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Because of this there will be a vicious cycle ensues, only exacerbated by further mechanical trauma to the joint, mostly in the form of sporting activity. Enzymatic breakdown of articular cartilage can lead to capsular distension and synovitis, worsening symptoms that causes the presence of an effusion . These pathologic changes create a feeling of achiness deep in the joint. After checking the patients' medical history, several key points on the physical examination should be specifically noted.

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