does not exceed 3 ml.

A large number of small vessels are located in the synovium, which lines the joint. In case of injury, the integrity of the vessels is violated and the blood, once in the joint space, mixes with the joint fluid. The joint capsule cannot contain so much fluid, so it is forced to stretch, and the pressure inside the joint increases. The largest number of vessels nourishes the joint in childhood, then, as the body grows older, their number decreases.

The cause of hemarthrosis of the knee can be not only a bruise, but also the presence of diseases such as:

• hemophilia;
• pathologies of the walls of blood vessels that occur in diabetes mellitus;
• hemorrhagic diathesis;
• scurvy.

But in the first place were and remain injuries of the knee joint. They most often lead to hemarthrosis. Less often, hemorrhage in the joint can provoke:

• ligament rupture;
• meniscus damage;
• intra-articular fractures;
• rupture of the capsule itself.

What are the symptoms of the disease?

If a person has hemarthrosis of the knee joint, the symptoms will be as follows:

1. Swelling of tissues usually begins in the area of ​​the patella.
2. The motor capabilities of the joint are significantly reduced, and every movement causes pain.

If the cause of hemarthrosis was the rupture of the anterior cruciate ligament, then in addition to the general symptoms, when the ligament is ruptured, a characteristic click is clearly heard during the injury, and the knee itself begins to “fall through” in its anterior part when palpated. Most intra-junctional operations inevitably result in bleeding. Especially frequent problems arise in patients who have diabetes mellitus and hemorrhagic diathesis in concomitant diseases. These 2 diseases proceed in such a way that they destroy the vascular wall.

In this case, blood can enter the joint unexpectedly for no apparent reason. Very rarely, liver diseases can interfere with the blood coagulation process and also automatically fall into the list of pathologies that cause hemarthrosis. The cause of bleeding into the joint can be hemophilia. But this happens very rarely, since hemophilia, which is a hereditary disease, is quite rare.

Too frequent hemorrhages in the articular bag can lead to joint contracture. Moreover, with hemophilia, the knee most often suffers and hemarthrosis of the elbow joint, which arose as a result of hemophilia, is much less frequently diagnosed.

Often such hemorrhages suggest the presence of hemophilia in a patient.

Intra-articular fractures and rupture of the capsule are in themselves pathologies that are difficult to treat. Therefore, if symptoms of hemarthrosis are attached to them, the main emphasis in treatment is on trauma, and hemarthrosis is treated as a concomitant disease. In this case, the treatment is carried out in a complex manner.

If bleeding into the joint cavity occurs with enviable constancy, the synovial membrane gradually loses some of its properties, including that it stops absorbing blood from the joint cavity and begins to grow. In this situation, doctors ascertain the presence of such a disease as chronic synovitis, which arose as a complication of hemarthrosis. As a result, the range of motion in the joint is significantly reduced, and the process of delivering nutrients to it along with the blood is disrupted.

In the case of such complications arising from hemophilia, it is forbidden to perform such a procedure as injections into the joint. Due to minor damage to the vessel during the injection, uncontrolled bleeding can begin, which will be very difficult to stop due to clotting problems.

The symptoms of knee hemarthrosis are always the same and practically do not depend on the causes that led to the onset of the pathology. The most characteristic symptom of hemarthrosis is severe pain in the area of ​​the affected joint, which necessarily increases when the leg is bent at the knee or during any movement. The next symptom of hemarthrosis of the knee will be swelling, and the tissues will swell right before our eyes. The patient will complain of a feeling of fullness, he will constantly be disturbed by something in the knee area.

Such strange sensations will occur due to the presence of a large volume of fluid containing blood in the joint. Due to edema, the shape of the articular bag changes, its clear contours are lost. If at this time you put pressure on the patella, it will begin to "swim", as it were, this symptom is called balloting. The defeat of the ankle has the same symptoms as with hemorrhage in the knee joint.

The body does not remain indifferent to what is happening, the villi of the synovial membrane are trying to eliminate the consequences of hemorrhage, trying to absorb foreign impurities in the form of blood in the liquid. An inflammatory process develops in the joint, which in this case is a protective reaction of the body. Therefore, doctors do not seek to stop inflammation. They intervene only if the serous fluid inside the connection turns into pus.

