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Re: Knee giving out and locking
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Re: Knee giving out and locking - March 10, 2005 1:05:00 AM
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JLS_PT_OCS
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From: USA
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If by "issue" you mean loose body then I agree.
:)
J
ps Alex, since I always knew your real name, can I still call you Army?
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Knee giving out and locking - March 10, 2005 1:10:00 AM
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Jeep
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The lateral view shows the tendon to have no calcific deposit, and that the loose body is in the joint. In light of the given history, and films submitted, I would consider this a Joint mouse.
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Re: Knee giving out and locking - March 10, 2005 3:54:00 AM
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tim
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From: Portland, OR
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CPPD mostly effects the meniscus but the lateral shows that the defect is a little superior to still be attached and inflicted w/CPPD......definitely loose. "No history of trauma" Hmmmmm.
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Re: Knee giving out and locking - March 10, 2005 6:06:00 AM
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chiroortho
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I'm tellin' ya...it's an osteochondral fragment.
That'll lock the knee.
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Greg Priest, DC, DABCO
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Re: Knee giving out and locking - March 10, 2005 7:23:00 AM
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Bournephysio
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I agree with the joint mice. You can clearly see a wisker on the AP and a prominent tail on the lateral. Lets hope it doesn't reach the foramen magnum. You'll never get it out.
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Re: Knee giving out and locking - March 10, 2005 10:27:00 AM
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JLS_PT_OCS
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When people say "joint mouse" they mean loose body or osteochondral fragment as Greg and I have called them?
Just want to make sure I understand it right...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Knee giving out and locking - March 11, 2005 4:33:00 AM
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Alex Brenner PT MPT OCS
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Tim,
When you say CPDD I assume you are talking about psuedogout or Calcium Pyrohosphate Deposition Disease. Can you tell us more about this?
Alex
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Alex Brenner, PT, MPT, OCS
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Re: Knee giving out and locking - March 11, 2005 6:39:00 AM
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chiroortho
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Joint mice can result from something called osteochondritis dissecans, whereas an osteochondral fragment can result from trauma/injury.
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Greg Priest, DC, DABCO
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Re: Knee giving out and locking - March 11, 2005 6:43:00 AM
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JLS_PT_OCS
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Greg, so a "joint mouse" would be the affected are of the OCD, or would be a loose body type of thing? We both know both OCD and an osteochondral lesion from trauma can produce those.
But does "joint mouse" equal loose body, or am I missing something?
Thanks.
CPPD is a worthwhile thing to know about, I just saw a patient with it the other day, very interesting.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Knee giving out and locking - March 11, 2005 10:11:00 AM
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tim
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First.....if you need to have undergone trauma to have an osteochondral fracture....why are we putting this at the top of the list?....the PT has no history of trauma (I know......they often omit what they deem insignificant trauma from their history)
A little bit about CPPD (more can be read about in Radiology books like Yochum and Rowe's 2 volume texts etc.)
Calcium pyrophosphate dihydrate is a crystal deposition disease and is referred (too oftenly) as pseudo-gout. This type of CPPD accounts for only 10-20% of the possible presentations (there are 7 documented clinical presentations). By far, the most commonc presentation is pseudo-osteoarthritis (30-60%). All of these presentations have one thing in common, chondrocalcinosis.....
There is a presentation called "asymptomatic" that includes just the chondrocalcinosis. Theoretically, if this occured at the meniscus (the knee is a common area for CPPD), it could create some internal derrangement, locking and catching. There are other diseases associated with chondrocalcinosis but not really indicated here without other clinical findings. Here's the catch......this patient is about 7 years too young to be within the lower end of the age range for this disorder (30-60 years old). Even though it may be high on the DDX list, the odds are on things like OD, and other disorders that may produce joint mice. In my head....joint mice is a sequella of an underlying disorder or trauma, not a diagnosis.....unless it's idiopathic. Hope I covered the important info on CPPD.....I reserve the right to be completely wrong with both my diagnosis of this case and the info in this post :)
I am....after all, just a lowly 4th year chiro student, although, as a massage therapist working with a PCP in Boulder, CO a few years ago, I saw this once and the guy had a similar presentation, although he was in his 40's
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Re: Knee giving out and locking - March 11, 2005 3:31:00 PM
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chiroortho
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The 'joint mouse' part is the loose body. I guess you could say joint mouse AKA loose body.
