Single leg half squat pain
Introduction
Introduction Single leg and half aching is one of the main symptom diagnoses of patellofemoral articular cartilage injury. Articular cartilage damage is very common in sports injuries, but it is difficult to diagnose, especially early diagnosis is almost impossible in routine examinations, so it is often ignored and not treated in time. However, no matter what kind of cartilage damage, it may eventually lead to degeneration and necrosis of chondrocytes, and left permanent damage, so it has attracted attention in recent years. Any mechanism that affects the normal secretion of the synovial membrane or the articular cartilage extrusion mechanism, which hinders the normal movement of the joint, can cause damage to the articular cartilage.
Cause
Cause
(1) Causes of the disease
Any mechanism that affects the normal secretion of the synovial membrane or the articular cartilage extrusion mechanism, which hinders the normal movement of the joint, can cause damage to the articular cartilage.
(two) pathogenesis
1. Acute or chronic trauma: It may directly hit the cartilage and destroy the collagen fiber mesh arch structure in the cartilage. It can also directly cause tangential fracture of cartilage. Chrisman has studied the relationship between trauma and tibial rickets in a biochemical perspective for many years. He found that within 2 hours after cartilage injury, the concentration of free arachidonic acid in cartilage can be increased by 4 times. Arachidonic acid is the main component of the phospholipid membrane. The prostaglandin precursor, its product is converted into prostaglandin E2, stimulates the AMP cycle, releases the tissue protein kinase, destroys the chondroitin sulfate-protein-binding chain in the cartilage matrix, and makes the cartilage matrix. Lost, causing cartilage to soften. Metabolites enter the synovial fluid to cause synovial inflammatory reaction, which in turn stimulates the synovial membrane to release a large amount of enzymes, further destroying the cartilage and causing a vicious circle.
2. Strain of the patellofemoral joint: long-term abnormal friction and compression of the tibial cartilage, especially in the knee flexion position, repeated lifting, jumping, weight, and torsion can cause excessive stress between the tibiofemoral Or the uneven distribution of stress causes the tibial cartilage to be easily damaged and suffer from tibial rickets.
3. patellofemoral joint instability: common unstable factors such as high or low tibia, knee Q angle abnormality, humeral tilt, humeral torsion deformity, humerus or femoral condyle dysplasia, due to abnormal position of the humerus or abnormal line alignment, or The contact surface between the patellofemoral and the abnormal contact stress cause the tibial rickets. Many scholars have done a lot of work on the stress distribution and stress test of the patellofemoral joints. There are high contact pressure theory, low contact pressure theory, pressure division unevenness theory and sacral bone internal pressure increase theory, etc., all have experimental support. However, whether the pressure is too high, the pressure is insufficient, or the pressure is not uniform, as long as the pressure exceeds or does not reach the normal range of the tibial cartilage, it may cause cartilage degeneration.
Examine
an examination
Related inspection
Bone and joint MRI examination arthroscopy
1. General Symptoms: The most common symptom is post-surgical pain, which occurs in active or semi-sacral position. It is initially acid-absorptive and later develops into persistent or progressive soreness. Often the pain is obvious at the beginning of the activity, the activity is relieved, and the pain is aggravated at the end of the activity or at rest. This pain is sometimes very distinctive and is often described as "caries and soreness." It is sore when going up and down the stairs, especially when going downstairs or downhill. There are often complaints about knees being soft and "slightly falling down." Sometimes there are joint interlocking symptoms.
2. Signs: In terms of physical signs, the main features are as follows:
(1) tibia grinding tenderness: mostly positive, the incidence rate is almost 100%.
(2) Pushing and resisting pain: It is also positive, pushing the tibia to the distal end, and the quadriceps contraction, and the soreness is positive under the armpit.
(3) One-legged semi-squat test: mostly positive, which is one of the most significant and diagnostic signs of tibial rickets. Qu Mianyu reported that the positive rate of this sign reached 100%, and Chen Shiyi reported more than 93%.
(4) quadriceps atrophy: more obvious, especially the medial head is more significant.
(5) Knee joint effusion sign: mostly positive in the middle and late stages, the floating sputum test can help diagnosis. When the amount of knee joint effusion is less than 30 ml, it can be detected by effusion induced bulging test. The joint puncture can extract a light yellow transparent liquid, and even the turbid joint fluid can be extracted.
(6) Periorbital tenderness: When the tibial chondrosis is accompanied by inflammation of the surrounding soft tissue, pain can be caused by scraping the periorbital with the index fingernail.
(7) This kind of sputum pronunciation is characterized by the fact that the knee joint moves to a certain fixed angle, and the repetition is repeated for a long time, which is caused by the friction of the rough and uneven cartilage. There are not many opportunities for pronunciation, but many authors believe that the rough pronunciation at a fixed angle after is meaningful for diagnosis.
Mainly based on the following characteristics:
1. Clinical features
When the patient is active, he complains of soreness after sputum, and the symptoms such as aggravation of pain when going upstairs or half a squat, combined with signs such as sacral tenderness, sputum sputum, single leg and half sputum pain, and periorbital tenderness can be roughly diagnosed as the disease. .
2. Imaging examination
(1) X-ray seeing: taking ordinary X-ray film does not make much sense for diagnosis. However, if you choose to take the axial position of the humerus at different knee angles, you can observe the shape of the tibia, the degree of hardening of the subchondral bone, and measure some indexes of the tibia, such as the humerus angle, the tibia depth index, the tibia index, the groove angle, the overlap angle, etc. . Lateral knee radiographs can detect abnormal position of the humerus. Normally, the length of the tibia (P) is equal to the length of the patellofemoral ligament (PT). When the PT exceeds 15% of P or exceeds 1 cm, it is a high tibia.
(2) MRI examination: exfoliation and ulceration of the tibial cartilage can be found.
3. The final diagnosis basis
Diagnosis depends on arthroscopy, surgical exploration or MR examination.
Diagnosis
Differential diagnosis
Differential diagnosis of single leg and half aching pain:
1, lower extremity radiation pain: lower extremity radiation pain symptoms: can be along the lower back, buttocks, the back of the thigh, the front of the calf or the posterolateral to the heel. The nature of pain is mainly radioactive sting. Radiation pain in the lower extremities can occur before low back pain or after the onset of low back pain. These two conditions vary from person to person.
2, squat difficulty: knee squat difficulty is a common manifestation of knee joint disease in the elderly, knee squat difficulty is essentially a chronic soft tissue disease, due to long-term congestion, edema, exudation, tissue Degeneration, necrosis, hyperplasia and hypertrophy, the tissue around the knee has a clear soft tissue change area. Through acupuncture and cutting, it can eliminate the adhesion of local soft tissue, relieve pain and promote the recovery of knee joint motor function.