In normal bleeding, the blood clots quickly. An exception is when the patient has hemophilia. When bleeding inside the joint cavity, the blood cannot clot due to the special properties of the synovial fluid.

At the beginning of the inflammatory process, there is a local increase in the temperature of the skin in the area of ​​\u200b\u200bthe connection. The knee area turns red. Moreover, all these symptoms appear within a few hours after the onset of bleeding.

The treatment of this pathology depends entirely on the intensity of bleeding and on the amount of accumulated fluid inside the joint.

Degrees of hemarthrosis of the knee

With the first degree of hemarthrosis of the knee joint, the pain is not so strong. The contours of the articular cavity are practically unchanged. A distinctive feature of the first degree of the disease is the fully preserved range of motion in the joint. A similar course of the disease suggests that only a small amount of fluid has entered the joint cavity. These symptoms usually accompany a meniscal injury.

Hemarthrosis of the knee joint of the 2nd degree is characterized by an already more pronounced pain syndrome. At this stage, the connection loses its shape. It visually increases in size. There is a sign of a ballot. In the second stage, the liquid volume reaches 100 ml. Usually this condition develops when the ligaments are damaged.

The third degree is the most severe. It occurs with dislocations and fractures of the joint, and also as a complication of hemophilia.

Before making a final diagnosis, the patient is prescribed an appropriate examination, which includes ultrasound, computed tomography and MRI. An x-ray examination will not be effective, because even if a contrast agent is used, the quality of the resulting image will be poor. An MRI will give the most accurate picture of the changes occurring in the joint.

How to treat hemarthrosis of the knee joint?

How to treat the disease? Only timely prescribed treatment will help maintain the connection, since the blood that has interacted with the intra-articular fluid begins to slowly destroy the cartilaginous tissue of the joint.

Until the moment of contacting specialists at home, it is only possible to fix the joint in such a way that the load on it is minimal.

Treatment with folk remedies must begin with the creation of an iodine mesh in the area of ​​the affected joint.

Therapeutic procedures depend on the intensity of bleeding and include:

• at the first degree - the imposition of a tight bandage;
• at the second degree - carrying out a puncture of a joint.

Thanks to this manipulation, all contents are removed from the joint cavity. Then a tight bandage is applied to the joint. Since the body continues to produce intra-articular fluid, its volume will be quickly restored, and the puncture itself, subject to all the rules of conduct, will not cause any harm.

If the patient's condition improves after the puncture, and the amount of fluid inside the joint does not exceed the norm, a second puncture is not performed. If after a week the level of fluid in the joint is high, the puncture is repeated, and drugs such as hydrocortisone are injected into the joint. This hormonal drug should slow down the development of the inflammatory process, which inevitably occurs by this time and already poses a threat to the joint.

A tight bandage is required. Sometimes, as an additional measure, the imposition of a splint is used, which is designed to limit the mobility of the joint. The need for such measures disappears after 3 weeks. Further treatment is reduced to physiotherapy.

First aid and treatment for dislocation of the knee joint

The knee is the largest joint in the human body, which is formed by the femoral condyles, the upper articular surface of the tibia and the patella (patella).

The knee joint consists of such joints: the main, femoral-tibial and femoral-patellar.

The muscle structures and tendons that surround the knee joint come from the side of the lower leg and thigh.

The patella is a small flat oval bone located in front of the knee.

In addition to the main functions of the patella, protecting the structures of the knee joint from damage, it is the patella that determines the function of flexion of the largest muscle in the human body - the quadriceps muscle, located on the front surface of the thigh.

In other words, the patella performs the function of transferring the muscle strength of the thigh to the lower leg. The functioning of the patella is provided by internal and external ligaments located in a sliding groove.

The knee joint takes on the load from the entire body while walking or standing.

Features of a dislocated knee

Dislocation of the knee - damage to the knee joint due to various injuries that lead to displacement of the articular surfaces of the bone, a change in the location of one bone relative to another, a change in their anatomical position without violating the integrity of their structures.

In case of dislocation, the capsule and ligamentous apparatus of the joint are damaged, the contact of the upper end of the leg bone with the lower end of the femur completely disappears.

This pathology is manifested by swelling, dysfunction and deformity of the limbs.

