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The knee and its disorders in terms of Homoeopathy

© Dr. Rajneesh Kumar Sharma MD (Homoeopathy) / Dr. (Km) Ruchi Rajput BHMS Homoeo Cure Research Centre P. Ltd. NH 74- Moradabad Road Kashipur (UTTARANCHAL) - INDIA Ph- 09897618594

Abstract he knee, largest of human joints, is compound joint. Despite its single cavity in man, it is convenient to describe it as two condylar joints between the femur and tibia and a sellar joint between the patella and femur. The former are partly divided by menisci between corresponding articular surfaces. The level of the joint is at the (palpable) proximal margins of the tibial condyles. Being too complex, the knee joint is prone to have a number of disorders. To study these problems, one must be thoroughly acquainted with anatomy and normal movements of the knee joint. Then after a very keen case taking as well as physical, radiological and pathological examinations needed, the correct diagnosis, prognosis and only then the remedial diagnosis could be made to meet the cure. Anatomy of Knee Joint One should study the following in detail from some standard books on anatomyArticular Surfaces, Fibrous Capsule, Synovial Membrane, Bursae, The ligaments of the knee, Menisci, Vessels and Nerve Supply to the Joint. The extensor mechanism of the knee Extension of the knee is produced by the quadriceps muscle acting through the quadriceps ligament, patella, patellar ligament and tibial tubercle.  Weakness of extension- It leads to instability, repeated joint trauma and effusion. There is often a vicious circle of pain→quadriceps inhibition →quadriceps wasting →knee instability →ligament stretching and further injury →pain.  Loss of full extension- It also leads to instability, as there is failure of the screwhome mechanism. Rapid wasting of the quadriceps is seen in all painful and inflammatory conditions of the knee. Weakness of the quadriceps is also sometimes found in lesions of the upper lumbar intervertebral discs, as a sequel to poliomyelitis, in multiple sclerosis and other neurological disorders, and in the myopathies. Quadriceps wasting may be the presenting feature of a diabetic neuropathy or secondary to femoral nerve palsy from an iliacus haematoma. The term ‘jumper’s knee’ is used to describe a number of conditions where there is pain in the patellar ligament or its insertion: it includes the Sinding–Larsen–Johansson syndrome- seen in children in the 10–14 age group, where there are X-ray changes in the distal pole of the patella. Osgood Schlatter’s disease- (often thought to be due to a partial avulsion of the tibial tuberosity) which occurs in the 10–16 age group. In it there is recurrent pain over the tibial tuberosity, which becomes tender and prominent. Radiographs may show partial detachment or fragmentation. Pain generally ceases with closure of the epiphysis. In an older age group (16–30) the patellar ligament itself may become painful and tender. This almost invariably occurs in athletes, and there


may be a history of giving-way of the knee. CT scans may show changes in the patellar ligament, the centre of which becomes expanded. Common Pathology about the Knee Swelling of the knee The knee may become swollen as a result of the accumulation within the joint cavity of excess synovial fluid (Psora/Sycosis), blood (Psora/ Syphilis) or pus (Sycosis/Syphilis). Much less commonly the knee swells beyond the limits of the synovial membrane. This is seen in soft tissue injuries of the knee when haematoma (Psora/Sycosis/Syphilis) formation and oedema (Psora) may be extensive. It is also a feature of fractures, infections (Psora) and tumours (Psora/Sycosis/Syphilis) of the distal femur, where confusion may result either from the proximity of the lesion to the joint or because it involves the joint cavity directly. Synovitis, effusion The synovial membrane secretes the synovial fluid of the joint; excess synovial fluid (Psora/Sycosis) indicates some affection of the membrane. Joint injuries cause synovitis by tearing or stretching the synovial membrane (Syphilis). Infections act directly by eliciting an inflammatory response (Psora). The membrane itself becomes thickened (Sycosis) and its function disturbed in rheumatoid arthritis (Syphilis/Sycosis) and villonodular synovitis (Psora/Sycosis); both are usually accompanied by large effusions (Sycosis). In long-standing meniscus lesions and in osteoarthritis of the knee (Sycosis/Syphilis), the synovial membrane may not be directly affected, and no effusion may be present. The recognition of fluid in the joint is of great importance. Effusion indicates damage to the joint (Syphilis), and the presence of a major lesion must always be eliminated. A tense synovitis (Sycosis) may be aspirated to relieve discomfort. Haemarthrosis Blood in the knee is seen most commonly where there is tearing of vascular structures. The menisci are avascular, and there may be no haemarthrosis (Psora/Syphilis/Sycosis) when a meniscus is torn. Bleeding into the joint will take place (Psora/ Sycosis), however, if the meniscus has been detached at its periphery or if there is accompanying damage to other structures within the knee (e.g. the cruciate ligaments) (Syphilis). Pyarthrosis Infections of the knee joint are rather uncommon, and usually blood-borne. Sometimes the joint is involved by direct spread from an osteitis (Psora) of the femur or tibia; rarely the joint becomes infected following surgery or penetrating wounds. In acute pyogenic infections (Psora/Syphilis), the onset is usually rapid and the knee very painful (Psora); swelling is tense (Sycosis), tenderness is widespread (Psora), and movement resisted (Syphilis). There is pyrexia and general malaise (Psora). Pyogenic infections in patients suffering from rheumatoid arthritis (Syphilis/Sycosis) have often a much slower onset, often with suppressed inflammatory changes if the patient is receiving steroids. Tuberculous infections of the knee (Psora/Syphilis) have a slow onset, spread over weeks. The knee appears small and globular, with the associated profound quadriceps wasting (Syphilis) contributing to this appearance. In gonococcal arthritis (Sycosis), great pain and tenderness (Psora) (often apparently out of proportion to the local swelling and other signs), are the striking features of this condition. When it is thought that there is pus in a joint, aspiration should be carried out to empty it and obtain specimens for bacteriological

examination. If tuberculosis is suspected, synovial biopsy to obtain specimens for culture and histology is required. Lesions of ligaments of the knee It is important to detect ligament injuries as they may account for appreciable disability. The commonest are Recurrent effusion  Lack of confidence in the knee  Difficulty in undertaking strenuous or athletic activities and  Sometimes trouble in using stairs or walking on uneven ground. The diagnosis and interpretation of instability in the knee is difficult as the main structures round the knee have primary and secondary supportive functions, and several may be damaged. The medial ligament has superficial and deep layers. Considerable violence is required to damage it.  If only a few fibres are torn, no instability will be demonstrated, but stretching the ligament will cause pain.  With greater violence, the whole of the deep part of the ligament ruptures, followed in order by the superficial part, the medial capsule, the posterior ligament, the posterior cruciate ligament and sometimes finally the anterior cruciate ligament.  Minor tears of the medial ligament in the older patient may be followed eventually by calcification in the accompanying haematoma (Sycosis), and this may give rise to sharply localised pain at the upper attachment (Pellegrini–Stieda disease).  The lateral ligament and capsule may be damaged by blows on the medial side of the knee which throw it into varus.  In the case of the medial ligament, increasing violence will lead to tearing of the posterior capsular ligament and the cruciates. In addition, the common peroneal nerve may be stretched and sometimes irreversibly damaged.  Impaired anterior cruciate ligament function is seen most frequently in association with tears of the medial meniscus. In some cases this is due to progressive stretching and attrition rupture. In others, the anterior cruciate ligament tears at the same time as the meniscus, and in the most severe injuries the medial ligament may also be affected (O’Donoghue’s triad). Isolated ruptures of the anterior cruciate ligament are uncommon, but do occur.  Chronic laxity (Sycosis) generally results from old injuries, and may cause problems from acute, chronic or recurrent tibial subluxations. There may be a history of giving way of the knee, episodic pain (Psora), and functional impairment (Psora). There is often quadriceps wasting (Syphilis) and effusion (Sycosis) and secondary osteoarthritis (Syphilis/Sycotic) may develop.  Posterior cruciate ligament tears are produced when in a flexed knee the tibia is forcibly pushed backwards (as for example in a car accident when the upper part of the shin strikes the dashboard). Instability (Psora/ Syphilis) is not uncommon, often leading if untreated to osteoarthritis of rapid onset.

Loss of elasticity in the menisci (Syphilis) through degenerative changes associated with the ageing process may give rise to horizontal cleavage tears within the substance of the meniscus. the patella engages in the groove separating the two femoral condyles (the trochlea).The commonest cause is a sporting injury. weight-bearing leg. Normally. and if an attempt is made to straighten the knee. They are tender (Psora). and sharply localized tenderness in the joint line is a common feature.Rotatory instability in the kneeTibial condylar subluxations. they render them more susceptible to tears (Syphilis). the anterior cruciate ligament and the lateral structures are torn. Patellofemoral instabilityThe patella has always a tendency to lateral dislocation as the tibial tuberosity lies lateral to the dynamic axis of the quadriceps.  Combinations of these lesions (particularly 1 and 2.Ganglion-like cysts (Sycosis) occur in both menisci.This abnormality. It may produce a very pronounced clicking from the lateral compartment. when the knee is stressed. when a twisting strain is applied to the flexed. prolonged loss of full extension may lead to stretching and eventual rupture of the anterior cruciate ligament (Syphilis). which . In the case of the medial meniscus. Medial meniscus cysts must be carefully distinguished from ganglions arising from the pes anserinus (the insertion of sartorius. at the beginning of knee flexion.  Posterolateral rotatory instability-The lateral tibial condyle subluxes posteriorly.  Degenerative meniscus lesions in the middle-aged. In the most severe cases.The lateral tibial condyle subluxes anteriorly. commonly presents in childhood. The trapped meniscus commonly splits longitudinally. This may follow rupture of the lateral and posterior cruciate ligaments. This prevents full extension (with physiological locking of the joint). In true cysts there is often a history of a blow on the side of the knee over the meniscus. and its free edge may displace inwards towards the centre of the joint (bucket-handle tear).  Meniscus tears in the young adult. The medial meniscus may also be damaged (Syphilis) and contribute to the instability (Psora/Syphilis). and 2 and 3) may be found.The medial tibial condyle subluxes anteriorly.In this group of conditions. and as they restrict the mobility of the menisci (Sycosis). a painful elastic resistance is felt (Psora) (‘springy block to full extension’). Lesions of the menisci  Congenital discoid meniscus.  Anterolateral rotatory instability.  Cysts of the menisci. gracilis and semitendinosus). but are much more common in the lateral. The main forms are as follows:  Anteromedial rotatory instability. a block to extension of the joint and other derangement signs (Syphilis). In the more severe cases. and there may be an associated lesion of the anterior horn of the lateral meniscus. the tibia may sublux forwards or backwards on the medial or lateral side. giving rise to pain and a feeling of instability in the joint (Psora/ Syphilis). these tears may not be associated with any remembered traumatic incident. most frequently involving the lateral meniscus. this follows tears of both the anterior cruciate ligament and the medial ligament and capsule. especially where there is major ligamentous disruption of the knee.

