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Why is glucose evaluated in the synovial fluid analysis? What are special tests used to differentiate type of Tendon tears in the knee ? Explain

Knee Injury

Case Studies

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A 15-year-old gymnast has noted knee pain that has become progressively worse during the

past several months of intensive training for a statewide meet. Her physical examination

indicated swelling in and around the left knee. She had some decreased range of motion and

a clicking sound on flexion of the knee. The knee was otherwise stable.

Studies Results

Routine laboratory values Within normal limits (WNL)

Long bone (femur, fibula, and tibia) X-ray No fracture

Arthrocentesis with synovial fluid analysis

Appearance Bloody (normal: clear and straw-colored)

Mucin clot Good (normal: good)

Fibrin clot Small (normal: none)

White blood cells (WBCs) <200 WBC/mm3 (normal: <200 WBC/mm3)

Neutrophils <25% (WNL)

Glucose 100 mg/dL (normal: within 10 mg/dL of serum

glucose level)

Magnetic resonance imaging (MRI) of the knee Blood in the joint space. Tear in the posterior

aspect of the medial meniscus. No cruciate

or other ligament tears

Arthroscopy Tear in posterior aspect of medial meniscus

Diagnostic Analysis

The radiographic studies of the long bones eliminated any possibility of fracture.

Arthrocentesis indicated a bloody effusion, which was probably a result of trauma. The fibrin

clot was further evidence of bleeding within the joint. Arthrography indicated a tear of the

medial meniscus of the knee, a common injury for gymnasts. Arthroscopy corroborated that

finding. Transarthroscopic medial meniscectomy was performed. Her postoperative course

was uneventful.

Critical Thinking Questions

1. One of the potential complications of arthroscopy is infection. What signs and symptoms of joint infection would you emphasize in your patient teaching?

2. Why is glucose evaluated in the synovial fluid analysis? 3. What are special tests used to differentiate type of Tendon tears in the knee ? Explain

how they are performed (Always on boards)

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