In medical practice, dislocations of the knee joint are diagnosed by:

Are you at risk of injury?

The main reasons that led to this pathology include:

• strong, direct blows to the patella;
• a sharp contraction of the quadriceps femoris muscle during active movements;
• falls from a height onto the knee joint. this type of injury is accompanied by a severe bruise of the legs, on which the maximum load was applied during the jump;
• congenital pathologies and anomalies. congenital weakness of the ligamentous apparatus, in which even the smallest impact can provoke injury.

Dislocation of the knee can also occur in an accident, since a large impact falls just on the front of the body of a person sitting in a car.

The risk group includes athletes who are engaged in power sports, participate in sprint races, marathons, high jumps, and cycling races.

Running and jumping can stretch the structures of the ligamentous apparatus and lead to a dislocation of the knee.

Features of symptoms

In the event of a dislocation of the knee joint, depending on the location, strength and area of ​​damage, as well as the causes that led to knee injury, symptoms of varying intensity may appear.

It is also important to understand that many signs of dislocations, sprains and fractures of the knees at the initial stage are similar.

The characteristic clinical signs that are diagnosed in all forms of injury include:

• sharp, severe pain in the joint area, which is especially pronounced when moving;
• severe swelling, swelling;
• hyperemia of tissues in the area of ​​the knee joint;
• deformation, change in the shape of the knee;
• numbness, feeling of coldness in the leg, loss of sensation below the injury site;
• lack of pulsation below the injured area;
• reduction or complete absence of joint mobility;
• temperature increase.

Habitual dislocation and its features

Habitual dislocation of the knee joint occurs in the patella as a result of repeated, periodic slipping of the patella from the usual channel of its sliding.

Habitual dislocations can occur after primary trauma to the patella.

Such a dislocation can occur even with a minor injury, any other actions, for example, when lifting weights.

Accompanied by unpleasant, mild pain symptoms, discomfort, while the constant loss of the cup can lead to the development of arthrosis of the knee.

To eliminate the pain symptom, you can independently adjust the patella.

The development of this pathology is facilitated by:

• excessive elasticity of the ligaments;
• too high position of the patella;
• non-fusion of the supporting ligament of the patella after injury;
• flattening of the sliding paths at the femur, since it is in this area that the groove is located, which directs the patella.

The formation of subluxation occurs in the patella and can occur when:

The above reasons over time lead to an unstable, unstable position of the patella, which, with the slightest injury, bruises, physical exertion, sharp bending of the legs, is easily exposed to this pathology.

The main symptoms of subluxation of the patella include:

• feeling of instability of the patella;
• pain during movement, usually when bending/extending the knee;
• during movements, a characteristic crunch or click is heard in the area of ​​​​the patella, which occur when the normal sliding of the articular surfaces is disturbed.

This pathology with a long course can lead to the development of arthrosis and synovitis.

congenital pathology

Congenital dislocation of the knee joint is a rare, severe pathological disease of the musculoskeletal system.

This pathology is not genetic and develops in the second trimester of pregnancy. In most cases, congenital dislocation of the knee is diagnosed in girls.

Treatment is based on the use of surgical techniques.

This pathology occurs quite often and can occur during running, performing sports exercises, dancing, with injuries, sharp turns.

Dislocation of the patella is classified into:

• habitual dislocation of the patella;
• old dislocation;
• spicy.

The main manifestation of this pathology is a sudden, severe sharp pain, a slight increase in the volume of the knee joint, step-like deformity, swelling of the tissues.

Pain occurs even with the slightest movement.

After an injury, the patella is displaced to the outside of the joint, causing acute pain.

After the time has passed, the cup can independently return to its usual position, but even in this case, it is best to contact a specialist.

Injury diagnosis

It is possible to prescribe effective treatment only after passing a comprehensive diagnosis.

Diagnostic methods include:

• visual inspection;
• radiography;
• arteriography (x-ray of the arteries);
• checking the pulse, which allows you to determine the localization of damaged areas and whether there is a violation of blood circulation.

First aid

If a knee dislocation is suspected, it is necessary to immobilize the injured limb as soon as possible with a splint or any available means.