and most commonly involves the medial femoral condyle. This system may be disturbed in a number of ways There may be an abnormal lateral insertion of the quadriceps  Tight lateral structures (Psora). often with increasing frequency and ease.  Recurrent lateral dislocation. The symptoms are initially of aching pain and recurring effusion (Psora). but is seen . Osteochondritis dissecans This occurs most frequently in males in the second decade of life. or as a feature of one of the joint laxity syndromes (Sycosis). with perhaps locking of the joint if a loose body is present (Sycosis).The patella dislocates every time the knee flexes (Psora) and this is pain free (Sycosis/ Syphilis). and the pathology is often uncertain. and may give rise to pain on extension of the knee (Psora). Complete separation may occur so that a loose body is formed.  Congenital dislocation of the patella-. often made worse by prolonged sitting or walking on slopes or stairs (Psora). In a number of cases there is softening (Syphilis)) or fibrillation (Sycosis) of the articular cartilage lining the patella (chondromalacia patellae). The dislocation is irreducible. It is not associated with any patellar instability. Fat pad injuries The infrapatellar fat pads may become tender and swollen. A segment of bone undergoes avascular necrosis (Psora/Syphilis).) There are a number of conditions characterized by loss of normal patellar alignment Acute traumatic dislocation of the patella. but in some there is evidence of patellofemoral malalignment or other of the factors responsible for recurrent dislocation (even although there may be no history of frank dislocation).helps to keep it in place as flexion continues.This is uncommon and may result from an untreated childhood or adolescent dislocation. Retropatellar pain syndromes/chondromalacia patellae These are characterized by chronic ill-localised pain at the front of the knee. or  The patella itself may be small and poorly formed (hypoplasia) (Syphilis) or  Highly placed (patella alta)-This is often associated with genu recurvatum.g.This injury occurs most frequently in adolescent females during athletic activities. This may occur as a complication of osteoarthritis. or  An increase in the angle between the axis of the quadriceps and the line of the patellar ligament (e.  Permanent dislocation of the patella.  Habitual dislocation of the patella. and a line of demarcation becomes established between it and the underlying healthy bone. especially if they are nipped between the articulating surfaces of femur and tibia. (A low set patella—known as patella baja or infera—is uncommon and may follow certain surgical corrective procedures. from fibrosis in a quadriceps muscle. It is commonest in females in the 15–35 age groups.Further painful dislocations of the patella occur. There may be no obvious precipitating cause. It often arises in childhood and may be due to an abnormal attachment of the iliotibial tract. as a result of knock-knee deformity or by a broad pelvis)  The lateral condyle may be deficient (Syphilis). and this may lead to patellofemoral osteoarthritis (Syphilis/Sycosis). The patella may be dislocated at birth in association with other congenital abnormalities (Syphilis).

In adults genu varum most frequently results from osteoarthritis. Fixed flexion (Syphilis/Sycosis). numerous loose bodies are formed by an abnormal synovial membrane in the condition of synovial chondromatosis (Sycosis). although the monoarticular form is occasionally seen. muscle wasting (Syphilis). Generally other joints are also involved. osteochondritis dissecans. It also occurs in Paget’s disease and rickets.more frequently in young women when the fat pads swell in association with premenstrual fluid retention (Psora). Being overweight. tenderness and pain (Psora). leading to joint space narrowing (Syphilis). Reiter’s syndrome This usually presents as a chronic effusion (Sycosis) accompanied by discomfort in the joint. Disturbances of alignment  Genu varum (bow leg) . Rheumatoid arthritis Characteristically. Nearly all cases resolve spontaneously by the age of 6. synovial thickening (Sycosis). where there is narrowing of the medial joint compartment (Syphilis). and there may be a history of urethritis (Psora/Sycosis/Syphilis) or colitis (Psora/Sycosis/Syphilis).  Secondary osteoarthritis may follow ligament and meniscus injuries. Stiffness of the spine (Psora) and radiographic changes in the sacroiliac joints are nevertheless almost invariably present (Syphilis/Sycosis). with swelling and discomfort in the knee joint. with an associated conjunctivitis (Psora/Sycosis/Syphilis). Distortion of the joint surfaces may lead to loss of movement and fixed flexion deformities (Syphilis/Sycosis). the articular cartilage becomes progressively thinner.This commonly occurs as a growth abnormality of early childhood. It is seen in association with knock-knee and bow-leg deformities. Rarely genu varum is caused by a growth disturbance (Psora) involving both the tibial epiphysis and proximal tibial shaft (tibia vara). and often small marginal osteophytes and cysts are formed (Sycosis). Exposure of bone and free nerve endings gives rise to pain and crepitus on movement. and overwork are common factors. It is often bilateral. Much less commonly. Osteoarthritis The stresses of weight-bearing mainly involve the medial compartment of the knee. In osteoarthritis. Loose bodies Loose bodies are seen most often as a sequel to osteoarthritis or osteochondritis dissecans (Sycosis/Syphilis).  Genu valgum (knock knee) . which throw additional mechanical stresses on the joint. The subarticular bone may become eburnated (Syphilis). the knee is warm to touch (Psora). valgus and (less commonly) varus deformities are quite common. the degenerative changes accompanying old age. joint infections and other previous pathology.This occurs most frequently in young children where it is usually associated with flat foot. there is effusion (Psora/Sycosis). and usually resolves spontaneously. Ankylosing spondylitis The first symptoms of ankylosing spondylitis are generally in the spine. but occasionally the condition presents at the periphery. limitation of movements (Syphilis). It is also seen in plump adolescent females and . and it is in this area that Primary osteoarthritis usually first occurs. recurrent dislocation of the patella. It is less common in rheumatoid arthritis.

(amyotrophic lateral sclerosis (ALS) a disease of the motor tracts of the lateral columns and anterior horns of the spinal cord. progressive muscular atrophy. progressive spinal amyotrophy. Fluctuant bursal swellings (Psora) may also occur over the patella (prepatellar bursitis or housemaid’s knee) or the patellar ligament (infrapatellar bursitis or clergyman’s knee). associated with a defect in superoxide dismutase. Duchenne-Aran disease. muscular trophoneurosis. in which only a lower motor neuron component occurs. wasting palsy. the deformity is seen in congenital joint laxity (Sycosis). A number of cases are inherited as an autosomal dominant trait. contributing to a tendency to recurrent dislocation or chondromalacia patellae. is 90–95% sporadic in nature. after uncorrected depressed fractures of the lateral tibial table. in which isolated or predominantly lower brainstem motor involvement is seen. Patient’s age and sex. and progressive bulbar palsy. Lou Gehrig's disease. Syn: AranDuchenne disease. it most frequently occurs in rheumatoid arthritis. increased reflexes.  Genu recurvatum.may be a contributory factor in recurrent dislocation of the patella Psora). This may communicate with the knee joint. In the latter cases there is corresponding elevation of the patella (patella alta). In adults. Variants include progressive spinal muscle atrophy. creeping palsy. and spastic irritability of muscles. Age Group Males Females 0–12 Discoid lateral meniscus Discoid lateral meniscus 12–18 Osteochondritis dissecans First incident of recurrent dislocation Osgood–Schlatter’s disease Osgood–Schlatter’s disease of the patella . Chronic prepatellar bursitis (Sycosis). and is usually fatal within 2 to 4 years of onset. wasting paralysis. and as a sequel to a number of paralytic neurological disorders (Syphilis) where there is ligament stretching and altered epiphyseal growth (Psora/Sycosis). is common in miners where it is referred to as ‘beat knee’. Cruveilhier's disease. fibrillary twitching.Hyperextension at the knee is seen after ruptures of the anterior cruciate ligament and in girls where the growth of the upper tibial epiphysis may be retarded from much point work in ballet classes or from the wearing of high heeled shoes in early adolescence. and this may help to distinguish it from deep venous thrombosis (Psora/Syphilis/Sycosis) or cellulites (Psora/Sycosis). This disorder affects adults. it is also associated with other occupations where prolonged kneeling is unavoidable (e.g. it is common in plumbers and carpet layers). Rupture may lead to the appearance of bruising on the dorsum of the foot. Charcot's disease. and fluctuate in size.bearing in mind the following important distribution of the common knee conditions. poliomyelitis (Psora/Syphilis) and Charcot’s disease (Psora/Syphilis).) Bursitis Cystic swelling occurring in the popliteal region is usually referred to as enlargement (Sycosis) of the semimembranosus bursa. causing progressive muscular atrophy. with or without local infection. More rarely. DIAGNOSIS OF A KNEE COMPLAINT 1.

it should be asked how it became free: unlocking with a click is suggestive of a meniscus lesion.An effusion (Psora/Sycosis/Syphilis) indicates the presence of pathology which must be investigated. 2. a footballer is unlikely to be able to finish a game with a freshly torn meniscus.  Asking if the knee ‘locks’o Patients often confuse stiffness and true locking.  Asking if the knee ‘gives way’o ‘Giving way’ of the knee on going down stairs or o Jumping from a height follows cruciate ligament tears. this can be done by Obtaining a convincing history of an initiating injuryo The degree of violence. Swelling of the knee . Ligamentous and extensor apparatus injuries are rare in children. o Locking from a loose body may occur in various degrees of flexion. a slight rotational force. such as the foot catching on the edge of a carpet. with long-standing meniscus lesions. weight-bearing is not an essential factor. The position of knee if it locks should be seen.) 3. o Locking which is due to a torn meniscus generally allows the joint to be flexed fully or nearly fully. Attempts to obtain full extension are accompanied by pain. locking not infrequently occurring during sleep. o What produces any locking. Mechanical problem (internal derangement) .  Asking about pain- Longitudinal meniscal tears . Normally the knee never locks in full extension. may be quite sufficient.according to the symptoms of the patient. (However. Reiter’s syndrome occurs in adults of both sexes. that the absence of effusion does not necessarily eliminate significant pathology. and its direction. o ‘Giving way’ on twisting movements or walking on uneven ground follows many meniscus injuries. but the last 10° to 40° of extension are impossible. o In chronic lesions. loss of full extension in the knee and quadriceps wasting (Syphilis). o If the knee is not locked at the time of the patient’s attendance. ankylosing spondylitis nearly always occurs in male adults. o Whether there was bruising (not a feature of meniscal injuries) or o Swelling after the injury (Psora). o There may be deformity with locking from a dislocating patella.18–30 Recurrent dislocation of the patella Chondromalacia patellae Fat pad injury 30–50 Rheumatoid arthritis Rheumatoid arthritis 40–55 Degenerative meniscus Degenerative meniscus lesions lesions 45+ Osteoarthritis Osteoarthritis Infections are comparatively uncommon and occur in both sexes in all age groups. and o Whether the patient was able to weight-bear. o The initial incapacity is important: for example.

