AANA Lab Course 1001 - Foundations in Arthroscopy (Resident/Fellow)-Roundtables-James P. Leonard, M.D.

Roundtables-James P. Leonard, M.D.

Pdf Summary

This clinical document by Dr. James Leonard presents two patient cases involving musculoskeletal injuries and outlines examination findings, diagnoses, and treatment considerations.<br /><br />Case 1 involves a 25-year-old male with an acute right knee injury sustained during recreational basketball. The patient describes immediate pain, a popping sound, and inability to bear weight after awkwardly landing and twisting his knee. Urgent care evaluation included radiographs, immobilization, crutches, and MRI referral. Physical examination showed severe suprapatellar effusion, tenderness along the lateral joint line, limited active and passive range of motion, inability to perform a straight leg raise, and positive Lachman test indicating instability. Due to pain, McMurray’s test could not be assessed. The diagnosis is a right anterior cruciate ligament (ACL) tear combined with a peripheral lateral meniscus tear. The document outlines treatment recommendations involving surgical planning, diagnostic arthroscopy, repair of the meniscus and ACL, followed by specific postoperative care.<br /><br />Case 2 describes a 58-year-old right-hand dominant female with a six-month history of left shoulder pain without trauma. Symptoms began with discomfort when lying on the shoulder and nighttime pain, progressing to pain during reaching and overhead activities. Prior management included NSAIDs, a subacromial corticosteroid injection, and 12 weeks of physical therapy, with persistent symptoms. MRI findings suggested a rotator cuff tear, biceps tendinitis, and subacromial impingement. Examination revealed mild scapular protraction, tenderness over the bicipital groove and subacromial space, limited range of motion with pain, decreased strength in forward elevation and external rotation, and positive special tests (Empty can, Speed’s, Yergason’s, Neer, Hawkins, and scapular dyskinesia including crossover adduction). Treatment recommendations involve surgical planning, diagnostic arthroscopy, addressing the rotator cuff tear, biceps pathology, and impingement, followed by postoperative protocols.<br /><br />Overall, the document emphasizes thorough clinical evaluation, imaging, and tailored surgical intervention for complex knee and shoulder injuries to optimize patient outcomes.

Keywords

musculoskeletal injuries

anterior cruciate ligament tear

lateral meniscus tear

knee injury

rotator cuff tear

biceps tendinitis

subacromial impingement

diagnostic arthroscopy

postoperative care

physical therapy