12: Knee Pain

Question 1

Softening and breakdown of articular cartilage of the patella (underside); bone rubbing on bone.

Answer 1

Chondromalacia

Question 2

T/F Always x-ray with patellar point tenderness or direct trauma to the patella.

Answer 2

True. Patellar fracture is a surgical emergency.

Question 3

• Caused by compression forces twisting and shearing.
• Often confused with meniscal tear, but over time it doesn’t improve.

Answer 3

Tibial plateau fracture

Question 4

Caused by twisting or rotary force usually applied to a flexed knee.

Answer 4

Meniscal tear (common in degeneration when menisci dry out)

Question 5

Ligament important for stabilization of the knee.

Answer 5

ACL

Question 6

Injury common in basketball and soccer.

Answer 6

ACL tear

Question 7

Injury common in football.

Answer 7

PCL tear

Question 8

Injury occurs when foot is planted, knee is flexed, and individual suddenly changes direction.

Answer 8

ACL tear

Question 9

Injury occurs when person is hit from behind to anterior proximal tibia and knee is flexed.

Answer 9

PCL tear

Question 10

Valgus stress or external force with knee flexed (football or basketball).

Answer 10

MCL tear

Question 11

Is an ACL or PCL tear more common?

Answer 11

ACL

Question 12

Is an MCL or LCL injury more commonly associated with an ACL tear?

Answer 12

MCL

Question 13

Varus stress causes injury.

Answer 13

LCL tear

Question 14

Can have sprains and pain for both the _____ and _____ ligaments, with stability.

Answer 14

Can have sprains and pain for both the lateral and medial collateral ligaments, with stability.

Question 15

Why is it important to ask if the knee buckles or gives out?

Answer 15

With a tear, the knee won’t give support.

Question 16

Locking may suggest a _____.

Answer 16

Locking may suggest a meniscal tear.

Question 17

What does a duck walk evaluate?

Answer 17

Meniscal tear

Question 18

Your patient presents with swelling and ecchymosis down the back of the leg. What do you suspect?

Answer 18

Ruputured Baker’s cyst.

Question 19

Where are Baker’s cysts found?

Answer 19

In popliteal fossa between heads of gastrocnemius.

Question 20

T/F We all have Baker’s cysts.

Answer 20

True. But some get enlarged and inflamed.

Question 21

According to Ottawa Rules for the knee, when do you order x-rays (5)?

Answer 21

1. 55+
2. Direct patellar point tenderness
3. Tenderness to head of fibula
4. Inability to flex 90 degrees
5. Inability to walk immediately (non-weight-bearing)

Question 22

What view of knee x-ray is best for looking underneath the patella?

Answer 22

Sunrise View

Question 23

Knee management (4).

Answer 23

1. NSAIDs
2. RICE
3. ACE wrap or knee support (better compression)
4. Evaluate for physical therapy

Question 24

T/F The knee is best examined immediately after injury.

Answer 24

Not always. Sometimes it can take a few days to optimally examine the knee (swelling).

Question 25

3 indications for an MRI.

Answer 25

1. Extremity is locked 2. Pain is too much 3. Patient cannot stand up (laxity)

Question 26

When do you refer to ortho for knee pain (7)?

Answer 26

1. Neurovascular compromise 2. Suspected fractures 3. Dislocation of patella 4. Grade 2 or 3 sprains (with laxity and bruising) 5. Suspected ACL injury 6. Torn meniscus 7. If no improvement after 2-4 weeks of conservative treatment

Question 27

If foot is turned medially (inward) and extended during McMurray it evaluates the \_\_\_\_\_.

Answer 27

If foot is turned medially (inward) and extended during McMurray it evaluates the **_lateral meniscus_**.

Question 28

If foot is turned laterally (outward) and extended during McMurray, it evaluates the \_\_\_\_\_.

Answer 28

If foot is turned laterally (outward) and extended during McMurray, it evaluates the **_medial meniscus_**.

Question 29

If the tibia subluxes and you can bring down the femur, this is a positive _____ and evaluates the ACL.

Answer 29

If the tibia subluxes and you can bring down the femur, this is a positive **_Lachmann_** and evaluates the ACL.

Question 30

Are MCL or LCL tears more common?

Answer 30

MCL

Question 31

A medial meniscus tear with point tenderness is more common after \_\_\_\_\_.

Answer 31

A medial meniscus tear with point tenderness is more common after **_trauma_**.

Question 32

Problems with _____ (patients with shallower grooves) esp in women can lead to arthritis, anterior knee pain, and patellar dislocation.

Answer 32

Problems with **_patellar tracking_** (patients with shallower grooves) esp in women can lead to arthritis, anterior knee pain, and patellar dislocation.

Question 33

In women, quadriceps contraction tends to have a more _____ pull (Q angle) that alters patellar tracking contributing to _____ knee pain.

Answer 33

In women, quadriceps contraction tends to have a more **_lateral_** pull (Q angle) that alters patellar tracking contributing to **_anterior_** knee pain.