o Radioisotope scan. and estimation of the sedimentation rate and C-reactive protein.may be helpful. there is often an increase in the signal intensity in the region of the posterior third of the medial meniscus which can lead to false interpretations.  Suspected acute infections o Aspiration and culture of the synovial fluid. o Examination under anesthesia. o Blood culture. The following additional investigations are often helpful Suspected internal derangement o Arthroscopy. o Estimations of rheumatoid factor.  Further investigation of poor mineralization. including differential white count. and in conjunction with the clinical examination will permit a firm. o MRI scans.  Suspected rheumatoid arthritis o Examination of other joints. o Skeletal survey and chest radiograph. etc-. o Serum uric acid. o Full blood count. o Estimation of serum calcium.o The circumstances in which it is present and the patient if he can localize it by pointing to the site with one finger should be identified. This may be followed up by arthroscopy. o Full blood count and sedimentation rate.can be useful in diagnosing lesion of the menisci and ligaments where there is uncertainty. with specimens of synovial membrane being sent for both histological and bacteriological examination. o Arthrography.may give much useful information. bone erosions. Although an accuracy of 90% is claimed. At the same time. o Synovial biopsy.  Suspected tuberculosis of the knee o Chest radiograph. accurate diagnosis to be made in the majority of cases. o Mantoux test. . by preventing flexion) anesthesia may allow this to be performed. although interpretation of the radiographs is specialized and often difficult. synovial fluid specimens are also sent for bacteriology and sensitivities. o Serum uric acid. o Full blood count and differential count.If pain prevents full examination (e. phosphate and alkaline phosphatase. Additional investigations Occasionally a firm diagnosis cannot be made on the basis of the history and clinical examination alone. o Estimation of rheumatoid factor. An increasing number of conditions are amenable to arthroscopic surgery which can often be performed after diagnostic arthroscopy as a follow-on procedure during the same session. Incorrect diagnoses are most common in lesions involving the menisci in their posterior thirds.g.

Bruising is not usually seen in meniscus injuries. pelvis and hips. b.Diaphyseal aclasis (exostosis.Suggesting infection (of the joint. aspirate negative o Tests as for suspected rheumatoid arthritis. with the possibility of psoriatic arthritis. Further investigation of severe undiagnosed pain. In beat knee.Note any bruising which suggests trauma to the superficial tissues. Further investigation of chronic effusion. and the peripheral pulses must be checked.Note scars of previous injury or surgery—the relevant history must be obtained i. suggesting in particular rheumatoid arthritis or infection. Always should be checked if any warm bandage the patient may have been wearing just prior to the examination. femur or tibia). f. haemarthrosis. Skin appearanceg. There may also be increased local heat as part of the inflammatory response to injury. and with the potential for reactivation j. o Radiography of the chest and sacroiliac joints.g. . Examine any local swelling. often multiple and sometimes familial). o Brucellosis agglutination tests.     o Bone biopsy.Meniscus cyst.infrapatellar bursitis (clergyman’s knee) e. tumour or major injury. or knee ligaments. often of bone. Both sides must always be compared. pyarthrosis or a space-occupying lesion in the joint. h. Temperature. e.If there is any swelling.Sinus scars are indicative of previous infections. prepatellar bursitis (housemaid’s knee) d.Note should be made for any increased local heat and its extent. note if it is confined to the limits of the synovial cavity and suprapatellar pouch. and in the presence of rapidly growing tumours. ASSESSMENT Inspection Swellinga. Aspiration of the knee joint. Note if any swelling extends beyond the limits of the joint cavity.Indications include the presence of a tense haemarthrosis or to obtain specimens for bacteriology in suspected infections. o Arthroscopy and synovial biopsy.Evidence of psoriasis. A warm knee and cold foot suggest a popliteal artery block. c.Suggesting effusion. Redness suggests inflammation. X-ray examination of the chest. occurring in the joint line. Arthroscopy or exploration.

Wasting of the quadriceps occurs most frequently as the result of disuse.Placing a hand behind the knee b. e. (4) Avulsion of the tibial tubercle. or from infection or rheumatoid arthritis. Substantial wasting may be confirmed by measurement. and proximal patellar displacement.To repeat on the other leg. .The site of the pathology may be determined by looking for tenderness. (2) Many patellar fractures.Small effusions are detected most easily by inspection. The muscle tone may be felt with the free hand c. B. Effusion. Loss of active extension of the knee (excluding paralytic conditions) follows(1) Rupture of the quadriceps tendon. Examination of the contracted quadriceps bya. palpable gaps in the components of the extensor apparatus.And asking the patient to press against it.Slight wasting and loss of bulk are normally apparent on inspection. f. h.The quadriceps muscle.Now asking the patient to dorsiflex the inverted foot to show and feel the tone in the important vastus medialis portion of the muscle.With the patient sitting with his legs over the end of the examination couch g.Feel for quadriceps contraction and i. assuming the other limb is normal. Compare the circumference of the legs at the marked levels.To begin by locating the knee joint and marking it with a ball-point pen. This objective test may be valuable for repeat assessments and in medico-legal cases. d.The first signs are bulging at the sides of the patellar ligament and obliteration of the hollows at the medial and lateral edges of the patella.Ask him to straighten the leg while you support the ankle with one hand.Look for active extension of the limb.With greater effusion into the knee the suprapatellar pouch becomes distended. Extensor apparatusA. a. (3) Rupture of the patellar ligament.To make a second mark on the skin 18 cm above this. generally from a painful or unstable lesion of the knee. Effusion indicates synovial irritation from trauma or inflammation. b.

d. collateral ligament and fat pad injuries. Any excess fluid present will be seen to move across the joint and distend the medial side. the joint has a doughy feel in the suprapatellar region. these lie over the joint line. . A click indicates the presence of effusion. e.In children and adolescents.B. g.Begin by flexing the knee and looking for the hollows at the sides of the patellar ligament.Now stroke the lateral side of the joint h.Tenderness over the lower pole of the patella is found in Sinding–Larsen– Johansson disease. Evacuate the suprapatellar pouch as in the patellar tap test. Localised tenderness here is commonest in meniscus. This test will be negative if the effusion is gross and tense. while in a pyarthrosis there is widespread tenderness. Then confirm by feeling with the fingers or thumb for the soft hollow of the joint with the firm prominences of the femur above and the tibia below.Now systematically examine the upper and lower attachments of the collateral ligaments.Small effusions may be detected by this manoeuvre. e. and jerk it quickly downwards. Associated bruising and oedema is a feature of acute injuries. d. c. f.Patellar tap test. If the effusion is slight or tense. tenderness is found over the tibial tubercle (which may be prominent) in Osgood–Schlatter’s disease and after acute avulsion injuries of the patellar ligament and its tibial attachment. slid firmly distally from a point about 15 cm above the knee to the level of the upper border of the patella.While closely watching the medial.c.Place the tips of the thumb and three fingers of the free hand squarely on the patella. b.Squeeze any excess fluid out of the suprapatellar pouch with the index and thumb. Tenderness It is the first essential to identify the joint line quite clearly. a.Stroke the medial side of the joint to displace any excess fluid in the main joint cavity to the lateral side of the joint.Begin by palpating carefully from in front and then back along the joint line on each side. the tap test will be negative. N.Fluid displacement test. In a haemarthrosis.

Loss of flexion is common after local trauma. A springy block to full extension is very suggestive of a bucket handle meniscus tear. Flexion of 135° and over is regarded as normal.Try to obtain full extension if this is not obviously present. look for patellar ligament tenderness. It sometimes accompanies tears of the anterior cruciate. a. Note that osteochondritis dissecans most frequently involves the medial femoral condyle. b. . Flexion (normal = 135° or more) – c. medial ligament. with full extension being recorded as 0°. and is recorded as ‘X° hyperextension’.Normally the line of the tibia and femur should coincide. chondromalacia patellae and recurrent dislocation of the patella. Movements Extension (normal = 0°) . A rigid block (commonly described as a fixed flexion deformity) is often present in the arthritic knee.Where a problem with the patellar ligament is suspected in an athletic patient.Hyperextension (genu recurvatum) .f. Loss of full extension may he described as ‘the knee lacks X° of extension’. but compare the two sides. especially while the patient is attempting to extend the leg against resistance. effusion and arthritic present if the knee extends beyond the point when the tibia and femur are in line. look for other signs of joint laxity.Measure the range of flexion using a goniometer.flex the knee fully and look for tenderness over the femoral condyles). If severe. It is often seen in girls associated with a high patella. In suspected osteochondritis dissecans g. or medial meniscus.

