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Pain in the hips and knees is common, and affects patients of all ages and occupations. Knee pain itself accounts for 30% of all musculoskeletal problems seen in the primary care setting.1 This chapter describes causes of pain to these joints in the adult population, reviewing the important points of the history and physical examination. Although major traumatic disorders are covered elsewhere in this textbook, almost all discomfort in these areas is related to the minor trauma that occurs from activities of daily living, including gardening, exercising, competing, or simply climbing stairs. Athletes, especially ballet dancers, soccer and football players, jumpers, and runners, are particularly prone to injury of the hip, where these activities transmit three to five times the body weight to the joint.

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The hip joint is comprised of the femoral head, which articulates with the acetabulum. It is best described as a spheroidal, or ball and socket joint (enarthrosis), which allows rotation in 360 degrees. The hip is similar to the shoulder in its significant range of motion, but, unlike the shoulder, the hip does not sacrifice stability to achieve this. The bones are reinforced by the fibrocartilaginous labrum rimming the acetabulum, a joint capsule, overlying ligaments, and numerous muscles.

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The knee is the largest synovial joint in the body, and the most complicated in structure. The joint is comprised of two separate articulating groups, the tibiofemoral and patellofemoral joints. The head of the fibula is attached to the tibia by ligaments, and ligamentous injury is another potential source for injury and pain. The joint is completed by a capsule, musculature, and surrounding ligaments. The patella is attached by the quadriceps tendon superiorly to the femur, and inferiorly by the patellar tendon to the tibia. The knee is stabilized interiorly by the anterior and posterior cruciate ligaments, and externally by the medial and lateral collateral ligaments. The medial and lateral menisci sit between the femoral and tibial condyles and act to reduce shocks between these bony surfaces (Figures 278-1 and 278-2).

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Figure 278-1.
Graphic Jump Location

Anterior view of the knee. (Reproduced with permission from Simon RR, Sherman SC, Koenigsknecht SJ: Emergency Orthopedics, The Extremities, 5th ed. © 2007, McGraw-Hill Inc., New York.)

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Figure 278-2.
Graphic Jump Location

Medial view of the knee. (Reproduced with permission from Simon RR, Sherman SC, Koenigsknecht SJ: Emergency Orthopedics, The Extremities, 5th ed. © 2007, McGraw-Hill Inc., New York.)

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The femoral and sciatic nerves are the major nerves within the thigh. The femoral nerve is the largest branch of the lumbar plexus, and the sciatic is the longest nerve on the body, traveling posteriorly and supplying sensation to the hip joint through its articular branches. The femoral and obturator nerves also innervate the hip. The femoral nerve divides into anterior ...

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