Clinical: Websites on knee pain and problems

Websites related to this week's Clinical Review, selected by Dr Keith Barnard.

THERAPEUTIC TAPE

I shamelessly plug this treatment for knee pain, because it is cheap, does not involve drugs and has virtually no side-effects apart from minor skin irritation. I know, because I've tried it myself, although the uninitiated should be taught the technique by a physiotherapist familiar with the method.

This paper demonstrates the efficacy of therapeutic taping of the knee in reducing pain, and, more importantly, tells you how it is done, complete with an illustration.

So, how does it work? Therapeutic tape (rigid strapping tape and hypoallergenic undertape) provides medial glide, medial tilt,and anteroposterior tilt to the patella. As inflamed soft tissue is aggravated by stretch, tape is also applied to unload the infrapatellar fat pad. The results are impressive, and benefit continues for some time after taping is discontinued.

Worth a try, especially in those intolerant of NSAIDS, because you can at least do no harm.

Why go there: more GPs should know about this.
Downside: none.
Information from: BMJ.
Address: http://bmj.
bmjjournals.com/cgi/reprint_ abr/327/7407/135

ACL REPAIR

This site is packed with goodies such as illustrations, arthroscopy views, animations and video clips about repairing the anterior cruciate ligament (ACL). It is not clear if this is intended for medical professionals or patients, but judging by the graphic nature of some of the images, a lay person might be put off surgery for life.

There is certainly enough information for GPs who want to know what goes on when an ACL repair is undertaken.

With the World Cup in full swing, there is an added advantage to being au fait with this particular sporting injury.

You just might get a spark of life from those sullen teenagers who sit there, normally offering only the odd grunt by way of communication. If some big soccer star damages their ACL (will make a change from a metatarsal), you will be the expert if you can discuss the finer points of their injury and its treatment.

Why go there: visually excellent and informative.
Downside: none.
Information from: The Center for Orthopaedics and Sports Medicine,
Georgia.
Address: www.arthroscopy. com/sp05018.htm

MRI SCANS

The remarkable detail of internal anatomy displayed by MRI scanning always makes interesting viewing. This collection of MRI scans is extensive, and the address given will take you to a series of five saggital section view of the knee. The images are all clearly labelled so that you can tell exactly what it is you are looking at.

There are also axial and coronal views, all with the anatomical features described. The quality of the images is excellent, and they can be enlarged or viewed as thumbnails. Not something you would apply in everyday practice, but will broaden your understanding of this essential investigation.

Why go there: see some interesting images.
Downside: little clinical information.
Information from: University of Kansas School of Medicine.
Address: http://classes.kumc.edu/som/ radanatomy/pages/image.asp?
F=7304&I=001&S=39

DIFFERENTIAL DIAGNOSIS OF KNEE PAIN

This PDF is well laid out and easy to read, although there is only one illustration, which is disappointing. I was particularly interested in the table that lists the differential diagnosis of knee pain by anatomical site.

Anterior knee pain in particular can be a difficult problem, especially in young, otherwise fit young people, and being certain of the nature of the underlying problem is essential. In these six pages everything is covered, from infants to old age.

Why go there: comprehensive.
Downside: some unfamiliar terminology.
Information from: University of Texas.
Address: www.aafp.org/afp /20030901/917.pdf

- Dr Barnard is a former GP in Fareham, Hampshire

WEBSITE OF THE WEEK

Who says the French never speak anything but their native tongue? This quite remarkable presentation is in excellent English, beautifully illustrated throughout, and covers all that a GP needs to know about the examination of the knee joint.

History, signs and symptoms, and examination of the standing, walking and supine patient are included, with coloured images to clarify the text.

All the familiar tests for patellar, meniscal and ligament function are described and illustrated. I can't recommend it enough.

Why go there: excellent.
Downside: none.
Information from: Department of Orthopaedic Surgery, Caluire, France.
Address: www.maitrise-orthop.com/
corpusmaitri/orthopaedic/mo56_knee_joint/knee_joint.shtml

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