Note that radiological varus is normal till a child is 18 months old. In the 10–16 age groups. The patient should be weight-bearing. note the wide and irregular epiphyseal plates. The shaded area represents genu valgum. < 8 cm in females and < 4 cm in males is regarded as normal. (C) 10–60° (or 10° fixed flexion deformity with a further 50° flexion).Alternatively.In children. Genu valgum and varus a. and the patellae should be facing forwards.Assess by bringing the legs together.d. which is approximately 6° in the adult. with 1 cm = 1. The degree of valgus (vl) may be roughly assessed by measuring the angle formed by the tibial and femoral shafts and deducting the ‘normal’ tibiofemoral angle (tf). measure the heel to buttock distance with the leg fully flexed. using the fingers as a gauge. It is also common in teenage girls. It is seen most commonly in osteoarthritis and Paget’s disease etc. In (B) tibia vara. and is useful for checking daily or weekly progress. b.knee) is unilateral or bilateral.) The range of movements in the examples would be recorded as follows: (A) 0–135° (normal range). (Note that the tibiofemoral angle is virtually the same as the Qangle used in the assessment of patellar instability. In adults. Normally the knees and malleoli should touch. < 4 cm in females and < 5 cm in males is regarded as being within normal limits. to touch lightly at the knees. and the films should be taken with the patient taking all his weight on the affected side (C) (and preferably in 30° flexion). In the older 10–16 age group. (This can be a very accurate way of detecting small alterations in the range. a. It is best measured by X-ray. genu valgum deformity is seen most often in association with rheumatoid arthritis. Measure the intermalleolar gap. Make sure the patellae are pointing upwards.) Genu varum (D) may be assessed by adding the ‘normal’ tibiofemoral to the actual (negative) angle (na). it should be noted if any genu valgum (knock. In (A) rickets. (B) 5° hyperextension–140° flexion. notable is the sharply down-turned medial metaphyseal border. Radiographs may help.5° approximately. Knee instability The following potential deformities may be looked for: .Genu varum (bow leg) may be assessed by measuring the distance between the knees.

c. Tenderness in injuries of the medial ligament is commonest at the upper (femoral) attachment and in the medial joint line.Severe valgus may indicate additional cruciate (particularly posterior cruciate) rupture.Moderate valgus is suggestive of a major medial and posterior ligament rupture. Examining for valgus stress instability. If in doubt. If there is still some uncertainty.(when the lateral ligament is torn: severe when the posterior cruciate is also torn). . (B) Varus. (2) The lateral condyle subluxes anteriorly (anterolateral instability): this is usually due to tears of the anterior cruciate plus the lateral structures.(A) Valgus. placed over the joint line may be used to detect any opening up as it is stressed. (C) Anterior displacement of the tibia (anterior cruciate tears: worse if medial and/or lateral structures torn). Rotatory(1) The medial tibial condyle subluxes anteriorly (anteromedial instability): this is usually due to combined tears of the anterior cruciate and medial structures. Types (3) and (4) are mainly due to tears of the posterior cruciate and lateral or medial structures. (3) The lateral tibial condyle subluxes posteriorly (posterolateral instability) or (4) The medial tibial condyle subluxes posteriorly (posteromedial instability). d. compare the two sides.Use one hand as a fulcrum. Extend the knee fully. (D) Posterior displacement of the tibia (posterior cruciate ligament tears). but haemarthrosis may be absent.(when the medial ligament is torn: severe when the posterior cruciate is also damaged). Bruising may be present after recent trauma. (5) Combinations of these instabilities. and the leg going into valgus. Look for the joint opening up. the thumb or index. and the medial ligament in particular.Begin by examining the medial side of the joint. a. and b.with the other attempt to abduct the leg.

Examining for varus stress instability. attempt to stress the ligament with a cross-over arm grip. preliminary aspiration of the joint may allow a more meaningful examination of the joint.Demonstration of an abnormal amount of valgus suggests less extensive involvement of the medial structures (e. there should be provision to carry on with a surgical repair or with an arthroscopy should major instability be demonstrated (i.First examine the lateral side of the joint. partial medial ligament tear.The foot internally rotated.e. Some opening up of the joint is normal. (In (e) there is evidence of opening up of the join. d. with one hand placed over the proximal part of the tibia distal to the knee joint. taken while applying a valgus stress to each.If the knee remains too painful to permit examination. e.If the knee is very tender and will not permit the pressure of a hand as a fulcrum.) If a haemarthrosis is present (and this is not always the case).a. If there is still some doubt. and it is essential to compare sides.Stress films. then compare radiographs of both knees. the joint should be fully tested under anesthesia.If no instability has been demonstrated with the knee fully extended. Examination under anesthesia. where there is the involvement of several major structures). looking for tenderness over the lateral ligament and capsule: then attempt to produce a . c. repeat the tests with the knee flexed to 30° and b. suggestive of a medial ligament tear when compared with the other side.g.

with possible involvement of the medial ligament as well as the anterior cruciate ligament.The anterior drawer test.Repeat the test with the foot in 15° of external rotation. and compare the sides. Excess excursion of the medial tibial condyle suggests a degree of anteromedial (rotatory) instability. and jerk the leg towards you. and compare one side with the other. Feagin . E. Carry out the test as in the case of valgus stress instability. One hand stabilizes the femur while the other tries to lift the tibia forwards.Now turn the foot into 30° of internal rotation. Repeat with the knee flexed to 70°. Anterior instability A. the knee should be relaxed and in about 15° flexion. Beware of the following fallacy: a tibia already displaced backwards as a result of a posterior cruciate ligament tear may give a false positive (fp) in the drawer tests. the anterior cruciate is almost certainly torn (s). Stress films and examination under anesthesia may be required. The test is positive if there is anterior tibial movement (detected with the thumb in the joint (t)). and repeat the test. C. Varus instability in extension as well as flexion. with possibly damage to the posterior cruciate and the posterior ligament as well as the anterior cruciate ligament. suggests tearing of the posterior cruciate ligament as well as the lateral ligament complex. D. If the displacement is less marked. This also applies to the following Lachman tests. the diagnosis is less clear: it may suggest an isolated anterior cruciate ligament laxity or a tibial condylar subluxation (rotatory instability).e. In the manipulative Lachman test.The Lachman tests.These are also used to detect anterior tibial instability.Check that the hamstrings are relaxed. and steady it by sitting on or close to it.5 cm or more).Flex the knee to 90°. first in full extension and then in 30° flexion.varus deformity by placing one hand on the medial side of the joint and forcing the ankle medially. When the displacement is marked (say 1. and one tibial condyle moves further forward than the other. Anterior subluxation of the lateral tibial condyle suggests some anterolateral rotational instability. Note that significant displacement (i. and there is a strong possibility of associated damage to the medial complex (medial ligament and medial capsule) and even the lateral complex. with the foot pointing straight forwards. Check by inspection of the contours of the knee prior to the examination. B. Check the common peroneal nerve. Grasp the leg firmly with the thumbs on the tibial tubercle. the affected side more than the other) confirms anterior instability of the knee. with a spongy end point.

F. with the patella pointing upwards. there will be anterior subluxation of the lateral tibial plateau as the quadriceps contracts.Rupture. and posterior subluxation when the muscle relaxes.Radiological analysis of anterior cruciate function. draw two lines parallel to the posterior shaft of the tibia.7 mm. detachment or stretching of the posterior cruciate ligament may permit the tibia to sublux backwards. Posterior instability a. with one tangent to the medial tibial plateau and the other tangent to the medial femoral condyle. Ruptured anterior cruciate = 10. Measure the distance between them.and Cooke recommend that the test be performed with the patient prone with the thigh supported with a sandbag (G). The diagnostic reliability of this examination is high. resisting extension by applying pressure to the ankle.In the active Lachman test. and the X-ray film cassette placed between the legs.The lower thigh is supported by a sandbag. It is considered that this is best seen from the medial side.the relaxed knee is supported at 30° and the patient asked to extend it. Repeat. The latter figure is slightly increased if the medial meniscus is also torn. If the test is positive. G. and the leg extended against the resistance of a 7 kilo weight.2 mm ± 2. The limb should be in the neutral position. often with a .Testing the posterior cruciate ligament.5 mm ± 2 mm. On the films. Normal = 3.

The cruciates may also be inspected by arthroscopy.) Ask the patient to lift the heel from the couch. but subluxation has not yet occurred (uncommon). Any posterior subluxation should normally correct. (The knee should be flexed 20°. Radiological examination of posterior cruciate ligament function. radiographs are taken while the same force is maintained. . Note that MRI scans allow an accurate assessment of the state of the cruciate ligaments in 80% of cases. with a sandbag under the thigh. along with that between the lateral condyles (l). This is repeated. If the posterior cruciate ligament is torn. Excessive movement on the lateral or medial sides indicates posterolateral or posteromedial instability. while observing the knee from the side. although this is inferior to clinical assessment. then backward pressure on the tibia will normally produce a detectable. and the tibia subluxed posteriorly. and after the second preloading cycle.A sandbag is placed behind the thigh. and the proximal tibia forcibly pressed backwards (with a force equivalent to 25 kilos). the forward movement as the tibia reduces will be easily felt. If the posterior cruciate is lax or torn. Try to pull the tibia forwards with the other hand. excessive posterior excursion of the tibia (posterior drawer test). A displacement in the order of 8 mm on each side is indicative of an uncomplicated posterior cruciate tear. The gap between the medial femoral and tibial condyles (m) is measured. Now place the thumb on one side of the joint line and the index on the other to assess any tibial movement.bcde- diagnostic deformity.

and recurvatum (c). The knee should be partly flexed. Apply a valgus stress (2). a dramatic clunk will occur as the lateral tibial condyle subluxes forwards (if rotatory instability is resent). e. begin by performing the posterior drawer test with the patient’s foot in external rotation.Begin by looking for bruising. c. the lateral femoral condyle will appear to jerk anteriorly. To do this. Now extend the joint (3).Begin by flexing the knee to 90°. To perform this. looking for excessive travel on the lateral side. while at the same time pushing the fibular head anteriorly (2). The patient should be completely relaxed. grasp the patient’s foot between your arm and chest and apply a valgus force to the knee (1). A positive test indicates an anterior cruciate abnormality. A further modification of the pivot shift or jerk test is preferred by some. with no tension in the hamstrings. In this position. Fully extend the knee while holding the foot in internal rotation (1). If the test is positive (and because the tibia is firmly held). a. c. d. Now flex the knee. noting any variations. tenderness b. Lean over to internally rotate the foot (2). As a further check for posterolateral instability. Jakob’s reverse pivot shift test may be employed.apply a valgus force and . To check for posterolateral instability. perform the Losee pivot shift test (also for anterior subluxation of the lateral tibial condyle).or oedema over the collateral ligaments. the femoral condyle will appear to jerk backwards. Then perform the external rotation recurvatum test. Apply a valgus force to the knee (1). As full extension is reached. Now flex the knee (3): reduction should occur at about 30° with an obvious jerk. Now extend the knee. the tibia will be in the subluxed position. stand at the end of the examination couch (with the patient in the supine position) and lift the legs by the great toes. varus (b). Perform the drawer tests. The test is positive if the knee falls into external rotation (a). with or without other pathology.Now externally rotate the foot.Rotatory instabilitya. Note: the patient should relate this to the sensations experienced in activity. and on varus stress (usually positive when the lateral tibial condyle subluxes forwards or backwards). if instability is present.Test for laxity on valgus stress (often positive in anterior subluxations of the medial tibial condyle). and as the tibia subluxes. b.Alternatively.Perform the MacIntosh test for anterior subluxation of the lateral tibial condyle (the pivot shift test).

