THE KNEE JOINT AND ITS COMMON DISEASE.

THE KNEE JOINT

THE ANATOMY OF THE KNEE JOINT

THE KNEE JOINT IS THE LARGEST JOINT IN THE HUMAN BODY.IT IS FORMED BY THREE PARTS:

1)THE LOWER END OF THE FEMUR.

             2)THE UPPER END OF TIBIA.

              3)THE PATELLA.

THUS, IT IS A COMPOUND JOINT. I.E, A JOINT, WHICH IS FORMED BY UNION OF MORE THAN ONE SINGLE JOINT.

HERE TWO COMPONENTS MAKE UP THIS JOINT.

1)   TIBIO-FEMORAL(UPPER END OF TIBIA AND LOWER END OF FEMUR) &

2) PATELLO-FEMORAL PART (A SURFACE END OF PATELLA AND LOWER END OF FEMUR).

BASICALLY, THE KNEE JOINT IS A MODIFIED TYPE OF HINGE JOINT.

HINGE JOINT IS A TYPE OF JOINT WHICH PERMITS MOVEMENT IN ONE DIRECTION ONLY, i.e FLEXION AND EXTENSION, JUST LIKE A HINGE OF A DOOR WHICH PERMITS ONLY OPENING AND CLOSING MOVEMENTS OF THE DOOR.

OTHER NAME FOR SUCH A JOINT IS GINGLYMUS JOINT.

HOWEVER, KNEE BEING A MODIFIED COMPOUND JOINT ALSO ALLOWS SLIGHT OUTWARD AND INWARD ROTATION ON THE AXIS APART FROM ITS MAIN FULL FLEXION AND EXTENSION ACTION

STRUCTURES RELATED TO KNEE JOINT

•     THE KNEE JOINT CONTAINS NUMEROUS TYPES OF ATTATCHMENTS CONSISTING OF VARIOUS MUSCLES, LIGAMENTS, & CARTILAGES(MENISCUS AND  ARTICULAR CARTILAGE) . WHICH HAVE THEIR OWN RESPECTIVE FUNCTIONS.

                                                          MUSCLES OF THE KNEE JOINT.

1) ARTICULARIS GENUS:

•     ORIGIN:ANTERIOR DISTAL END OF TIBIAL SHAFT/ FRONT LOWER END OF TIBIA.

   •     INSERTION:ON THE SYNOVIAL MEMBRANE OF THE KNEE JOINT.

   •     ACTION: IT PULLS THE SUPRA-PATELLAR BURSA,.i.e. A FLUID FILLED BAG LIKE STRUCTURE (BURSA), LOCATED ABOVE THE PATELLA(KNEE CAP), DURING EXTENSION OF KNEE JOINT, TO PREVENT INJURY TO THE KNEE BY REDUCING FRICTION.

ARTICULARIS GENU MUSCLE

                 

         1)THE QUADRICPES

•     THIS MUSCLE HAS 4 MUSCLE HEADS AS THE NAME SUGGESTS(QUAD)

1.      RECTUS FEMORIS, COVERING THE FRONT OF THE THIGH.

2.   VASTUS LATERALIS: LOCATED ON OUTER THIGH.

3.   VASTUS MEDIALIS: INNER THIGH.

4.   VASTUS INTERMEDIUS: INFRONT OF THE THE THIGH BEHIND RECTUS FEMORIS.

        FUNCTION:STRONG EXTENSION OF THE KNEE.

        LIGAMENTS OF THE KNEES

          THE LIGAMENTS OF THE KNEE JOINT ARE CLASSIFIED BY THEIR LOCATION, USING THE SYNOVIAL CAPSULE OF THE KNEE AS A REFERENCE. THUS, THE TYPES OF LIGAMENTS OF THE KNEES CAN BE DIVIDED INTO TWO PARTS.

1.        INTRACAPSULAR LIGMENTS.(INSIDE THE SYNOVIAL CAPSULE)

2.      EXTRACAPSULAR LIGAMENTS.(OUTSIDE THE SYNOVIAL CAPSULE)

1). EXTRACAPSULAR LIGAMENTS:

•      MEDIAL COLLATERAL LIGAMENT(M.C.L).

•      FUNCTION:PREVENT EXCESSIVE OUTWARD/EXTERNAL ROTATION OF THE JOINT

•      LATERAL COLLATERAL LIGAMENT(L.C.L)

•      FUNCTION:PREVENT EXCESSIVE INWARDS/INTERNAL ROTATION OF THE JOINT

2). INTRACAPSULAR LIGAMENT:

•      ANTERIOR CRUCIATE LIGAMENT( A.C.L):

FUNCTION: PREVENTS OVERFLEXION OF THE KNEE.