In case of circulatory disorders in the foot or lower leg, you can try to reduce the displacement of the bones by very gently pulling the foot along the longitudinal axis of the leg, slightly pressing the lower leg in the opposite direction to its displacement.

Ice or a cold compress can be applied to the damaged area.

If you suspect a dislocation of the patella, you can give the victim an anti-inflammatory drug. The victim must be taken to the clinic for an appointment with a specialist.

Therapy in a medical institution

Any medical procedures should be carried out and prescribed only by a medical specialist, since independent attempts to reduce the joint can worsen the condition and lead to fractures of the articular ends.

Conservative treatment for dislocation of the knee joint is carried out only in a hospital.

If necessary, a traumatologist performs a puncture of the knee joint, removing the accumulated exudate.

All manipulations are performed under local or general anesthesia. After repositioning the knee joint and returning it to its place, the joint is fixed using an immobilizer or a plaster cast, which ensure the immobility of the damaged limb.

The next stage of treatment includes a complex of therapeutic and medical procedures aimed at restoring the integrity of the ligaments.

In severe cases, if the injury is associated with ruptures of ligaments and tendons in the area of ​​the patella, surgery is performed. Minimally invasive surgery is performed using an arthroscope.

Exercise therapy is also a method

In the treatment of habitual dislocation, a course of therapeutic exercises (exercise therapy), wearing a side knee splint is prescribed. In severe cases, surgery is performed to stabilize the joint.

For the treatment of subluxation of the knee joint, conservative treatment methods are used.

Patients are prescribed a set of specially designed exercises that help strengthen muscle structures, ligaments of the knee joint and allow you to develop the correct technique of flexion-extensor movements.

During treatment, it is necessary to limit the mobility of the injured limb, to prevent overstrain, loads on the leg, to fix the limb while resting in a suspended state.

Patients are prescribed medication, taking symptomatic, analgesic, anti-inflammatory drugs.

Full recovery and return of all functions occurs in the third or fourth month after the end of treatment.

Recovery period

After the end of treatment, the rehabilitation period should be under the supervision of the attending physician. To restore muscle tone, they gradually begin to develop the damaged leg.

Prompt recovery and restoration of functions are facilitated by:

• massage;
• physiotherapy techniques;
• physiotherapy exercises;
• proper, balanced nutrition;
• intake of vitamin and mineral complexes.

Houses and walls help

At home, unconventional treatment methods will help speed up the healing process after a dislocation of the knee joint.

Simple and effective folk remedies:

1. Compresses, lotions based on medicinal herbs are applied to the place of dislocation.
2. A good effect is the use of a milk compress. To do this, a gauze bandage soaked in hot milk is applied to the damaged area for several minutes.
3. You can also apply onion gruel with the addition of sugar to the place of dislocation for five to six hours, in a ratio of 1/10.
4. You can prepare a gruel from two or three heads of garlic with the addition of apple cider vinegar, which is insisted for a week in the refrigerator before use.

Possible Complications

It is worth noting that a dislocation of the knee joint is a rather serious injury and its consequences can be very severe.

Incorrect treatment and inappropriate therapy can lead to a complete limitation of knee mobility, to the appearance of constant, aching, chronic pain.

Therefore, it is very important to immediately consult a doctor when the first symptoms and signs of this pathology appear, in no case self-medicate and strictly follow all the recommendations and instructions of a medical worker.

Preventive actions

It is worth noting that people who adhere to a correct, healthy lifestyle, regularly exercise, are less prone to knee dislocations.

Therefore, do not neglect physical activity, sports and aerobics.

Running, cycling, exercising in the gym, walking, swimming pool will help to strengthen the ligamentous apparatus of the knee, improve the tone of the muscle structures of the lower extremities.

As a rule, with timely diagnosis and proper treatment, the prognosis is favorable. But it must be borne in mind that if medical prescriptions are not followed during the rehabilitation period, pain may occur in the future.

It is very important to prevent re-injury to the patella or joint. After recovery, you need to wear comfortable, practical and high-quality shoes that contribute to the correct position of the foot while walking.

At first, it is worth minimizing the load on the injured limb, avoiding sudden movements, hypothermia.

If the dislocation of the knee has become chronic, which is accompanied by frequent, aching pain, it is likely that a surgical operation will be required.