Now extend the joint. Press the thumb firmly into the joint line at the medial side of the patellar ligament. These two signs.Posterior meniscal lesions. the posteriorly subluxed lateral plateau suddenly reduces. The patient should be taking his weight through the slightly flexed knee.-f. while carrying out this test. (A). and with the thumb at the joint line press the anterior part of the lateral femoral condyle medially (m). A click. Bruising is not a feature of meniscal injuries. look for tell-tale oedema in the joint line. Grasp the knee.d. coming from the joint.Alternatively. e. Sweep the heel round in a U-shaped arc. accompanied by pain. This position is critical. The palm of the hand should rest on the patella. usually at about 20°. Repeat on the other side of the ligament. If the test is positive. . accompanied by pain. perform the standing apprehension test for posterolateral instability. Examining the menisci Look for tenderness in the joint line. looking and feeling for clicks. The test is positive (p) if movement of the condyle occurs (allowing the tibia to slip posteriorly under it).extend the joint. not the knee. Now fully flex the knee and place the thumb and index along the joint line. (B). is often found in anterior meniscal lesions. In recent injuries. and note if there is a springy block to full extension. are the most consistent and reliable signs of a torn meniscus. Watch the patient’s face. in association with evidence of quadriceps wasting. as it allows you to localize the source of any clicks or other sensations emanating from the joint. and if this is accompanied by a feeling of giving-way.Anterior meniscal lesions.

or where any pain occurs. Note if there is any knock knee deformity. or from soft tissues snapping over bony prominences). (D). First (1). a. Feel for any clicks accompanied by pain as the joint is extended (e). In the tests. and a laterally placed patella. Keeping up abduction pressure. repeat the test with the sensing finger or thumb removed. extend the joint smoothly (4). Repeat the last test with the foot internally rotated (i) and the leg adducted (ad).McMurray manoeuvre for the medial meniscus.Cysts of the menisci may be associated with tears. A click in the medial joint line. To test the lateral meniscus. Repeat in a greater degree of flexion to test the posterior horn. Note the presence of any meniscal cysts. e. If a unilateral painful click is obtained. This may show a torsional deformity of the femur or tibia. Place the thumb and index along the joint line to detect any clicks.g. 162 The patella Examine both knees flexed over the end of the couch. Because this leads to an increase in the quadriceps angle (similar to the tibiofemoral angle and readily measured). the suspect meniscus is subjected to compression and shearing stresses. gracilis and semitendinosus). and abduct the lower leg (3). The source of the click may be visible on close inspection of the joint line. sharp pain is suggestive of a tear. the examiner throws his weight along the axis of the limb and f.the knee flexed fully c.g. These lie in the joint line. Severe sharp pain is indicative of a medial meniscus tear. which will be predisposed to instability (e. accompanied by pain. then externally rotates the foot (2). from the patella clicking over the femoral condyles. This demonstrates any limitation of rotation. Lateral meniscus cysts (g) are by far the commonest.Mc Murray manoeuvre for the lateral meniscus.Externally rotates the foot.Apley’s grinding test-. nonpathological clicks (e. The sides are compared. suggests a medial meniscus tear. while standing on a stool. recurrent dislocation) or chondromalacia patellae. repeat the tests with the foot forcibly internally rotated.(C). (E). A high-placed patella (patella alta) is a predisposing factor in recurrent lateral dislocation of the patella. it predisposes . g.Then. Look for genu recurvatum and the position of the patella relative to the femoral condyles. flex the leg fully. Cystic swellings on the medial side are sometimes due to ganglions arising from the pes anserinus (insertion of sartorius. feel firm on palpation and are tender on deep pressure.then the foot is internally rotated and d. The normal limb should be examined to help eliminate symptom less.The patient is prone.The knee extended. The foot is externally rotated and b. A grating sensation may be felt in degenerative lesions of the meniscus.

generally by pushing the examiner’s hand away. quadriceps tendon and tibial tuberosity in other extensor apparatus traction injuries and variants of ‘jumper’s knee’. e.) c. . bipartite ridge is present. The source of crepitus from damaged articular surfaces can then be detected. b. displacing the patella laterally. anterior knee pain and chondromalacia patellae. Two thirds of the articular surface is normally accessible in this way.palpate its articular surface.Lower pole tenderness occurs in Sinding–Larsen–Johannson disease. Flex and extend the joint.the knee to recurrent dislocation.Now displace the patella medially and d. Articular surfaces. Tenderness is found when this is diseased. Compare one side with the other. g. Pain is produced in hondromalacia patellae and retropatellar osteoarthritis.Look first for tenderness over the anterior surface of the patella and note if a tender.Apprehension test. Tendernessa. in chondromalacia patellae. Repeat the test.while flexing the knee from the fully extended position. These are particularly common in adolescent girls.g. the patient will be apprehensive and try to stop the test. (Tenderness may also occur over the patellar ligament. Also test sideto-side mobility of the patella.Try to displace the patella laterally h.Move the patella proximally and distally.Place the palm of the hand over the patella and the thumb and index along the joint line. If in doubt.At the same time pressing it down hard against the femoral condyles. e. If there is a tendency to recurrent dislocation. f. this is reduced in retropatellar osteoarthritis.

RADIOGRAPHS . both by inspection and palpation.auscultate the joint. The hip Always examine the hip. Ignore single patellar clicks. A bursa may be small at the time of examination. especially where there is complaint of severe knee pain without any obvious cause: remember that hip pain is often referred to the knee joint. Semi-membranosus bursae become obvious when the knee is extended. noting pain or restriction of movements. Compare the sides. The hip may be screened by testing rotation at 90° flexion. Do not forget to examine the back of the joint. If the knee is flexed the roof of the fossa is relaxed. Note that semimembranosus bursae may be secondary to rheumatoid arthritis or other pathology in the joint. Note also if there is any apparent broadening of the joint and palpable exostosis formation typical of osteoarthritis. Popliteal region All the previous tests have involved examination of the joint from the front. and transillumination is worth trying although not always positive. and deep palpation becomes possible.

Do not mistake the fabella (f). (k) calcified meniscus and pseudo gout. Look for alterations in bone texture (e. The medial tibial condyle blends with the shadow of the tibial spines. or epiphyseal lines (e) for fracture. may be reduced to zero or reversed (r) in recurrent dislocation of the patella. loose bodies (h). The lateral patellofemoral angle (pf). cysts (c). rheumatoid arthritis.In the AP the patellar shadow is faint. Note any bone defects (d) or periosteal reaction (p) such as may occur in tumours or infection.g. Medially. Do not mistake a bipartite patella. Note abnormal calcification as in (j) Pellegrini–Stieda disease. evidence of chondromalacia patellae. osteomalacia. an inconstant seasamoid bone.Intercondylar radiographs often help in diagnosing osteochondritis dissecans (od) (as they show the common site of origin in the medial femoral condyle). a tangential (skyline) view may show (1) a marginal (medial) osteochondral fracture. marginal sclerosis (s). (4) bipartite patella. varus or valgus (all common in osteoarthritis). common in recurrent dislocation of the patella. Where the patella is suspect. which affects the upper and outer quadrant (b). lipping (l). in the diagram it is drawn in bold. The lateral condyle of the tibia (also in bold) may be distinguished from the medial by the tibiofibular articulation (tf). (2) other fractures. Representative pathology. Representative radiographs . and in locating loose bodies (h). normally positive in a 20° radiographic projection. Reduction of the sulcus angle (sa) — normal 132° to 144°— is highly significant in cases of suspected patellar instability. for a loose body. infections). in Paget’s disease. (3) occasionally. In the lateral note the condylopatellar sulcus (marked with an arrow): this helps identify the lateral femoral condyle which is large and flat. two tibial shadows (t) are formed by the anterior and posterior margins of the medial tibial plateau. Other projections.Note joint space narrowing (indicating cartilage loss) (n).

Right: The arrow indicates a loose body associated with osteoarthritis.Clinical .Amelioration .knees and elbows.GENERALS .. 1Clarke J. Left: Osteochondritis dissecans with involvement of a large portion of the medial femoral condyle.Left: Tuberculous arthritis with destruction of the medial joint compartment. . Right: Osgood–Schlatter’s disease. Right: Gross patellofemoral osteoarthritis. Rubric No. Left: Patella alta with a minor degree of genu recurvatum.housemaid's knee 2 Pulford A. Clinical Repertory (English) . Note the narrowing and irregularity of the lateral joint compartment.sitting amel. with cyst formation both in the femur and the patella. And T.. Note the prominent exostoses on both sides of the distal femur and of the upper tibia. Right: diaphyseal (metaphyseal aclasis). . rests head and arms on knees 3 ABDOMEN . Repertory of Pneumonia .lying . on Total remedies 7 1 1 Left: The CAT scan shows an intact anterior cruciate ligament. there are also changes in the proximal fibula. H. Note the horizontal striations (Looser’s zones) indicative of transient growth arrest.must sit up in bed with knees drawn up. Rubrics related to knee available in various Homoeopathic RepertoriesS.H . D.