•      POSTERIOR CRUCIATE LIGAMENT(L.C.):

FUNCTION: PREVENTS OVEREXTENSION OF THE KNEE.

BOTH THESE LIGAMENTS TOGETHER FORM AN ‘X’ (CROSS) LIKE ARRANGEMENT.HENCE, THEY ARE TERMED AS CRUCIATE.

                               

         LIGAMENTS OF THE KNEE JOINT

          THE SYNOVIAL CAPSULE

•      THIS IS A THIN LAYER OF FIBROUS TISSUE SURROUNDING THE KNEE JOINT. THE CAVITY FORMED IS KNOWN AS SYNOVIAL MEMBRANE WHICH BEARS SYNOVIAL FLUID.

•      THE MAIN FUNCTION OF THE SYNOVIAL CAPSULE IS TO PROTECT THE KNEE JOINT. THE SYNOVIAL MEMBRANE INSIDE THE CAPSULE  SECRETES THE SYNOVIAL FLUID IN THE SYNOVIAL CAVITY. THE SYNOVIAL FLUID INSIDE THE SYNOVIAL MEMBRANE, IS A FILTRATE OF PLASMA AND ALSO THE PROTEINS PRODUCED BY JOINT TISSUES. BASICALLY THE FLUID CONTAINS HYALURONAN(FIBROBLAST LIKE CELLS IN SYNOVIUM) AND LUBRICAN PROTEOGLYCANS(CHONDROCYTES OR CARTILAGE CELLS).

•      THIS SYNOVIAL FLUID ALSO CREATES A MEMBRANE WHICH IS ADSORBED ON THE CARTILAGE, WHICH WHEN EXPOSED TO MOVEMENT SQUEEZES OUT SYNOVIAL FLUID TO REDUCE THE DAMAGE TO THE CARTILAGE AND ALSO FACILITATE SMOOTH MOVEMENT.

•      THE SYNOVIAL FLUID HELPS IN REDUCTION OF FRICTION, SHOCK ABSORPTION AND PROVIDING NUTRITION TO THE JOINT.

COMMONEST PROBLEMS AFFECTING THE KNEES

•      KNEES BEING THE MOST WEIGHT BEARING PARTS, ARE CONTINUOUSLY SUBJECTED TO WEAR AND TEAR, HERE ARE THE COMMONEST PROBLEMS WHICH INVOLVE THE KNEE.

                      

  LIGAMENT INJURY/ SPORTS INJURY

•    SPRAINS

•      M.C.L AND L.CL. SPRAIN ARE THE COMMONEST INJURY, SPECIALLY IN ATHLETES. IT CAN OCCUR DUE TO A SUDDEN OUTWARD THRUST(L.C.L INJURY), OR SUDDEN INWARD THRUST(M.C.L INJURY) OR MISSTEP

•       

•      SYMPTOMS:

•      DEPENDING UPON THE LIGAMENT INVLOVED.

•      L.C.L SPRAIN:PAIN IN THE OUTER/LATERAL PART OF THE KNEE, WITH OR WITHOUT TENDERNESS. PAIN SPECIALLY FELT OF TURNING THE FOOT OUTWARD.

         M.C.L SPRAIN: PAIN IN THE INNER/MEDIAL PART OF KNEE, WITH OR WITHOUT TENDERNESS. PAIN SPECIALLY FELT OF TURNING THE FOOT INWARDS

·      A.C.L & P.C.L INJURY: ANTERIOR CRUCIATE LIGAMENT AND POSTERIOR CRUCIATE LIGAMENT INJURY AND SPRAIN ARE ALSO VERY COMMON. COMMONLY FOUND IN ATHLETES, THIS SPRAIN IS CAUSED BY SIDDEN OVEREXTENSION(P.C.L SPRAIN) OR SUDDEN OVER FLEXION (A.C.L SPRAIN).

        SYMPTOMS INCLUDE:

          EXCRUCIATING PAIN INSIDE THE HOLLOW OF THE KNEE TO AN EXTENT THAT PREVENTS MOVEMENT. SWELLING AND TENDERNESS             OF THE KNEE.          WITH SENSE OF IMPROPER ARTICULATION/GIVE IN SENSATION, MADE WORSE BY WALKING.