How to Treat Schlatter's Disease of the Knee in Adolescents, Children and Adults

Schlatter's disease is a pathology that affects the upper part of the tibia, about 2 cm below the patella. This bone forms the basis of the lower leg. In its upper section there is a tuberosity, in the area of ​​\u200b\u200bwhich there is a zone of growth of the tibia. Schlatter's disease is osteochondropathy, it is accompanied by changes in the structure of bone and cartilage tissue.

• Causes of Schlatter's disease
• Disease pathogenesis
• Schlatter's disease in adolescents: causes, symptoms, photos
• Diagnosis of Schlatter's disease of the knee joint
• Treatment of Schlatter's disease with conservative methods
• Treatment with physiotherapy methods
• Features of treatment with surgical methods
• Possible Complications
• Prevention of pathology
• Disease prognosis
• How to choose a knee brace for Schlatter's disease?
• What is the code for Osgood-Schlatter disease according to ICD-10?
• Do they take to the army with Schlatter's disease

Most often, the disease occurs in adolescents involved in sports. It is characterized by pain, inflammation, and swelling below the knee. Osgood-Schlatter disease is not a serious disorder and responds well to treatment. Only sometimes it leads to calcification and excessive ossification of the focus of inflammation.

Causes of Schlatter's disease

Osgood-Schlatter disease is one of the common causes of knee pain in active teenagers who play a lot of sports. It most often occurs in boys. The most dangerous sports in this regard involve running or jumping. In this case, the quadriceps femoris muscle is involved, which is energetically reduced.

Less often, pathology appears for no apparent reason in children who are not involved in sports.

Some scientists believe that this disease has a genetic basis. It has been established that inheritance can be carried out according to an autosomal dominant type with incomplete penetrance. This means that the predisposition to it can be transmitted from parents to children. However, this pattern is not always revealed. Mechanical injury is considered the triggering factor of the disease.

Disease pathogenesis

The quadriceps muscle is designed to extend the leg at the knee. It is located on the thigh, with its lower part attached to the patella (patella), which in turn is connected to the upper part of the tibia, where the ossification zone has not yet closed in adolescents. Excessive contraction of a poorly stretched quadriceps femoris leads to excessive stress on the patellar ligaments.

The tibia in adolescents is not fully formed and continues to grow. She is not strong enough for such loads. Therefore, in the place where the ligaments are attached to it, inflammation and soreness occur. As a result of circulatory disorders, small hemorrhages appear. In more severe cases, there is a detachment of the upper epiphysis and aseptic (microbial-free) necrosis of the bone and cartilage areas. Periosteal detachment may occur.

The disease is characterized by a change in the periods of death of small areas of tissue and their recovery. The area of ​​necrosis is replaced by dense connective tissue. Gradually, at the site of a long-term injury, an overgrowth forms - a callus. Its value depends on the intensity and duration of the damaging effect. In the popliteal region, a thickened tuberosity is determined - a bump. It can be detected by probing the lower leg, and with a large size - during the examination.

Schlatter's disease in adolescents: causes, symptoms, photos

The disease occurs in boys aged 12-15 years, less often in girls aged 8-12 years. Sex differences in the prevalence of the disease are associated with the fact that active sports are usually preferred by boys. If a girl attends such classes, she is no less likely to develop pathology.

Dangerous sports that can lead to thigh muscle injuries and damage to the upper tibial epiphysis:

• football;
• gymnastics and acrobatics;
• volleyball;
• basketball;
• fencing;
• skiing;
• tennis;
• cycling;
• boxing and wrestling;
• ballroom dancing and ballet.

Initially, the disease is not accompanied by any complaints. In time, unrecognized pathology quickly becomes chronic. After a while, the main symptom appears - pain just below the kneecap. The intensity of discomfort changes over time. As a rule, it increases during exercise and immediately after it. Particularly severe pain appears when jumping, walking up stairs and squats, but subsides at rest. It does not spread to other parts of the limb. This symptom persists for several months. Sometimes it goes away only after the child's growth is completed. This means that some children have pain in their legs for 2 to 3 years.

The difference between the disease in childhood is a rather long asymptomatic course. Pain under the knee, either appearing or disappearing, should alert parents.

The disease can also appear in adults. In this case, it often causes a violation of the mobility of the knee joint and the development of arthrosis.