Distortion .knee LOWER EXTREMITIES . including tetters .knee LOWER EXTREMITIES . in popliteal spaces LOWER EXTREMITIES .joints .joints . as if .joints .Nail driven in.joints .joints .knee 48 LOWER EXTREMITIES .Exudation into .joints .knee LOWER EXTREMITIES . weakness in COUGH .joints .knee LOWER EXTREMITIES .joints .Inversion of . pain as from .knee LOWER EXTREMITIES .knee LOWER EXTREMITIES .knee LOWER EXTREMITIES .Gait .knee LOWER EXTREMITIES .Numbness .knee LOWER EXTREMITIES .joints .joints .sense of .knee 2 1 2 13 1 2 2 21 4 24 3 11 23 16 1 9 1 1 1 5 52 2 1 4 7 3 9 15 22 1 2 2 1 12 1 17 2 17 6 1 20 1 17 1 10 .Bent inward .Gout-like pain .Muscles .Laming pain .Inflammation .Asleep.knee LOWER EXTREMITIES .joints .knee joints LOWER EXTREMITIES .knee LOWER EXTREMITIES .knees.Fatigue. pain as if . cramp (contraction) .contraction. etc.joints .knee joints LOWER EXTREMITIES .knee LOWER EXTREMITIES .up .knee LOWER EXTREMITIES .knee LOWER EXTREMITIES .joints . lancinating .joints .Constriction. as of a .Cramps .sense of . as if .kneeling or getting on hands and knees LOWER EXTREMITIES .Itching .knee LOWER EXTREMITIES .Eruption .Cutting.Band around.knee LOWER EXTREMITIES .knee LOWER EXTREMITIES .Breaking.Concomitants after coition .knee LOWER EXTREMITIES .Humming . easy .4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 SEXUAL IMPULSE .joints .Amelioration .Jerks .joints .Crawling. .joints .of knees and chin LOWER EXTREMITIES .knee joints LOWER EXTREMITIES .Distension .knee LOWER EXTREMITIES .joints .Drawn .knee LOWER EXTREMITIES .joints .knee LOWER EXTREMITIES . brittle.knee LOWER EXTREMITIES .Dryness .knee LOWER EXTREMITIES .Dislocation.knee joints LOWER EXTREMITIES .knee LOWER EXTREMITIES .Excoriation .knee joints LOWER EXTREMITIES . creeping. hamstrings 47 LOWER EXTREMITIES .knee LOWER EXTREMITIES .Eruption .herpes.Knock together .knee LOWER EXTREMITIES .Dislocative feeling .knee joints LOWER EXTREMITIES .Heaviness .Loose sensation .pimples .knee LOWER EXTREMITIES .knee LOWER EXTREMITIES .knee LOWER EXTREMITIES .Beating and throbbing .joints .pain .Burrowing or rooting pain .knee LOWER EXTREMITIES .joints .Gnawing .knock knee LOWER EXTREMITIES .Boring . shortening of . pain as from .Bruised .Fatigue.joints .Gurgling .Boils .joints .knee LOWER EXTREMITIES .Drawing .joints .joints .joints .Cracking .joints .knee.joints knee.

knees CONDITIONS OF AGGRAVATION AND AMELIORATION IN GENERAL .knee joints LOWER EXTREMITIES .Aggravation .Partial chill .Amelioration .knee LOWER EXTREMITIES .concomitants .joints .lower extremities .Swollen sensation .partial coldness .Soreness.knees CHILL .knee.knee joint LOWER EXTREMITIES . elbow position.knees CHILL .Quivering .Partial heat .joints .joints .Partial sweat .49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 LOWER EXTREMITIES .Whizzing.Twisting .Falling to sleep.joints .knee joints LOWER EXTREMITIES .knees CHILL .knee LOWER EXTREMITIES .Paralysis .Sprains and dislocations .knee joint LOWER EXTREMITIES .knee SENSATIONS AND COMPLAINTS IN GENERAL . tonic .lower extremities . late . impulse to move .Shooting .knee LOWER EXTREMITIES . as if .Stretched .knee joints LOWER EXTREMITIES .Stiff .Sensitiveness .joints .knee joints LOWER EXTREMITIES .knee LOWER EXTREMITIES .Partial coldness .Pulsation .of lower extremities .drawing .Spots .pain .Knee.knee LOWER EXTREMITIES .Ulcers or sores .Stubby . pain in HEAT AND FEVER IN GENERAL .Weak and weary .Short.knee joint LOWER EXTREMITIES .Sprained or dislocative pain. sense of . 16 8 28 2 4 1 16 2 8 6 13 1 1 3 27 38 72 7 1 18 6 63 39 4 29 1 20 1 67 1 2 1 1 1 11 28 8 2 8 48 9 7 .partial .Spasm. shooting . chilliness. .in joints .knee LOWER EXTREMITIES .lying .lower extremities .partial sweat .knee LOWER EXTREMITIES .partial chill .Restlessness. amel.joints .Partial coldness .knee.joints .Chill.joints .Tension .Pain.Twitching .Pressure .lower extremities .joints .knee LOWER EXTREMITIES .knee SLEEP .up . pain in CHILL .knee LOWER EXTREMITIES . .red .knee LOWER EXTREMITIES .knee LOWER EXTREMITIES .knee joint LOWER EXTREMITIES .knee LOWER EXTREMITIES .joints .on lower extremities .knee LOWER EXTREMITIES .knee LOWER EXTREMITIES .Tearing.Rheumatic pain .joints .joints .knee LOWER EXTREMITIES .Rending.knee LOWER EXTREMITIES .Swelling .knee LOWER EXTREMITIES .Trembling .joints . as if .partial .joints .Shivering .knee LOWER EXTREMITIES . ulcerative .or tight feeling in . simple .Thrusting pain .joints .joints .partial heat .knee LOWER EXTREMITIES .prevented by . tugging.knee LOWER EXTREMITIES .joints .coldness.knee joints LOWER EXTREMITIES . etc.knee LOWER EXTREMITIES .knee LOWER EXTREMITIES .knees CHILL .joints .in knees SWEAT .joints . etc. whirring .Stitches .

lying on back. to 103 I .91 CONDITIONS OF AGGRAVATION AND AMELIORATION IN GENERAL . on knees drawn up.cold .knees.Lying .middle. heart and knees were 128 Neck and back . illusions.Spine . with amel 113 S . to 114 S .Imaginations. on 116 S .Coryza . chest.lying . bed.below knees 107 L .on back.Groins . bent backwards.tuberculosis of.Lying .elbows and knees.hands and knees on amel 109 L .Pushed . knock against each other 101 G .sitting .Feet .knee were pushed against anterior wall from within 126 Abdomen .out against anterior walls in morning.knees.back.with knees drawn up.knees.Sciatica .lies. 92 CONDITIONS OF AGGRAVATION AND AMELIORATION IN GENERAL . drawn up and spread apart with 108 L .were biting above right knee 1 3 3 1 1 1 1 1 1 7 1 1 1 1 15 9 1 8 1 1 3 1 1 1 1 1 1 5 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .knee.Abdomen . on 120 S . with 98 C . hot with 111 P . knee to 125 Abdomen . hot.Crawling .arms and knees were 130 Upper extremities .Angina pectoris .Paralyzed . back. on body.vertebra . with 123 S .bending knee agg 112 R .head. delusions .beneath skin on right knee and back 129 Upper extremities . on.knees. 131 Lower extremities . knees. in .lies.Scrotum . amel.knees 106 L .knees.knees.knees.Lying .elbows.Lying . with 122 S .knees.curvature .Gait . clammy. fancies. 93 A .Knocked together. of . on .Cough . with 119 S . to 100 G .Wasp sting at knee and elbow. with knees drawn up amel 105 K .cord like swelling.knee chest position.Thighs . knees. on amel 118 S . up to knee with 97 C .Ants . to 121 S .Nose .hot. Pott' s disease . bends forwards and lifts his knees up.knees. with 110 N . in .back.knee. to knee 102 G .knees.Kidneys . elbow position. going through knee joints 132 Lower extremities . a child's knee were 127 Heart and circulation . on. bed. up to 115 S .Swallowing .Groins .Sits. resting her head and arms on knees 117 S . body bent backwards. with knees drawn up amel 94 A . knees.walks on knees.Sleeps .knees. as if 104 K .Aura .lies.Sleeps .Chorea .cold.Sits.Soles . with 95 A .Respiration .Air .Poplitaei .Legs .head bent forward on knee. amel.Child's . back. to hypogastrium 96 C . with head on pillow amel 99 F . on knees drawn up.lying .knees drawn up.Lying .Spine .numb. on .Sitting . while 124 T .face.

about knees Lower extremities .Claw of bird were clasping the knee Lower extremities .from feet to knee.Beaten .Band .Cord .Beaten .in knee.on the bend of left knee Lower extremities .Dislocated . in left knee Lower extremities .in knees Lower extremities . ready to Lower extremities .bubbles in hollow of right knee Lower extremities .from knee to heel.too tightly.Bugs were crawling from feet to knees Lower extremities .Beaten . something would Lower extremities .below the knee.above right knee.Crushed .133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 Lower extremities .in right knee Lower extremities .beneath skin on right knee and back Lower extremities .Blow .obliquely above left knee in wave-like intervals Lower extremities .Crawling .Bubbling .inwardly.above knees Lower extremities .Bruised .Drawn . bugs were Lower extremities .Blow . something had Lower extremities .Bruised .Crawling .Bubbles bursting in hollow of right knee Lower extremities .in sore knee Lower extremities . something were Lower extremities .Boiling .in knees Lower extremities .Biting . bones had been Lower extremities . wind were Lower extremities .Cord . flea were Lower extremities .Creeping .Bursting .in thighs and knees Lower extremities . knee joint would Lower extremities .bones above knee were Lower extremities .in knees Lower extremities .Beaten .tied around leg under knee Lower extremities . feet were Lower extremities .Burst .above the knee Lower extremities .of knee shortened Lower extremities .Blowing .Burst .Broken .above the left knee Lower extremities .Creak on motion.above right knee Lower extremities .in knee joint Lower extremities .in knee Lower extremities .Dead .Cold . freezing cold wind were Lower extremities .Biting .knees were Lower extremities . ants were Lower extremities .Dislocated .water or molten metal under skin in hollow of knee and down back of leg Lower extremities . knees were Lower extremities .Beaten .Bandaged .Cords .Bandaged .Broken .Bite of flea on inner side of right knee Lower extremities .in knees and ankles.up to knees.Crawled from knees to toes.around leg midway between hip and knee Lower extremities .knee were Lower extremities .on him from bend of knees.Blowing .Crushed .firmly about the knees when sitting Lower extremities .cords of legs behind knee were 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .Bound .Dislocated .

