11- knee pain Flashcards
Patellofemoral Pain Syndrome
location: Anterior knee pain
overuse injury, women
“theater sign”- mild to moderate anterior knee pain, worse after prolonged sitting
Iliotibial Band Tendonitis
location: Lateral knee pain
repetitive knee flexion)
Pain aggravated with activity
Anterior Cruciate Ligament Sprain
General knee pain
trauma: noncontact deceleration forces
Moderate to severe joint effusion
Swelling within two hours of “pop”
Medial Collateral Ligament Sprain
location: Medial joint line pain
trauma: misstep or collision
Immediate onset of pain/swelling after trauma
Lateral Collateral Ligament Sprain
LOCATION: Lateral joint line pain
trauma–> Immediate onset of lateral knee pain
Meniscal Tear
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
Septic arthritis
Generalized extreme pain with any movement
fever, elevated WBC, ESR
Abrupt onset of pain and swelling
Arthrocentesis with turbid synovial fluid
Osteoarthritis
pain aggrevated by weight-bearing activities, relieved by rest
Chronic joint stiffness and pain
Crepitus on exam
Mild or no joint effusion
Gout / pseudogout
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
Popliteal (Baker’s) Cyst
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.
A positive anterior drawer sign is indicative
anterior cruciate ligament injury.
Lachmans test assesses the stability of
anterior cruciate ligament
The valgus stress test assesses
the medial collateral ligament.
An abnormal varus stress test could indicate
rupture of the lateral collateral ligament.
posterior drawer test
posterior cruciate ligament
Children and adolescents who present with knee pain are likely to have
patellar subluxation, tibial apophysitis (Osgood-Schlatter), patellar tendonitis
Ankylosing spondylitis
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
SLE arthritis is typically
migratory
how many joints does RA usually affect
3 or more
when is MRI indicated
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.
Major radiographic features of OA
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.)
what is the first choice for short-term, mild to moderate pain related to osteoarthritis.
Paracetamol, or acetaminophen (NSAIDS 2nd choice)
exercise- low impact
Intra-articular corticosteroid injections
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!
is acupuncture helpful in knee pain?
yes
glucosamine and knee pain
may provide benefit
tramodol and knee pain
Older patients with moderate to severe pain may experience modest benefit; use is limited by side effects
can diet help knee pain?
omega 3- anti-inflammatory
Carpal Tunnel Exam tests
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
diagnostic test of choice for carpal tunnel syndrome is
electrodiagnostic test (a nerve conduction velocity study)
only needed if fail conservative management
signs it’s carpal tunnel
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
conservative management of carpal tunnel
nocturnal wrist splint for a month
Recommended Chronic Pain Control When Initial Conservative Treatment Fails
tramodol
long acting opioid
TCAs
tramodol
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
tramodol side effects
serious: seizures, serotonin syndrome, respiratory depression, angioedema, bronchospasm and dependency.
common :constipation, nausea, dizziness, and pruritis.
what is the color of normal synovial fluid,
straw colored
what is different colors of synovial fluid indicate
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
what test can confirm lyme disease in knee?
synovial fluid PCR