In the area under the kneecap, swelling of the tissues is noticeable. With pressure, local pain is determined here. During an exacerbation, local skin temperature rises. In advanced cases, bone growth becomes visible on the front surface of the leg under the knee.

The disease affects the epiphysis, located on the lower leg and under the kneecap. In an uncomplicated course, it does not affect movements in the knee joint, so that the range of motion in it is preserved. Symptoms often occur on one side, but in a third of cases, both knees are affected.

Diagnosis of Schlatter's disease of the knee joint

Recognition of the disease is based on a thorough physical (external) examination of the patient and the history of the pathology. If the diagnosis is clear after examining and questioning the patient, an additional examination may not be performed. However, doctors usually order a 2-view knee x-ray to rule out more serious causes of knee pain.

X-rays show damage to the periosteum and epiphysis of the tibia. In severe cases, it is fragmented. There is a characteristic x-ray sign in the form of a "proboscis". In the future, at the site of injury, tuberosity occurs - callus.

Thermography is a method for determining local temperature. During an exacerbation of the disease, a localized focus of temperature increase is visible on the thermogram, caused by an increase in blood flow in the area of ​​inflammation; it is absent in the remission phase.

In preparation for surgical treatment, the patient can undergo computed tomography of the knee joint and adjacent areas, which helps to clarify the size and location of the pathological tuberosity.

To exclude other injuries of the knee joint, in doubtful cases, an examination of the articular cavity is performed using a flexible optical device - arthroscopy. Endoscopic surgical treatment is used for intra-articular injuries of the knee; it is not used for Osgood's disease.

Data on concomitant injuries of the knee can also be obtained using ultrasound. Its advantage is non-invasiveness, painlessness and speed of execution.

Radioisotope scanning is used to identify the focus of pathology in doubtful cases. It allows you to visualize the site of inflammation in the bone tissue.

Severe knee pain that persists at rest, at night, or is accompanied by bone tenderness in other areas of the body, fever, damage to other organs requires a differential diagnosis with the following conditions:

• infectious or juvenile rheumatoid arthritis;
• osteomyelitis;
• tuberculosis or bone tumor;
• Perthes disease;
• patella fracture and other knee injuries;
• bursitis, synovitis, myositis.

Treatment of Schlatter's disease with conservative methods

The pain usually resolves within a few months without any treatment. When the disease worsens, it is necessary to take painkillers and anti-inflammatory drugs, such as paracetamol or ibuprofen. The introduction of glucocorticoids into the knee joint is not recommended.

To stimulate metabolic processes in the bone tissue, calcium preparations, vitamins D, E and group B are prescribed.

For acute post-workout pain, apply an ice pack below the knee for a few minutes. This will help you quickly get rid of discomfort.

To protect the patella during football and other dangerous sports, knee pads must be worn.

At home, doctors recommend using cold compresses, limiting physical activity on the affected leg, and doing daily exercises that increase the elasticity of the thigh muscles and patella ligaments. A massage is shown with anti-inflammatory and blood circulation-improving agents, for example, with troxerutin ointment.

Treatment with physiotherapy methods

To increase the elasticity of the thigh muscles, reduce inflammation, and prevent the formation of callus, physiotherapeutic methods are used:

1. Electrophoresis with painkillers (procaine), metabolic agents (nicotinic acid, calcium salts), hyaluronidase, cocarboxylase.
2. In mild cases, magnetic therapy is used. You can use home apparatus for physiotherapy, the action of which is based on the properties of the magnetic field.
3. Therapy with ultra-high frequency (UHF) waves.
4. Warming up the knee with infrared rays, ozocerite, paraffin compresses, therapeutic mud, warm baths with sea salt or mineral water.

Physiotherapy courses should be carried out regularly for a long time - up to six months. Under the influence of these methods, blood circulation in the affected area improves, swelling and inflammation are removed, normal bone regeneration is accelerated, callus growth and the development of arthrosis are prevented.

Features of treatment with surgical methods

Surgery in adolescents is usually not performed. It is performed later in life with persistent knee pain. The cause of this condition is the formed callus, which constantly injures the patella. The operation consists in opening the periosteum and removing excess bone tissue. Such an intervention is very effective and practically does not cause complications.