Sometimes when people experiencing knee locking from joint mice, they try to 'kick it out'. That's never a good idea, although it's very common to hear of people trying to kick out their locked knee.
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Greg Priest, DC, DABCO
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Re: Knee giving out and locking - March 12, 2005 8:35:00 AM
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fapt
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From: Taiwan, R.O.C.
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Hi, chiroortho
what is 'joint mouse' part ....
I don't understand
Thanks a lot...
Lin, MS PT Taiwan
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夏之日，冬之夜，百歲之後，歸于其居。
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Re: Knee giving out and locking - March 12, 2005 4:08:00 PM
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chiroortho
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Hi Lin,
The joint mouse is a little piece of bone or osteochondral tissue that 'scoots' around the joint because it's not directly attached to anything and doesn't belong there.
Kind of a silly term.
By the way, I'm not smart enough to figure out your signature, but all of the Chinese letters look cool. For all I know you're saying "chiroortho is a dummy and eats bad cheese".
_____________________________
Greg Priest, DC, DABCO
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Re: Knee giving out and locking - March 12, 2005 4:18:00 PM
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jma
Posts: 2356
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From: NY
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Would they use the term joint mouse in the clinical findings of the radiology report or just a loose body?
JMA
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Re: Knee giving out and locking - March 12, 2005 6:08:00 PM
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Synergy
Posts: 589
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I thought this was pretty funny! Why, probably because I've never seen this before and it appears as though it's an actual ICD-9 code.
[URL=http://icd9cm.chrisendres.com/index.php?action=child&recordid=6269]Joint Mice 718.1[/URL]
:)
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Chris Adams, PT, MPT
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Re: Knee giving out and locking - March 13, 2005 4:56:00 AM
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jma
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Now thats interesting. If it has its own code, then it can be used in the radiology report. Hmmm, thats a first for me.
JMA
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Re: Knee giving out and locking - March 13, 2005 5:31:00 PM
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Synergy
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Actually, I provided the wrong code! It says "Excludes knee"...oops! I suppose this is the correct one. ROFL! This knee code also includes the term "Rice Bodies". This is a bit odd and I'm sure I've never heard of this. Anyone else?
[URL=http://icd9cm.chrisendres.com/index.php?srchtype=diseases&srchtext=717.6&action=search]Joint Mice 717.6[/URL]
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Chris Adams, PT, MPT
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Re: Knee giving out and locking - March 14, 2005 12:46:00 AM
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Alex Brenner PT MPT OCS
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Radiologist report: 1 cm calcification is noted within the joint space on the AP and lateral
images. This is not visible on the sunrise view. A small calcification is also noted lateral to the lateral femoral condyle on the sunrise image.
IMPRESSION: Osteochondral fragment in the joint space.
[IMG]http://img.photobucket.com/albums/v85/brennerak/mouse.jpg[/IMG]
What would be the best follow on study to better evaluate the osteochondral fragment?
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Alex Brenner, PT, MPT, OCS
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Re: Knee giving out and locking - March 14, 2005 2:00:00 AM
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SJBird55
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From: Michigan
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Have a floating osteochondral trap inserted within the anterolateral joint capsule and anchored at the tibial tubercle with nondisolving sutures approximately 3" in length. The trap cannot be baited with typical external environmental bait because that sort of bait tends to reduce hydration which would be a potential hazard for the joint space. Instead, use some negatively charged component that will readily bind with the calcium... therefore the trap is not the traditional snapping trap, but instead a binding trap. Check the trap in 48 hours - if it's really an osteochondral fragment, it's guaranteed to be bound by that time.
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Re: Knee giving out and locking - March 14, 2005 4:13:00 AM
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chiroortho
Posts: 655
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SJ, LOL!
Captain Brenner, I might get jumped on here for saying this, but I'd just send the guy on to ortho surgeon for a scope. MRI would be useless IMO since the knee is atraumatic, and even though the MR could confirm the 'chondral' part of osteochondral fragment, that would be academic as far as I'm concerned and would only add 2 Large to the poor guy's bill.
_____________________________
Greg Priest, DC, DABCO
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