今回は膝関節の捻挫です。
膝関節を捻挫と聞くと内側半月板や前十字靭帯など大きい損傷を疑われることが多く、注意してエコー観察しなければならない症例です。
ただ、今回は半月板や靭帯の大きな損傷はありませんでしたが、内側側副靭帯に腫れと膝蓋上嚢に水腫を観察できました。
靭帯の腫れの引きと水腫の引きの経過を観察できたので報告していきます。
40代女性、会社員。
朝の通勤中に満員電車の中、体勢を崩し踏ん張って内折れで捻挫。
負傷当日に整形外科でレントゲンを撮り、骨には異常がないと診断。サポーターを処方され、少しの間装着していた。
負傷した翌日にこちらに来院。
4/13
歩行可能だが、強い破行と膝関節屈曲制限あり。
MCL（内側側副靱帯）損傷と膝蓋上嚢に水腫を確認。
最大屈曲不能。屈曲制限に対して徒手整復。処置後、最大屈曲が可能になる。歩行時痛に対してはヒールリフトを装着すると軽減。
サポーターはその日に外して生活するように指導。

4/16
少し破行はあったが、前回より歩行時痛が軽減。
MCL（内側側副靱帯）の腫れと膝蓋上嚢の水腫と共に減少。
ヒールリフトがあれば楽に歩行が可能。

4/20
屈曲時痛は消え、伸展時痛がでてきた。
MCL（内側側副靱帯）の腫れと膝蓋上嚢の水腫も前回より減少。
ヒールリフトをしていたことにより、右股関節に違和感がでてきたので、外して生活。特に差はないとのこと。

今回は前十字後十字靭帯や半月板など大きい損傷はありませんでしたが、歩行困難になるほど重症な症例でした。ヒールリフトは足関節の症状の時に使用することが多いですが、今回は膝にも有効的だと知ることが出来ました。

english ver

"This time it's a sprain of the knee joint. When you hear 'sprain of the knee joint,' it often raises suspicions of significant damage such as to the medial meniscus or anterior cruciate ligament, so it's a case that requires careful observation with an ultrasound. However, this time there were no major injuries to the meniscus or ligaments, but swelling was observed in the medial collateral ligament and effusion in the suprapatellar pouch. I'll report on the progress of the swelling and effusion. The patient is a woman in her 40s, employed. She sprained her knee in an inward direction while bracing herself after losing balance in a crowded train during her morning commute. She had an X-ray taken at an orthopedic clinic on the day of the injury, which showed no abnormalities in the bones. She was prescribed a supporter and wore it for a short while. She came to this clinic the day after the injury. On April 13th, she could walk but experienced severe pain and had limited knee flexion. MCL (medial collateral ligament) injury and effusion in the suprapatellar pouch were confirmed. Maximum flexion was impossible. Manual reduction was performed for flexion restriction. After the treatment, maximum flexion became possible. Pain during walking was alleviated by wearing a heel lift. She was instructed to remove the supporter that day and resume normal activities. On April 16th, there was some pain, but walking was less painful than before. Swelling of the MCL (medial collateral ligament) and effusion in the suprapatellar pouch had decreased. Walking was comfortable with the heel lift. On April 20th, pain during flexion disappeared, but pain during extension emerged. Swelling of the MCL (medial collateral ligament) and effusion in the suprapatellar pouch had also decreased compared to before. Due to wearing the heel lift, discomfort in the right hip joint arose, so she stopped wearing it. There were no notable differences in particular. Although there were no major injuries such as to the anterior or posterior cruciate ligaments or meniscus this time, it was a severe case that made walking difficult."