Forced .Hairs were being pulled out on inside of left knee Lower extremities .Paralysis .knees were Lower extremities .Loosened . tendons were too Lower extremities .Stone . left knee were being Lower extremities .Grasped . knees would not Lower extremities .above knee Lower extremities . Morning on rising Lower extremities .Loose .bite on inner side of right knee Lower extremities .ankles or knee joints were Lower extremities . knees would Lower extremities . thighs were Lower extremities .extends from above knee down lower leg Lower extremities .by both hands in evening. knees would Lower extremities .Swollen .Short .Stiffness in hollows of knees from a long walk.muscles in bend of knees were too Lower extremities .Pithy . left limb were severely Lower extremities .Flea .Short .Sprained .Pins .knees were Lower extremities .Paralyzed .Grasped .Larger .Paralyzed .a heavy.inside of left knee.Paralyzed .knees were too Lower extremities .way in knees and legs Lower extremities .Paralyzed .Flea .Knife .in bends of knees 1 1 1 5 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 5 1 1 1 1 2 1 1 .way.knees were.Give . he had been.Sink under her.Give .Short .extending to calves and knees.extends from above knee to foot Lower extremities .and beaten in knees Lower extremities .Pulled .Sting of a wasp at knee and elbow Lower extremities .Short .extending from feet to knees Lower extremities . agg.Kneeling a long time.arms and knees were Lower extremities .Sprained .Shortened .internal ligaments in right knee were Lower extremities .extending to knees. knee were Lower extremities .177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 Lower extremities .were biting above the knee Lower extremities .Ripped with a knife.cords of knee were too Lower extremities . immensely Lower extremities .by someone in anterior part of right knee Lower extremities .asunder. in right knee Lower extremities .in knees Lower extremities .left leg were from knee to hip Lower extremities .Swollen .under the knees.right knee were ripped with Lower extremities .of right knee Lower extremities .Sore . thighs were Lower extremities .way after emission.Grasped .the body. were tied to feet and knees Lower extremities . right knee were being Lower extremities .Support .Swollen .above the knee. hairs were being Lower extremities . knee were Lower extremities . knees would Lower extremities .Giving .Paralysis .knees were Lower extremities .cords of knees were Lower extremities .Molten metal or boiling water under the skin in the hollow of knee and down back of leg Lower extremities .Paralysis .Out of joint.

Pruritus . right knee were Skin . bends of knees FEVER .Walk . legs .Turned .knees SKIN .Concomitants .a few inches below the knee.Of . blowing on him from bend of the knees Lower extremities .knees.nausea.Erysipelas .Lower Extremities .were blowing on the knees Lower extremities .Wind .221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 Lower extremities .begins .Of .Ulcerated .Leg.Pruritus . hypogastrium NERVOUS SYSTEM .Chill .from .Pruritus .back.extending below knees in a.Tight . ankles. vomiting.were too short in hollow of knee Lower extremities .lying with knees drawn up LOCOMOTOR SYSTEM .Sweat .Water .knees. knees knock against each other when walking LOCOMOTOR SYSTEM . elbows.Walks on knees Lower extremities .Wrenched .above knee while standing and walking Lower extremities .Digging.Ulcerate .knees. cold knees SKIN .Tendons . morning on rising Lower extremities .Wind . below knee SKIN .around leg under knee. feet and knees FEVER . legs and knees would be Lower extremities . wrists. pantaloons were too Lower extremities .Herpes .Flea .In knees FEVER .about knee.Of . coldness .Wind .knees were Lower extremities .around or off.Biting .Tied .bends of elbows. makes knees cold Lower extremities .flexures of knees SKIN .when going upstairs. coldness .Chilliness.amelioration .Thighs.tightly below the knees Lower extremities .m. knees SKIN .Twisted .Water . a flea were Skin .thighs.boiling or molten metal under skin in hollow of knee and down back of leg Lower extremities .Pain in . hairy parts SKIN . vertigo. knee would Lower extremities .Aura . LOCOMOTOR SYSTEM .concomitants with .Of .Reflexes .in .outward only during walking.Epilepsy .Colic pain .when walking.were biting knee ABDOMEN .Asthma .above knee. from a long walk.feet were in cold. weak stomach. ascends to 2 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 6 7 1 1 5 2 2 2 1 2 3 1 1 .Tight .Herpes .Ulcerated .Crawling .Tightness at bend of knee Lower extremities .cold.In hands . right knee joint and leg below the knee were Lower extremities .Spastic.Chilliness. in left knee LOCOMOTOR SYSTEM .Gait . cardiac weakness.beneath skin on right knee and back Skin .Tied .Stiffness of knees RESPIRATORY SYSTEM .Of . cord were Lower extremities .Knees . something were Lower extremities .freezing cold.Knees .Pains .stiffness in hollow of knees. up to knees Lower extremities .

on .knee MIND .URINATION .NUMBNESS .PAIN .PAIN . pain in right HEAD .PAIN . on . .Inguinal region .extending to .labor pains .amel.extending to . with ABDOMEN .PAIN .extending to .Insomnia .back.extending to .SITTING .swelling of right knee.PAIN .knees upward during cough.accompanied by .accompanied by . with ABDOMEN .Sleep .JUMPING .PAIN . out of .PAIN .Position .alternating with .URINATION .ITCHING .Knees and up to sacrum FEMALE GENITALIA/SEX .dysuria . .left .TWITCHING . must wait for urine to start . on LOWER LIMBS .Inguinal region .grasping knees MIND .elbows on knees.bed.PAIN .Ovaries .Crest of ileum .extending to .Testes .LYING .Knee. on .Knees FEMALE GENITALIA/SEX .on hands and knees CONDITIONS OF AGGRAVATION AND AMELIORATION .amel.extending to .GESTURES.Joints .PAIN . and FEMALE GENITALIA/SEX .Scrotum . he walks on his MIND . on .PAIN . can pass only in BLADDER .hands.Temples .cold feet to knees in dysentery BLADDER . can pass urine only when on the KIDNEYS . with FEMALE GENITALIA/SEX .Thighs - 2 1 8 14 1 3 1 1 1 2 2 2 1 1 1 1 1 1 3 1 3 1 1 5 1 1 2 1 1 3 1 1 1 1 2 1 . bent double.swallowing .PAIN ..259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 hypogastrium NERVOUS SYSTEM .Ovaries . has to bend ABDOMEN .forward .CORYZA . pain in right NOSE .knees drawn up.amel.knees drawn up.DELUSIONS .walking . makes .extending to .knees drawn up.fell and knees gave out MIND .right .SITTING .PAIN .inclination to sit .back.back.Feet up to knees.separating knees as far as possible.extending to .Knee RECTUM .coldness of .lying .causes .Knee ABDOMEN .JERKING of the head .head forward and lift up knee. . .retarded.forward .bending .head on hands and elbows on knees.Knee ABDOMEN .extending to . with MIND .mushroom.Temples .COLDNESS .PAIN .Knee MALE GENITALIA/SEX . hot FACE .amel.knee-elbow position. he is commanded by a .extending to .PAIN .agg.inclination to sit .DELUSIONS .back.Knee ABDOMEN .confess his sins.knees NERVOUS SYSTEM .alternating with .Knees ABDOMEN . with HEAD .lying .Knee ABDOMEN .DYSENTERY .Knee. with KIDNEYS . . and HEAD .Knees MALE GENITALIA/SEX .knees drawn up.Iliac region .Knees.knees and pressing head against floor.Lying hands and knees amel.knees.PAIN .lying . cold and clammy THROAT .Ilium .PAIN .extending to . with ABDOMEN . involuntary motions of the . to fall on his knees and to MIND .

Knees .extending to .Hollow of knee EXTREMITIES .Knees BACK .coldness .elbows and knees amel.knees ..COLDNESS . sitting EXTREMITIES .dysentery.ANGINA pectoris .CARIES of bone .Legs .PAIN .Knee.Vertebrae.BANDAGED.knees 1 1 1 2 2 1 3 3 1 9 1 11 1 1 6 2 15 1 3 2 5 2 1 2 18 1 1 1 11 59 1 2 2 6 16 1 58 1 2 56 37 .ARTHRITIC nodosities .knees EXTREMITIES .rush of blood to .Knees Extremities .COLDNESS .BENDING .extending to .Knees.agg.Lumbar region . in EXTREMITIES .CLUCKING . of .VIOLENT . sitting .knees EXTREMITIES .swollen knee EXTREMITIES .CURVATURE of spine .elbows resting on knees COUGH .BUBBLING sensation .Feet .Knee.Knees Extremities .Bends of knees EXTREMITIES .knees EXTREMITIES .knees Extremities . . on BACK .knees EXTREMITIES .COLDNESS .Knees EXTREMITIES .Knees . on EXTREMITIES . sensation as if . with COUGH .AIR . below EXTREMITIES .lying on back with knees drawn up Extremities .CLUCKING .constriction .Knee.COLDNESS .head on knee-position RESPIRATION .COLDNESS .CRACKING in joints .cramps .Feet .Knee BACK .right .DIFFICULT .knees EXTREMITIES .abscess .CONTRACTION of muscles and tendons .Down knee.CONSTRICTION .Knees EXTREMITIES .sitting .Lumbar region .Knees .Knees EXTREMITIES .PAIN .BANDAGED. sensation of Extremities .extending to .Knees Extremities .Knee.jerking of head forward and knees upward.extending to .ankylosis .Knees.Hollow of knee EXTREMITIES .Knees Extremities .CALLOSITIES .JERKING of head forward and knees upward.extending to .knees EXTREMITIES .ASTHMATIC .Feet .lies on back with knees drawn up BACK .Knees RESPIRATION .lies on knees with body bent backwards BACK .compression .Hollow of knees EXTREMITIES .CONVULSION .295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 Inner surface .knees EXTREMITIES . sensation as if . .TUBERCULOSIS .extending to .amel.Legs . up to Extremities .Knees Extremities . spasmodic CHEST .chilliness .warm air through knees.arthrosis .bent forward . hollow of EXTREMITIES .convulsion . and FEMALE GENITALIA/SEX .BUBBLING sensation .Knees .Hollow of knees EXTREMITIES .PAIN .Knees .Uterus .BLOOD . cold feet to knee.PAIN .