• within a month, use a knee brace or a bandage on the joint;
• to restore bone tissue, electrophoresis sessions with calcium salts are shown;
• oral calcium-based medication for 4 months;
• limiting the load on the joint for six months.

Possible Complications

With timely diagnosis and protection of the knee joint, the disease does not lead to serious consequences. However, it is impossible to predict the outcome of the disease in advance, so its prevention is important.

Prolonged trauma to the tibial tuberosity can lead to an upward displacement of the patella, which limits the functioning of the knee joint and leads to pain.

In rare cases, the joint begins to form incorrectly, its deformation is possible, the development of arthrosis. Arthrosis is degeneration of the articular cartilage. It leads to inability to bend the knee, pain when walking and other physical exertion, and impairs the patient's quality of life.

Prevention of pathology

It is possible to prevent the development of Schlatter's disease. If the child is involved in sports associated with an increased load on the thigh, he needs to thoroughly warm up before training, perform stretching exercises. It should be checked whether the coaches pay enough attention to physical preparation for the lesson.

Knee pads should be used during traumatic sports to prevent Schlatter's disease.

Disease prognosis

Sport or physical activity does not permanently damage the bone or impair its growth, but it does make the pain worse. If these sensations interfere with full-fledged activities, it is necessary to decide whether to refuse training or reduce their intensity, duration and frequency. This is especially true for running and jumping.

The pain can persist from several months to several years. Even after growth is completed, it can bother a person, for example, in a kneeling position. Adults with Schlatter's disease should avoid work that involves long walks.

In very rare cases, if the pain persists, surgical treatment is used. In most patients, the results of this intervention are very good.

How to choose a knee brace for Schlatter's disease?

A knee brace is a device that stabilizes the knee joint. It protects the athlete from damage to the knee joint and surrounding tissues.

To prevent the development of pathology, you should choose a soft knee brace. It provides easy fixation, prevents displacement of the patella, distributes the load more evenly, which helps to avoid microtrauma of the tibia. Such knee pads often have a massaging effect, warming up the tissues and increasing their elasticity.

In the postoperative period, a semi-rigid knee brace can be used. It is attached to the leg with straps or Velcro and provides good support for the joint. Rigid knee braces are generally not recommended for the prevention and treatment of Schlatter's disease.

When choosing a product, you need to pay attention to the material from which it is made. It is best to purchase a knee pad made of lycra or spandex. These materials not only fit the knee well and support the joint, but also allow air to pass through, preventing excessive skin moisture. An excellent choice is a product made of nylon. Nylon knee pads are more expensive than others, but they will last much longer.

The disadvantage of the cotton knee pad is its low strength. Neoprene products do not pass moisture and air well, and therefore their long-term use is not recommended. These models are designed for swimming.

If the child is engaged in gymnastics, acrobatics, dancing, sports models with thick pads will suit him. For volleyball training, it is better to choose a knee pad with gel inserts. These products take on an individual shape over time, they are very comfortable and perfectly protect the joint. For football, it is better to use durable knee pads with stitched pads.

Universal knee pads are characterized by a small thickness, they can be used when practicing any sport.

When choosing a product for a child, it is necessary to take into account its size. A sports doctor or orthopedist, as well as a consultant in a medical equipment or sporting goods store, can help with this. The size is determined by the circumference of the knee joint. Thigh and calf circumferences may be needed.

Before buying a knee pad, you need to try it on. It is better to purchase a product a little larger than necessary, and adjust its size with Velcro. This will facilitate the use of the product in case of inflammation or joint injury. The knee pad should not constrict the limb and interfere with movement, it should be light and comfortable.

These devices should not be used for inflammation of the veins of the limb, dermatitis and other skin diseases in the knee area, acute arthritis, individual intolerance to the material used.

What is the code for Osgood-Schlatter disease according to ICD-10?

Osgood-Schlatter disease is an osteochondropathy. According to the international classification of diseases of the 10th revision, it corresponds to the code M92.5 - juvenile osteochondrosis of the tibia. Differences in terminology are explained by the traditionally different classification of bone and joint lesions in domestic and foreign medical practice.

