[ 會員#20306 ] CHAU CHUN SING
正確的治療方法?
病患者男 - 34歲
CLINICAL HISTORY:
Injury left knee.
Sensation of click.
Lateral + medial tenderness.
MRI Report
FINDINGS:
the knee alignment is normal, there is moderate joint effusion with superior plica.
no popliteal cyst is noted. increased signal seen in the infra-patellar fat pad due to synovitis. some fluid is seen between the inferior patellar tendon and anterior tibial tubercle due to deep bursitis.
there is soft tissue swelling seen medially and involves the medial collateral ligament and is compatible with a grade 1 sprain.
increased signal along the ilio-tibial tract and also between the ilio-tibial tract and lateral femoral condyle compatible with ilio-tibial band syndrome.
there is abnormal signal without thinning of the mid facet patellar articular cartilage.this is due to grade I chondromalacia.
there is no abnormal signal on T2 FS images in the femur, tibia and fibula to suggest fracture or bone oedema / bruises.
on T2* and PD images, there is no abnormal meniscal signal.
The anterior and posterior cruciate ligmaents outline normally. The fibres are well visualized especially on T2 FS images. No evidence of discontinuity. No tear is detected.
there is no abnormality detected in the lateral collateral ligaments. No soft tissue swelling or oedema is seen. No tear is detected.
the patella is normal in position. there is no dislocation. the quadriceps and the inferior patellar tendon are unnremarkable.
COMMENT:
1. moderate joint effusion with superior plica.
2. Sprain MCL.
3. Ilio-tibial band syndrome.
4. Chondromalacia.
本人想提問醫生正確的治療方法? 謝謝。
CLINICAL HISTORY:
Injury left knee.
Sensation of click.
Lateral + medial tenderness.
MRI Report
FINDINGS:
the knee alignment is normal, there is moderate joint effusion with superior plica.
no popliteal cyst is noted. increased signal seen in the infra-patellar fat pad due to synovitis. some fluid is seen between the inferior patellar tendon and anterior tibial tubercle due to deep bursitis.
there is soft tissue swelling seen medially and involves the medial collateral ligament and is compatible with a grade 1 sprain.
increased signal along the ilio-tibial tract and also between the ilio-tibial tract and lateral femoral condyle compatible with ilio-tibial band syndrome.
there is abnormal signal without thinning of the mid facet patellar articular cartilage.this is due to grade I chondromalacia.
there is no abnormal signal on T2 FS images in the femur, tibia and fibula to suggest fracture or bone oedema / bruises.
on T2* and PD images, there is no abnormal meniscal signal.
The anterior and posterior cruciate ligmaents outline normally. The fibres are well visualized especially on T2 FS images. No evidence of discontinuity. No tear is detected.
there is no abnormality detected in the lateral collateral ligaments. No soft tissue swelling or oedema is seen. No tear is detected.
the patella is normal in position. there is no dislocation. the quadriceps and the inferior patellar tendon are unnremarkable.
COMMENT:
1. moderate joint effusion with superior plica.