knees EXTREMITIES .Knee EXTREMITIES .amel.JERKING .extending to .Knees Extremities .Knee EXTREMITIES .LIMPING .extending to .jerking .NUMBNESS .extending to .EXCRESCENCES .Knees EXTREMITIES .336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 EXTREMITIES .Knees .Legs .CRAMPS .extending to .Knees .Knee.extending to .Knees .PAIN .sensation of looseness .Knees. easy .lameness .HEAT .KNEES.Calves .itching . below EXTREMITIES .knees EXTREMITIES .Knees Extremities .Hollow of knees Extremities .Knee EXTREMITIES .Knee.Knees.knees Extremities . pain in EXTREMITIES .LYING .knees Extremities .Hollow of knees Extremities .KNOCKED together .PAIN .alternating with .FISTULOUS openings .Elbows .Thighs .ENLARGEMENT .eruptions .Sole of .PAIN . above 14 1 2 2 26 26 4 11 2 1 1 10 12 1 1 1 1 67 1 49 1 48 1 2 1 59 15 1 124 12 23 1 1 1 1 1 23 1 1 5 1 1 1 9 2 2 .gangrene .alternating with .Hollow of knees EXTREMITIES .Knee joints EXTREMITIES .Hollow of knees Extremities .sensation of .NUMBNESS .right knee.Knees EXTREMITIES .pain in knee.Knees Extremities .knees EXTREMITIES .aching .Below knees Extremities .formication .knees EXTREMITIES .Feet .knees EXTREMITIES .CRAMPS .Legs .jumping to knee EXTREMITIES .PAIN .inflammation .Knees .FORMICATION .ERUPTIONS .drawing up knee Extremities .MOISTURE .Knees .heaviness .Knees EXTREMITIES .IRRITATION of skin .fungous .Hollow of knee EXTREMITIES .Knees.Knees .give way .PAIN .Knees EXTREMITIES .LOOSENESS . complaints of EXTREMITIES . complaints of .Hollow of knees Extremities .Feet .Knees .agg.Ankles . from EXTREMITIES .Knees . below Extremities . under skin of EXTREMITIES .Feet . pain in EXTREMITIES .Knees.Knees.Soles .EXTENSION . hollow of EXTREMITIES .FORMICATION .FEET.PAIN .Hollow of knees EXTREMITIES .Legs .heat .knees Extremities .dislocation.PAIN . bend of EXTREMITIES .knees EXTREMITIES .Legs .Feet .inversion .knees Extremities .knees Extremities .knees EXTREMITIES .extending to .EXCORIATION .Soles .knees EXTREMITIES .knees EXTREMITIES . . .flexed .INFLAMMATION .HEAVINESS .Knees .Elbows .nodules .numbness .knees EXTREMITIES .

PAIN .Calves . 1 EXTREMITIES .PAIN .Hips .Knees .left .Knees .Knee 14 EXTREMITIES .Knee 34 EXTREMITIES .left knee 1 Extremities . pain in 1 left EXTREMITIES .Legs .extending to .Knees 1 EXTREMITIES .relaxation .extending to 2 Knees Extremities .Thighs .extending to . above 54 EXTREMITIES .supporting body with knee 1 EXTREMITIES .Tibia .Knee 1 EXTREMITIES .Thighs .Bones .and left knee 1 EXTREMITIES . from EXTREMITIES .Hollow of knee 1 EXTREMITIES .PAIN .extending to .sensation of .Hollow of knees .roughness .PAIN .Knee 1 EXTREMITIES .Thighs .extending to .right .Thighs .bending knee agg.Toes .restlessness .extending to .Knees.Calves .extending to .PAIN .Hips .PAIN .left knee 3 EXTREMITIES .PARALYSIS .right .Knee 2 EXTREMITIES .PAIN .Hollow of knees 126 EXTREMITIES .knee 14 Extremities .knees 1 EXTREMITIES .extending to .Knee 1 EXTREMITIES .PAIN .extending to .Knee.Hollow of knees 3 Extremities .PULSATION .knees 17 EXTREMITIES .bending knee agg.right .Knees .Knee 1 EXTREMITIES .Knee .PAIN .Nates .Legs .sitting with knees bent 1 EXTREMITIES .extending to .PAIN .Knee 2 EXTREMITIES .perspiration .PAIN .Knees 1 Extremities .Knees.cough agg.PAIN . 5 EXTREMITIES . 3 EXTREMITIES .Thighs .Legs .extending to .PAIN .bent.PAIN .Legs .Knees .Hips .pain .PAIN .and .PAIN .PAIN .extending to .Sciatic nerve .knees 4 Extremities .Hips .Knees .PAIN .Inner side .accompanied by .Bends of knees 1 EXTREMITIES .Forearms ..382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 EXTREMITIES .PAIN . during .knees 17 .paralysis .right .Shoulders . when knees are 1 EXTREMITIES .Legs .extending to .Thighs .knees 18 Extremities .Toes .First .PAIN .Lower limbs .PAIN .PAIN .sensation of .Legs .Patella .extending to .pulsation . below 4 EXTREMITIES .PAIN .right .followed by .bending knee agg. above 13 EXTREMITIES .PAIN .extending to .Lower limbs .Hollow of 2 knees EXTREMITIES .Knees .Knee 7 EXTREMITIES .PAIN .Knees.PAIN .Knees .PAIN .Sciatic nerve .Knee 1 EXTREMITIES .Trochanter .knees 13 EXTREMITIES .knees 379 EXTREMITIES .Knee.sensitive .SCRATCHING .extending to .evening .Calves .PAIN .Knee 1 EXTREMITIES .PAIN .extending to .PAIN .Thighs . hollow of 1 Extremities .Thighs .PAIN .Anterior part .Knees .Knee 4 Hip to knee.Upper limbs .

Knees 1 Extremities .Knees 3 Extremities .TWITCHING .THIGHS. .Knees .bending knee 1 agg.STANDING .ulcers .agg.TENSION .Knees .Hollow of knees 3 Extremities . on hands 3 .chin would be knocked together.Knees 1 EXTREMITIES . on 1 EXTREMITIES . . 1 pain in SLEEP .Legs .THRILLING sensation .bearing the weight upon the leg.tingling .knees 9 EXTREMITIES . complaints of .Knees 14 Extremities .back.WEAKNESS .Knee.alternating with swelling of knee 1 Extremities .Hollow of knees 62 EXTREMITIES . sensation of .knees 45 EXTREMITIES .knees 72 EXTREMITIES .Wrists .hands .shuddering .and knees.Knees .knees 10 Extremities .Knees .TWITCHING .Hollow of knees 11 EXTREMITIES .knees 2 EXTREMITIES .Knees .accompanied by .Hollow of knees 15 EXTREMITIES .knees 4 EXTREMITIES . 1 as if knees and EXTREMITIES .knees bent 6 SLEEP . 2 EXTREMITIES .weakness .shocks .knees 1 EXTREMITIES .Knees .Thighs . joints .knees 2 Extremities .knees 90 EXTREMITIES . with 1 knee bent EXTREMITIES .SWELLING .UNSTEADINESS. on .Thighs .Hollow of knees 3 EXTREMITIES .tension .Knees 13 Extremities . below 1 Extremities .Knee.sensation of .Knees .bending knee agg.Posterior part .SWELLING .Knees 22 Extremities .WEAKNESS .TWISTING sensation .POSITION .extending to 1 Knee Extremities .back.Knees .TENSION .knees.Lower limbs .tumors .knees 188 EXTREMITIES .varices .stiffness . middle of 1 EXTREMITIES .STIFFNESS .trembling .Hollow of knees 1 EXTREMITIES .swelling .twitching .Thighs .TWITCHING .WALKING .while .Knees.Knees .VIBRATION.TWITCHING .agg.POSITION .SITTING .knees 64 Extremities .Hollow of knees 4 EXTREMITIES . sensation as if . on .while .WEAKNESS .424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 Extremities .Knees .Hollow of knees .suppuration .foot rests on opposite knee with one leg 1 drawn upward SLEEP .knees 10 EXTREMITIES . EXTREMITIES .POSITION .SHORT.Hollow of knees 7 EXTREMITIES .extending to .STIFFNESS .knees 108 EXTREMITIES .TENSION .TUMORS .

8350 7405 7294 7169 7159 6845 6409 2. 6250 spig. 965 nit-ac.CONVULSIONS .LYING . nat-m.Sycosis76% c.BITING . Norman L.Knee.BEGINNING in .knees .Miasms present in total 474 rubrics related to kneea.Cancerous64% e. chin. rhus-t.must sit up in bed with knees drawn up. 65 58 54 53 53 53 4.fleas were biting. 49 chin.chest position.fleas were biting.Repertorization based on prominence of remediessulph.POSITION .Feet .CHOREA . III.Knees SKIN . as if . nux-v.SLEEPLESSNESS . puls. petr.Repertorization based on rare remediessulph. the SKIN . 997 caust. Browse  Case Taking Work Book .cold clammy feet up to knee. body bent backward. 1605 1331 1133 1091 1066 1008 argmet.POSITION . 46 caust. nat-m. puls.Knees.Above the knee GENERALS . rests her head and arms upon knees 15 7 3 2 4 1 1 1 2 1 2 Repertorial analysis of all the rubrics related to knee1. nit-ac. on GENERALS . kali-c. knee SLEEP . from .Tubercular65% d.pain. Bibliography A Comparison of the Chronic Miasms. If diagnosed in terms of homoeopathy in time. This leads to gross pathological changes and worsens the prognosis.epileptic . sep. in GENERALS . 49 ars. 6185 anac.BITING . knees and SLEEP . plat.knees .coldness.Knee CHILL . we find that most of the complaints are Psoric.Repertorization based on sum pf symptomsled. Due to being late in treating it correctly. the condition grows worsening and other miasms start harboring and manifesting their role actively. Phillis Speight  A Dictionary of Practical Materia Medica.SITTING .aura . John Henry Clarke  American Journal of Classical Homoeopathy  An Introduction to the Symptoms and Signs of Surgical Diseases.Knee.knees.Syphilis63% ConclusionAfter studying the disorders of knee joint in terms of homoeopathy.SLEEPLESSNESS . 986 chin.elbows bent. of SLEEP . sep. 46 3.Psora79% b. nux-v. the . as if . 968 bry. II. the knee complaints can surely be cured permanently.464 465 466 467 468 469 470 471 472 473 474 SLEEP . Vol. rhus-t. with GENERALS . I.Knees. 5680 zinc. coloc. from .

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