          MANY A TIMES, IF THE BLOW IS SEVERE ENOUGH, IT CAN LEAD TO TOTAL DAMAGE TO THE LIGAMENTS WITHIN, LEADING TO LIGAMENTAL TEAR. MOST COMMON LIGAMENTAL TEARS INVOLVE ANTERIOR CRUCIATE LIGAMENT TEAR AND POSTERIOR CRUCIATE LIGAMENT TEAR.

          IF THE BLOW IS SEVERE ENOUGH IT CAN CAUSE A.C.L OR P.C.L OR SOMETIMES COMBINED BUCKLING OF BOTH TOGETHER.

      OSTEOARTHRITIS OF THE KNEE

•      BY FAR THE MOST COMMONEST DISEASE INVOLVING THE KNEE JOINT,

•    OSTEOARTHRITIS IS A DEGENERATIVE DISEASE OF THE JOINT. IN THIS CONDITION THERE IS A GRADUAL DEGRADATION OF THE CARTILAGE AND REDUCTION IN JOINT SPACE.ULTIMATELY THE ARTICULAR SURFACES GET EXPOSED AND FRICTION BETWEEN THE TWO SURFACES LEAD TO PRODUCTION OF CALCIUM SPIKES KNOWN AS ‘OSTEOPHYTIC SPURS’.

•     CAUSES AND RISK FACTORS OF OA

•      PRIMARY: WHERE NO SPECIFIC CAUSE IS FOUND, AND FAMILIAL TENDENCY AND AGE FACTORS INCREASE THE CHANCES OF DEVELOPING O.A., HOWEVER OBESITY AND FAMILIAL BACKGROUND INCREASE THE SUSCEPTIBILITY OF DEVELOPING IT.

•      OVEREXERTION LIKE LIFTING HEAVIER WEIGHTS, CONTINUOUS EXERTION LIKE STAIR CLIMBING AND WORKPLACE ETC.

•      SECONDARY CAUSES:

•      DIABETES MELLITUS.

•      HAEMOCHROMATOSIS AND WILSON DISEASE.

•      MARFANS SYNDROME.

•      JOINT INFECTION.

•      EHLER-DANLOS SYNDROME.

•      PERTH’S DISEASE.

•      AUTOIMMUNE DISEASE:RA AND GOUT.

•      SIGNS AND SYMPTOMS:

•      PAIN AND STIFFNESS ARE THE CHIEF COMPLAINTS IN PATIENTS SUFFERING FROM OA.

•      PAINS ARE MADE WORSE ON PRLONGED EXERTION AND IMPROVE BY REST.BUT LATER ON, AS THE DISEASE PROCEEDS WITH WORSENING PATHOLOGY AND JOINT SPACE GOES ON REDUCING, THE PERSON MAY EXPERIENCE SEVERE PAIN ON THE SLIGHTEST MOVEMENTS.

•      THE JOINT MAY PRODUCE A TYPICAL CRACKLING SOUND(CREPITUS) WHEN MOVED.

         CLASSIFICATION OF OA:

•      OSTEOARTHRITIS, IN GENERAL, CAN BE CLASSIFIED IN VARIOUS WAYS:

•      DEPENDING ON THE CAUSE:1)PRIMARY O.A.2) SECONDARY O.A.

•      WOMAC(Western Ontario and McMaster Universities Osteoarthritis Index):PAIN, STIFFNESS AND FUNCTIONAL LIMITATIONS.

•      Kellgren-Lawrence grading scale FOR OSTEOARTHRITIS OF KNEE DIAGNOSIS IS DONE BY 2D RADIO IMAGING.

      THE ROLE OF HOMOEOPATHY IN KNEE JOINT TROUBLES.

     HOMOEOPATHY IN KNEE TROUBLES, SPECIALLY OSTEO ARTHRITIS, NOT ONLY REDUCES PAIN, SWELLING AND RESTRICTED MOVEMENTS, BUT ALSO IMPROVES THE PATHOLOGY WITHIN.THEREBY COMPLETELY RESTORING THE PATIENT TO NORMAL.

            THOUGH A CONSTITUTIONAL APPROACH IS THE BEST IN RESTORING THE PATIENT SOME IMPORTANT REMEDIES ARE AS FOLLOWS.

1.        ARNICA

2.      BELLIS PER

3.      RHUS TOX

4.      CALCAREA CARB

5.      CALCAREA FLOUR

6.      CALCAREA PHOS

7.       RUTA G

8.      STONTIUM CARB

9.      NATRUM MUR

10.    LEDUM PAL AND MANY MORE….