Previously, osteochondrosis was called a large group of lesions of bones and joints. Later, osteochondropathy was isolated from it - processes accompanied by primary damage and aseptic necrosis of bone tissue. The term "osteochondrosis" began to be used to refer to a pathology that primarily affects the cartilage and leads to its thinning.

Therefore, Schlatter's disease is classified as osteochondropathy. However, this is not taken into account in the latest ICD, and the disease is called "osteochondrosis".

Do they take to the army with Schlatter's disease

Osgood-Schlatter's disease may be grounds for exemption from military service only if it is accompanied by a functional impairment of the knee joint. Simply put, if the disease was diagnosed in adolescence, but the knee is fully flexed and extended, the young person is more likely to be called into service.

If there is a limitation of mobility in the joint, constant pain, the inability to run normally, jump, squat, then, according to the result of the orthopedist's opinion, the young man is released from the draft.

If there is Schlatter's disease, and the growth of the tibia has not yet completed (this is determined by x-rays), a deferment from the draft for six months is usually granted with a second re-examination.

In general, it can be said that if the disease does not interfere with the activity of a person, it does not serve as a basis for a delay. The degree of functional disorders is determined by the orthopedist, who gives the appropriate conclusion for the draft board.

Osgood-Schlatter disease is a disease that affects the upper part of the tibia of the lower leg in the area where the patellar ligament is attached to it. Its cause is the constant overload of the knee joint during sports, mainly in adolescents. The disease may not be accompanied by complaints or be manifested by pain, swelling, inflammation of the tissues under the kneecap. In the future, a callus is formed at the site of the injury, which can disrupt the function of the joint.

Treatment consists of limiting the load, the use of patellas, cold, anti-inflammatory drugs and physiotherapy. In severe cases, surgery is performed to remove the bone growth. An important role in prevention is the preparation for playing sports, including stretching the thigh muscles.

Schlatter's illness serves as a basis for deferment or exemption from conscription in that case. If it is accompanied by complaints and objectively worsens the mobility of the knee joint. The degree of functional impairment is determined by the orthopedic surgeon.

Balloting is a fluctuation of a dense formation (organ, tumor, etc.), determined by its. It is found especially noticeable if there is a liquid next to the investigated mobile formation or around it. A distinct ballot of a mobile tumor of the abdominal cavity (coming, for example, from a large one) indicates a developed one. Less noticeable is the increased balloting; it is manifested by the fact that the push with one hand from the front is transmitted to the other hand, placed under the lower back, and vice versa.

The most important is the symptom of balloting the patella - a symptom of a floating patella, as it is found with the smallest accumulation of fluid (effusion, blood) in. During the study, the patient lies on his back with a straightened knee, the examiner puts the ends of the fingers of his right hand on the patella (Fig.) and tries to immerse it deep (“drown”), which normally fails. With the accumulation of fluid in the joint, the patella "sinks" - goes into the depths until it rests on the surface, and when the pressure stops, it "floats" as if pushed out by a spring. To detect balloting of the patella with scanty effusion, it is necessary to squeeze the area of ​​​​the upper inversion of the knee joint with the left hand and thereby force out the fluid from it under the patella.

Balloting (from the French balloter - to oscillate, to swing) is a phenomenon of vibration or displacement of a dense body or organ (with its return to its original position) in one of the body cavities. Balloting is especially pronounced when the dense body (organ) is in a liquid medium. Balloting gives you the feeling of pushing back.

Balloting is caused by short, jerky blows of the tips of bent fingers on a dense body through the wall of the cavity. In some cases, the balloting of organs is determined by their probing. Balloting is an important diagnostic sign, it often indicates the accumulation of fluid in the cavity.

In the abdominal cavity, in the presence of fluid, balloting of mobile tumors emanating from the greater omentum, mesentery of the intestines and ovaries can be caused. With tumors of the kidney, balloting can be caused by short blows of the hand on the corresponding side of the lumbar region and is determined by the other hand placed on the same half of the abdomen (right or left). With effusion or hemorrhage in the cavity of the knee joint, balloting of the patella is observed; with a large effusion, it may be accompanied by a well-audible knock from the impact of the kneecap on the articular ends of the bones (“patella natans” - a floating patella). With a small effusion, a ballot of the patella can be detected by squeezing the upper inversion of the knee joint with the other hand to force fluid out of it.