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group_5_presentation_3_-_acl_injuries [2016/11/24 14:41] jogendm |
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| ====== Symptoms ====== | ====== Symptoms ====== | ||
| - | MS symptoms vary from person to person (Multiple Sclerosis Clinical Presentation, 2016). | + | Symptoms of a severe and acute ACL injury include: |
| - | MS Symptoms include: | + | • Feeling or hearing a "pop" in the knee at the time of injury. |
| - | * Sensory loss | + | • Sudden instability in the knee. This may happen after a jump or change in direction or after a direct blow to the side of the knee. |
| - | * Walking difficulty | + | |
| - | * Spasticity | + | |
| - | * Bladder, bowel, and sexual dysfunction | + | |
| - | * Tremors | + | |
| - | * Optic neuritis | + | |
| - | * Heat intolerance | + | |
| - | * Fatigue | + | |
| - | * Pain | + | |
| - | * Cognitive difficulties | + | |
| - | * Constipation | + | |
| - | <HTML> | + | • Pain on the outside and back of the knee. |
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| - | ====== Diagnosis ====== | + | • Knee swelling within the first few hours of the injury. This may be a sign of bleeding inside the joint. Swelling that occurs suddenly is usually a sign of a serious knee injury. |
| - | <style float-right> | + | • Limited knee movement because of swelling and/or pain. |
| - | {{:ms-mri_t1_535x314-01.jpg|}} | + | |
| - | **Figure 1**: A T1-weighted MRI demonstrating permanent lesions in a MS patient. The dark spots | + | Following an acute injury, the patient will almost always have to stop whatever activity they are doing, however, they may still be able to walk. |
| - | in the scan are the lesions. (Source: Spinms, 2016) | + | If the ACL injury is chronic (long-lasting and recurrent), the knee buckles or gives out, sometimes with pain and swelling. This occurs more frequently over time. It is important to note that not everyone with an ACL injury develops a chronic ACL deficiency. |
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| + | ====== Diagnosis ====== | ||
| - | <style justify> | + | For the clinical examination of a suspected ACL injury, the pivot-shift test, anterior drawer test and Lachman test are used. |
| - | The diagnosis of Multiple Sclerosis (MS) can be detected through MRI, lumbar puncture and electroencephalography. MS is difficult to diagnose due to the multiple symptoms associated with the disease, which can vary from person to person. Magnetic resonance imaging (MRI) can be used to reveal areas of lesions. However, MRI has disadvantages as it lacks specificity and many conditions have similar conditions of MS and as a result many false positives occur. It has been determined that 90% of MS patients will display an abnormal MRI scan and thus MRI should be the first diagnostic tool to be used. However, 5% of individuals show no sign of lesions in the brain while using MRI (Rolak, 2003). | + | |
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| - | When there are abnormalities in the cerebrospinal fluid, it can be used to diagnose MS. In the Cerebral spinal fluid (CSF), the white blood cell and spinal fluid proteins are slightly elevated. An elevated Immunoglobin G level in CSF is the most significant in detecting MS. The Immunoglobin G reflects an autoimmune activation and appears as oligoclonal bands on the electrophoresis performed on the CSF. Oligoclonal bands indicate the presence of immunoglobins, which indicate inflammation in the central nervous system. The oligoclonal bands vary from MS patient, but 90% of MS patients present these bands. A limitation to this method is other diseases produce these bands as well and can lead to misdiagnosis. To obtain the CSF it requires undergoing lumbar puncture, which many patients are unsure of doing (Rolak, 2003). | + | |
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| - | Another method that could be used is evoked potential, which is used to measure conduction rates in the CNS pathway though the recording of electroencephalographic response to sensory stimulation. Slow conduction rates indicate inflammation and demyelination, presenting an MS lesion (Rolak, 2003). | + | |
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| - | **Prognosis and progression** | + | |
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| - | There are four different patterns of MS, | + | |
| - | * Clinically Isolated Syndrome (CIS) | + | The Lachman test is known by most authorities as the most reliable and sensitive test, and usually a better alternative to the anterior drawer test. The ACL can also be detected using a magnetic resonance imaging scan (MRI scan). |
| - | * Relapsing and remitting (RRMS) | + | |
| - | * Secondary progressive (SPMS) | + | |
| - | * Primary progressive (PPMS) | + | |
| - | Clinically Isolated Syndrome refers to a first episode where there is inflammatory demyelination in the CNS. It is not yet considered MS, but could become MS if further activity occurs. In the relapse and remitting stage this indicates good health followed by an immediate change in symptoms. Secondary progressive MS occurs after the relapse and remitting stage. At this point there are more symptoms that are progressively getting worse. Primary progressive MS is the steady development of symptoms that will eventually become worse as the diseases progresses. RRMS, SPMS, and PPMS can be active or not active depending on if there is evidence of relapse or disease activity present (Hedley, 2012). | + | Even though clinical examination if done by a professional can be accurate, the diagnosis is usually confirmed by MRI scan, which has significantly narrowed the need for diagnostic arthroscopy and which has a greater accuracy than clinical examination. It may also show a graphic of other structures which may have been involved in the injury, such as a meniscus, or collateral ligament, or posterolateral corner of the knee joint. |
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