18: Approach to Knee Complaint

Question 1

What causes bruising in a sprain?

Answer 1

Bleeding outside the sprained ligament

Question 2

Symptom vs sign

Answer 2

Symptom: subjective (reported by pt)
Sign: objective (can be appreciated by physician)

Question 3

What type of sensation might be felt with sprain vs strain

Answer 3

Sprain: pop
Strain: grabbing sensation

Question 4

Swelling in a ligament disruption or fracture vs sprain or meniscus injury

Answer 4

Ligament disruption and fracture: swelling immediate or within 2hrs of injury
Sprain or meniscus injury: swelling appears after 2hrs from onset

Question 5

Weight bearing with ligament disruption and fracture vs sprain or meniscus injury

Answer 5

Ligament disruption and fracture: unable to bear weight

Sprain and meniscus injury: can typically bear weight

Question 6

How to start palpating a joint

Answer 6

Start with the unaffected side - tell the patient that everything you do to that side, you’ll do to the other side

Question 7

Apprehension test

Answer 7

Suggest moving the patella - if pt is apprehensive, they likely have patellar instability

Question 8

Most commonly injured knee ligament

Answer 8

ACL

Question 9

Contact vs non-contact injury of the ACL

Answer 9

Contact: fixed lower leg with direct blow -> hyperextension or valgus deformation
Non-contact: sudden deceleration + change in direction

Question 10

Which is more common for ACL injuries, contact or non-contact injury?

Answer 10

Non-contact (70% of ACL injuries)