(2) Pathologies of the Knee Flashcards
What does pain at the knee cap which can worsen walking down the stairs normally indicate?
- patellofemoral pain
- patella tracking
- bursitis
- arthritis
What does pain on the medial aspect of the knee indicate?
- meniscus tear
- medial collateral ligament
- arthritis / bursitis
What does pain on the side of the knee cap (inside or outside) indicate?
- meniscus / lig tear
- arthritis
What does pain that runs down the side of the leg causing pain at the hip or patella indicate?
Iliotibial band syndrome
What is Knee OA?
- chronic degenerative joint disease
- progressive damage to and loss of articular cartilage
How does osteoarthritis occur?
- overexpression of degenerative enzymes
- loss of glycogen & proteoglycans
- chondrocytes secrete tissue inhibitors of MMP’s
- insufficient & loss articular cartilage elasticity
- cracking & fissuring cartilage
- +/- erosion of articular surface
What do osteophytes do?
- reactive bone formation/remodeling
- cellular repair response
What are the different grades of knee OA?
I - minimal disruption, 10% cartilage loss
II - joint spacing narrowed, cartilage breakdown, osteophytes
III - moderate joint space reduction, gaps cartilage expand bone
IV - joint space greatly reduced, 60% cartilage loss, large osteophytes
What are the risk factors for knee OA?
- trauma / instability
- weight gain / obesity
- other inflammatory arthritis (RA, Gout)
- genetics
What are the symptoms for knee OA?
- pain
- stiffness
- crepitus
- swelling
- weakness
- giving way
What can be seen on X-rays for knee OA?
- joint space narrowing
- osteophyte formation
- subchondral sclerosis
- subchondral cysts
What are the emerging phenotypes of knee OA?
- Minimal joint disease
- Chronic pain
- Maligned biomechanical
- Inflammatory
- Metabolic disorders
- Bone and cartilage metabolism
- Complex ROA
How is knee OA managed?
- exercise
- weight management
- info & support
- pharmaceutical management
What is rheumatoid arthritis?
- chronic autoimmune inflammatory disease that affects the joints
- results in pain, swelling & stiffness
What are signs of RA?
- morning stiffness >30 mins
- pain
- stiffness
- swelling
- red & warmth
How is RA diagnosed?
- blood tests
- X-rays
What is Calcium Pyrophosphate Deposition (CPPD) disease?
- accumulation calcium pyrophosphate crystals
- sudden swelling/pain in joints
What is the treatment for RA?
- similar presentation to OA
- treat as OA
What is Baker’s Cyst?
Fluid filled swelling develops at the back of the knee
What are the symptoms of Baker’s Cyst?
- asymptomatic
- posterior pain
- swelling
- tightness
What causes Bakers Cyst?
- OA
- RA
- septic arthritis
What is the Rx for Bakers Cyst?
- reassurance & explanation
- NSAID’s
- corticosteroids
What is the meniscus?
The cartilage found between the bones in the knee joint that protects them when you move
What is the function of the meniscus?
- force transmission
- shock absorption
- stability
What is the MOI for traumatic meniscus injuries?
twisting of flexed (weight-bearing) knee
What are the signs of a traumatic meniscal injury?
- pain
- +/- swelling
- +/- locking
What are the signs of a traumatic meniscal injury?
- decreased ROM
- block extension
- +/- meniscal tests
- joint tenderness
What is the Rx protocol for traumatic meniscal injury?
- acute (PRICE)
- sub-acute (POLICE)
What is the role of the physio in traumatic meniscal injuries?
- ROM
- strengthening
- proprioception
- RTP
- advice and education
How do degenerative meniscal injuries occur?
- Older age (~50-70 years)
- most are asymptomatic
- insidious onset (gradual but harmful)
What are the risk factors for degenerative meniscal injuries?
- > 60 years
- work related kneeling / squatting
- BMI >25
What are the symptoms of degenerative meniscal tears?
- pain
- joint line tenderness
- +/- locking
- +/- swelling
What is the treatment for degenerative meniscal tears?
- based clinical signs & symptoms
- advice / education / counselling
- exercise rehab
- corticosteroid injection
- defer from mri and surgery unless suspicion
What is the role of the anterior cruciate ligament (ACL)
- primary stabiliser
- limits anterior tibial translation and IR
What happens when there is an ACL deficiency?
- anterior & rotatory instability
What is the MOI for an ACL?
- non contact (70%)
- pivoting/twisting with foot planted
- cutting/ jumping / landing knee slight flex & valgus
- hyperextension landing
- hyperflexion (skiing)
What is a grade 1 ACL injury?
- no tear
- min pain & swelling
- no instability
- firm end feel
What is a grade 2 ACL injury?
- partial/incomplete tear
- moderate pain/swelling
- possible instability
- increased anterior translation but firm end feel
- likely +ve tests
What is a grade 3 ACL injury?
- fibres completely torn
- min pain
- variable swelling
- instability
- +ve tests
- bleeding in the joint cavity
What are symptoms of an ACL injury?
LIMP
- Leg giving way
- Inability continue after injury
- Marked effusion
- Pop at time injury
Other
- appropriate MOI
- pain, swelling, instability
What are signs of an ACL injury?
- swelling
- decreased ROM
- arthrogenic muscle inhibition
- limping gait
- +ve anterior drawer & Lachmans
How is the anterior drawer test performed?
- supine w knee 45 degrees
- shift tibia forward/anteriorly at joint line
- +ve considerable mvmt
How is the Lachman test performed?
- supine w knee 20-30 degrees
- shift/glide tibia anterior in front femur
- +ve significant gliding anterior motion with soft end feel (little resistance)
What is the Tx for the acute phase of an ACL injury?
- PRICE/POLICE
- Early exercise
- ROM, strength, walking aid
What is the Tx during the sub-acute phase and onwards for an ACL injury?
- progressive
- strength & power
- proprioception & NM
- speed and agility
- RTP
How is the Post ACL reconstruction rehab structured?
- Timing & Structure
- Modalities
- Exercise Initiation
- Strength & motor control
- Return activities
What is the MOI for an MCL injury?
- abrupt turning
- cutting/twisting
- direct impact lateral knee
What are signs of an MCL injury?
- medial pain
- hear/feel pop
- decreased ROM
- +ve valgus stress test
- pain palpation
What is the Rx for an MCL injury?
- PRICE/POLICE
- +/- brace
- ROM
- Endurance & Strength
- Proprioception
- RTP advice
What is ITB syndrome?
lateral knee pain
How does ITB syndrome occur?
- repetitive friction of the ITB sliding over lateral femoral epicondyle
- compression syndrome
- weakness ext rotators & abd
What are the symptoms of ITB syndrome?
- localised pain around lateral femoral condyle
- +/- snapping, clicking sound
- +/- swelling
What are the signs of ITB syndrome?
- +ve Obers/modified obers
- local tenderness at inferior lateral femoral epicondyle
What is the Rx for ITB syndrome?
- soft tissue
- ice/heat
- hip strengthening & co-ordination
- advice & educate
- corticosteroid or NSAIDs
