12: Knee Pain Flashcards
Softening and breakdown of articular cartilage of the patella (underside); bone rubbing on bone.
Chondromalacia
T/F Always x-ray with patellar point tenderness or direct trauma to the patella.
True. Patellar fracture is a surgical emergency.
- Caused by compression forces twisting and shearing.
- Often confused with meniscal tear, but over time it doesn’t improve.
Tibial plateau fracture
Caused by twisting or rotary force usually applied to a flexed knee.
Meniscal tear (common in degeneration when menisci dry out)
Ligament important for stabilization of the knee.
ACL
Injury common in basketball and soccer.
ACL tear
Injury common in football.
PCL tear
Injury occurs when foot is planted, knee is flexed, and individual suddenly changes direction.
ACL tear
Injury occurs when person is hit from behind to anterior proximal tibia and knee is flexed.
PCL tear
Valgus stress or external force with knee flexed (football or basketball).
MCL tear
Is an ACL or PCL tear more common?
ACL
Is an MCL or LCL injury more commonly associated with an ACL tear?
MCL
Varus stress causes injury.
LCL tear
Can have sprains and pain for both the _____ and _____ ligaments, with stability.
Can have sprains and pain for both the lateral and medial collateral ligaments, with stability.
Why is it important to ask if the knee buckles or gives out?
With a tear, the knee won’t give support.
Locking may suggest a _____.
Locking may suggest a meniscal tear.
What does a duck walk evaluate?
Meniscal tear
Your patient presents with swelling and ecchymosis down the back of the leg. What do you suspect?
Ruputured Baker’s cyst.
Where are Baker’s cysts found?
In popliteal fossa between heads of gastrocnemius.
T/F We all have Baker’s cysts.
True. But some get enlarged and inflamed.
According to Ottawa Rules for the knee, when do you order x-rays (5)?
- 55+
- Direct patellar point tenderness
- Tenderness to head of fibula
- Inability to flex 90 degrees
- Inability to walk immediately (non-weight-bearing)
What view of knee x-ray is best for looking underneath the patella?
Sunrise View
Knee management (4).
- NSAIDs
- RICE
- ACE wrap or knee support (better compression)
- Evaluate for physical therapy
T/F The knee is best examined immediately after injury.
Not always. Sometimes it can take a few days to optimally examine the knee (swelling).
3 indications for an MRI.
- Extremity is locked
- Pain is too much
- Patient cannot stand up (laxity)
When do you refer to ortho for knee pain (7)?
- Neurovascular compromise
- Suspected fractures
- Dislocation of patella
- Grade 2 or 3 sprains (with laxity and bruising)
- Suspected ACL injury
- Torn meniscus
- If no improvement after 2-4 weeks of conservative treatment
If foot is turned medially (inward) and extended during McMurray it evaluates the _____.
If foot is turned medially (inward) and extended during McMurray it evaluates the lateral meniscus.
If foot is turned laterally (outward) and extended during McMurray, it evaluates the _____.
If foot is turned laterally (outward) and extended during McMurray, it evaluates the medial meniscus.
If the tibia subluxes and you can bring down the femur, this is a positive _____ and evaluates the ACL.
If the tibia subluxes and you can bring down the femur, this is a positive Lachmann and evaluates the ACL.
Are MCL or LCL tears more common?
MCL
A medial meniscus tear with point tenderness is more common after _____.
A medial meniscus tear with point tenderness is more common after trauma.
Problems with _____ (patients with shallower grooves) esp in women can lead to arthritis, anterior knee pain, and patellar dislocation.
Problems with patellar tracking (patients with shallower grooves) esp in women can lead to arthritis, anterior knee pain, and patellar dislocation.
In women, quadriceps contraction tends to have a more _____ pull (Q angle) that alters patellar tracking contributing to _____ knee pain.
In women, quadriceps contraction tends to have a more lateral pull (Q angle) that alters patellar tracking contributing to anterior knee pain.