2. Sprain MCL.
3. Ilio-tibial band syndrome.
4. Chondromalacia.
本人想提問醫生正確的治療方法? 謝謝。
陳禮樂醫生回覆: [ 9/19/2018 ]
您好，多謝讀者你的來信。
膝關節皺褶（Knee joint plica syndrome）病變好發於長跑、自行車、階梯運動等這些必須重複彎曲-伸直膝蓋的運動員，但也常於交通事故的患者身上發現。膝關節皺褶病變起因於長期與關節軟骨相互摩擦，引起炎性反應（滑液囊發炎、膝關節腫脹），影響到關節功能性表現；長時間炎症無法解除會造成皺褶纖維化及增厚，甚至導致關節軟骨之磨損與退化。臨床理學檢查可發現膝關節有局部性的壓痛，膝關節彎曲時，會感覺到有喀喀聲響出現。另外，將髕骨推往外側時，會因為內側皺褶的張力變大，而誘發出更明顯的症狀。對於膝關節皺褶（Knee joint plica syndrome）處理原則：
（1）急性發作遵循PRICE運動傷害處理原則，應適當休息。
（2）炎症反應藉由保守療法即可得好良好的控制（超音波治療、手法治療）。
（3）運動的熱身/收操應加強膝關節周邊肌群的伸展運動。
（4）情況無法改善應考慮關節鏡手術的必要性。
祝生活愉快
膝關節皺褶（Knee joint plica syndrome）病變好發於長跑、自行車、階梯運動等這些必須重複彎曲-伸直膝蓋的運動員，但也常於交通事故的患者身上發現。膝關節皺褶病變起因於長期與關節軟骨相互摩擦，引起炎性反應（滑液囊發炎、膝關節腫脹），影響到關節功能性表現；長時間炎症無法解除會造成皺褶纖維化及增厚，甚至導致關節軟骨之磨損與退化。臨床理學檢查可發現膝關節有局部性的壓痛，膝關節彎曲時，會感覺到有喀喀聲響出現。另外，將髕骨推往外側時，會因為內側皺褶的張力變大，而誘發出更明顯的症狀。對於膝關節皺褶（Knee joint plica syndrome）處理原則：
（1）急性發作遵循PRICE運動傷害處理原則，應適當休息。
（2）炎症反應藉由保守療法即可得好良好的控制（超音波治療、手法治療）。
（3）運動的熱身/收操應加強膝關節周邊肌群的伸展運動。
（4）情況無法改善應考慮關節鏡手術的必要性。
祝生活愉快
以上資料只供參考，不能作診症用途，
請與家庭醫生查詢並作出適合治療。
如有身體不適請即求診，切勿延誤治療。
若資料有所漏誤，本網及相關資料提供者恕不負責。
請與家庭醫生查詢並作出適合治療。
如有身體不適請即求診，切勿延誤治療。
若資料有所漏誤，本網及相關資料提供者恕不負責。
其他陳禮樂醫生醫務信箱回覆James : 膝關節問題
病患者男 - 27歲 打籃球後一屈 間中啪啪聲，但沒痛 想問醫生，我朋友打開籃球，可能落地不好，之.......stellang : 頸椎寰樞椎錯位
病患者女 - 25-30歲 看了中醫骨科説我是寰樞關節錯位,有頭暈(行路不穩飄浮的感覺),兩側頭痛,手痺.......Louis Leung : 蹲下時膝蓋痛
病患者男 - 25歲 最近１－２個月覺得蹲下到盡的時候（就腿摺合到最盡的時候），右邊膝蓋關節有疼的感覺。.......Ms Lai : 腰痛和腳痛和腳麻痺巳經三個月
媽媽70歲，腰痛和腳痛和腳麻痺巳經三個月，去照x光，話肚位條骨向前，現在睇緊中醫，用電、用機推、吊腳定位、吃藥.......Amy : 長期用有藥性鎮痛貼
病患者女 - 30歲 家人因肩頸痛，常貼鎮痛貼。有朋友提醒所用的止痛貼有flurbiprofen，不宜長.......johnlmiko : 跑步後滕蓋受傷
病患者男 - 26歲 2017年11月過量跑步引致jumper's knee, 兩隻腳都有，2017年1.......Laikm : 會陰神經疼痛症
本人51歲有踩單車運動、但因會陰痛連坐都不能久坐、請問醫要看那一專科才對.......Rosalina : 膝蓋位置附近拉得緊崩及有點痛
病患者女 - 55歲 我右腳最近不知為何,有點不舒服,記憶中沒扭傷,沒撞擊,,站在地上,右腳沒法站直,膝.......Li Siu Ling : 腰痛大腿後側麻痺
病患者男 - 63歲 醫生，你好！我先生兩年多前在外地工作，宿舍和辦公室都沒有電梯，每天都要上下樓梯。一年半.......annlee : 葡萄胺
病患者女 - 50歲 本人現時每日服食血清素fluoxetine一粒20個mg 最近膝頭哥痛腳趾頭有些....... 發出提問使用細則
致陳禮樂醫生 提問
即時提問 ?
