11- knee pain

Question 1

Patellofemoral Pain Syndrome

Answer 1

location: Anterior knee pain

overuse injury, women

“theater sign”- mild to moderate anterior knee pain, worse after prolonged sitting

Question 2

Iliotibial Band Tendonitis

Answer 2

location: Lateral knee pain

repetitive knee flexion)

Pain aggravated with activity

Question 3

Anterior Cruciate Ligament Sprain

Answer 3

General knee pain

trauma: noncontact deceleration forces

Moderate to severe joint effusion

Swelling within two hours of “pop”

Question 4

Medial Collateral Ligament Sprain

Answer 4

location: Medial joint line pain
trauma: misstep or collision

Immediate onset of pain/swelling after trauma

Question 5

Lateral Collateral Ligament Sprain

Answer 5

LOCATION: Lateral joint line pain

trauma–> Immediate onset of lateral knee pain

Question 6

Meniscal Tear

Answer 6

Medial or lateral joint line

sudden twisting injury

Can occur with chronic degenerative process

Mild effusion

Possible atrophy of the vastus medialis obliquus portion of the quadriceps

Catching/locking of the knee

Can have positive McMurray test

Question 7

Septic arthritis

Answer 7

Generalized extreme pain with any movement

fever, elevated WBC, ESR

Abrupt onset of pain and swelling
Arthrocentesis with turbid synovial fluid

Question 8

Osteoarthritis

Answer 8

pain aggrevated by weight-bearing activities, relieved by rest

Chronic joint stiffness and pain
Crepitus on exam
Mild or no joint effusion

Question 9

Gout / pseudogout

Answer 9

Extreme pain with any movement; also painful to touch

Acute pain and swelling without prior trauma
Arthrocentesis with clear or slightly cloudy synovial fluid

Negatively birefringent rods in gout
Positively birefringent rhomboids in pseudogout

Question 10

Popliteal (Baker’s) Cyst

Answer 10

insidious onset of mild to moderate pain in the popliteal area of the knee

Arise in association with underlying disease, including rheumatoid arthritis or osteoarthritis.

Posterior knee pain if the cyst is large, and can also have difficulty fully flexing the knee.

Symptomatic cysts can often be palpated on exam in the posterior fossa.

Question 11

A positive anterior drawer sign is indicative

Answer 11

anterior cruciate ligament injury.

Question 12

Lachmans test assesses the stability of

Answer 12

anterior cruciate ligament

Question 13

The valgus stress test assesses

Answer 13

the medial collateral ligament.

Question 14

An abnormal varus stress test could indicate

Answer 14

rupture of the lateral collateral ligament.

Question 15

posterior drawer test

Answer 15

posterior cruciate ligament

Question 16

Children and adolescents who present with knee pain are likely to have

Answer 16

patellar subluxation,
 tibial apophysitis (Osgood-Schlatter),
 patellar tendonitis

Question 17

Ankylosing spondylitis

Answer 17

It is a chronic inflammatory process of the axial skeleton, resulting in chronic back pain and progressive loss of motion of the spine. Hips are sometimes affected as well.

young adults, hla-b27

Question 18

SLE arthritis is typically

Answer 18

migratory

Question 19

how many joints does RA usually affect

Answer 19

3 or more

Question 20

when is MRI indicated

Answer 20

if locking, popping, or joint instability were of concern, to detect meniscal or ligament damage. However, if an x-ray shows significant joint space narrowing, an MRI would likely not be needed even if there were mechanical symptoms, unless the patient fails to improve with conservative management.

Question 21

Major radiographic features of OA

Answer 21

Joint space narrowing

Subchondral sclerosis (Hardening of tissue beneath the cartilage. In osteoarthritis, there is increased periarticular bone density.)

Osteophytes (Also known as bone spurs; bony projections arising from the joint.)

Subchondral cysts (Fluid-filled sacs in the bone marrow.)

Question 22

what is the first choice for short-term, mild to moderate pain related to osteoarthritis.

Answer 22

Paracetamol, or acetaminophen (NSAIDS 2nd choice)

exercise- low impact

Question 23

Intra-articular corticosteroid injections

Answer 23

Should be considered if the knee joint is inflamed, as evidenced by swelling and pain.

No more than three injections per year, and no more frequent than one injection per month.

Long-acting triamcinolone is typically preferred over methylprednisolone, and 1 ml of steroid should be combined with 3-4 ml local anesthetic.

24 hours of immobilization following the injection helps maximize the effects, but prolonged rest should be avoided.

short term!

Question 24

is acupuncture helpful in knee pain?

Answer 24

yes

Question 25

glucosamine and knee pain

Answer 25

may provide benefit

Question 26

tramodol and knee pain

Answer 26

Older patients with moderate to severe pain may experience modest benefit; use is limited by side effects

Question 27

can diet help knee pain?

Answer 27

omega 3- anti-inflammatory

Question 28

Carpal Tunnel Exam tests

Answer 28

Tinel’s sign: Tap over the median nerve at the wrist to reproduce symptoms.

Phalen’s test: Flex wrist by having patient place dorsal surfaces of hands together in front of her for 30 to 60 seconds to reproduce symptoms.

low sensitivity

Question 29

diagnostic test of choice for carpal tunnel syndrome is

Answer 29

electrodiagnostic test (a nerve conduction velocity study)

only needed if fail conservative management

Question 30

signs it’s carpal tunnel

Answer 30

Hand symptom diagrams (patient indicates symptoms in at least 2 of digits 1, (thumb) 2, and 3 (“classic” pattern), or with palmar symptoms as long as not confined only to ulnar aspect of palm (“probable” pattern))

Hypalgesia (decreased sensitivity to pain)

Weak thumb abduction strength testing

Question 31

conservative management of carpal tunnel

Answer 31

nocturnal wrist splint for a month

Question 32

Recommended Chronic Pain Control When Initial Conservative Treatment Fails

Answer 32

tramodol

long acting opioid

TCAs

Question 33

tramodol

Answer 33

a centrally acting analgesic with effects on the μ-opioid receptor that also stimulates release of serotonin and inhibits reuptake of norepinephrine,

alleviating moderate to severe pain

lower abuse potential than other opioids

Question 34

tramodol side effects

Answer 34

serious: seizures, serotonin syndrome, respiratory depression, angioedema, bronchospasm and dependency.

common :constipation, nausea, dizziness, and pruritis.

Question 35

what is the color of normal synovial fluid,

Answer 35

straw colored

Question 36

what is different colors of synovial fluid indicate

Answer 36

yellow- green: increased number of plasma/nucleated cells, seen in inflammatory and septic arthritis.

cloudy: increased number of WBC’s or crystals

pink, red: blood- traumatic tap

Question 37

what test can confirm lyme disease in knee?

Answer 37

synovial fluid PCR