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Medical Testing, Doctors, And “X-Ray Vision”

Boston Celtics basketball player Kendrick Perkins injured his knee during the NBA Finals against the Lakers when he landed awkwardly. Unable to weightbear, he left Game 6 not to return for the following pivotal Game 7.

Based on his mechanism of injury and his physical examination, his trainer reported that he tore his medial collateral ligament (MCL) as well as the posterior cruciate ligament (PCL). More amazingly, this was done without the help of a MRI. Since Perkins was unable to play the final game, there was no urgent medical need to expedite the test, as regardless of the result his season was already done.

How do doctors know what’s wrong without X-ray vision or an imaging test? (Note that Perkins did get a X-ray, but X-rays generally don’t show ligament injuries.) Is it guessing? Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Ski Season, Knee Injuries, And Posterior Cruciate Ligament Tears

We’re in ski season and so a few unfortunate individuals will suffer few knee injuries. A while back, a reader asked me to describe an uncommon injury, which is a torn posterior cruciate ligament (PCL).

This injury usually occurs during a fall. As you can see from the drawing, the PCL keeps the lower leg bone (tibia) from moving too far back in relation to the upper leg bone (femur). If a sudden unnatural force is applied, usually a direct blow to the front of the lower leg near the knee while the knee is bent, the tibia is jammed backwards and the PCL may be torn. In the skiing situation, this usually happens during a fall and a tumble, when someone strikes an immovable object, or when the knee is bent or “twisted” and struck forcefully from the side.

The immediate sensation is pain, and there may be a feeling of instability to the knee, particularly when trying to walk or change levels (e.g., walk over the snowpack or on stairs). When the injury occurs, there usually is not the “pop” sensation noted with an anterior cruciate ligament tear. However, the knee will almost always swell, because there is bleeding into the knee joint and/or soft tissue swelling. Read more »

This post, Ski Season, Knee Injuries, And Posterior Cruciate Ligament Tears, was originally published on by Paul Auerbach, M.D..

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