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MsK Lower Limb > (2) Pathologies of the Knee > Flashcards

(2) Pathologies of the Knee Flashcards

1
Q

What does pain at the knee cap which can worsen walking down the stairs normally indicate?

A
  • patellofemoral pain
  • patella tracking
  • bursitis
  • arthritis
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2
Q

What does pain on the medial aspect of the knee indicate?

A
  • meniscus tear
  • medial collateral ligament
  • arthritis / bursitis
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3
Q

What does pain on the side of the knee cap (inside or outside) indicate?

A
  • meniscus / lig tear
  • arthritis
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4
Q

What does pain that runs down the side of the leg causing pain at the hip or patella indicate?

A

Iliotibial band syndrome

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5
Q

What is Knee OA?

A
  • chronic degenerative joint disease
  • progressive damage to and loss of articular cartilage
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6
Q

How does osteoarthritis occur?

A
  • 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
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7
Q

What do osteophytes do?

A
  • reactive bone formation/remodeling
  • cellular repair response
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8
Q

What are the different grades of knee OA?

A

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

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9
Q

What are the risk factors for knee OA?

A
  • trauma / instability
  • weight gain / obesity
  • other inflammatory arthritis (RA, Gout)
  • genetics
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10
Q

What are the symptoms for knee OA?

A
  • pain
  • stiffness
  • crepitus
  • swelling
  • weakness
  • giving way
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11
Q

What can be seen on X-rays for knee OA?

A
  • joint space narrowing
  • osteophyte formation
  • subchondral sclerosis
  • subchondral cysts
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12
Q

What are the emerging phenotypes of knee OA?

A
  1. Minimal joint disease
  2. Chronic pain
  3. Maligned biomechanical
  4. Inflammatory
  5. Metabolic disorders
  6. Bone and cartilage metabolism
  7. Complex ROA
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13
Q

How is knee OA managed?

A
  • exercise
  • weight management
  • info & support
  • pharmaceutical management
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14
Q

What is rheumatoid arthritis?

A
  • chronic autoimmune inflammatory disease that affects the joints
  • results in pain, swelling & stiffness
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15
Q

What are signs of RA?

A
  • morning stiffness >30 mins
  • pain
  • stiffness
  • swelling
  • red & warmth
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16
Q

How is RA diagnosed?

A
  • blood tests
  • X-rays
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17
Q

What is Calcium Pyrophosphate Deposition (CPPD) disease?

A
  • accumulation calcium pyrophosphate crystals
  • sudden swelling/pain in joints
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18
Q

What is the treatment for RA?

A
  • similar presentation to OA
  • treat as OA
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19
Q

What is Baker’s Cyst?

A

Fluid filled swelling develops at the back of the knee

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20
Q

What are the symptoms of Baker’s Cyst?

A
  • asymptomatic
  • posterior pain
  • swelling
  • tightness
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21
Q

What causes Bakers Cyst?

A
  • OA
  • RA
  • septic arthritis
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22
Q

What is the Rx for Bakers Cyst?

A
  • reassurance & explanation
  • NSAID’s
  • corticosteroids
23
Q

What is the meniscus?

A

The cartilage found between the bones in the knee joint that protects them when you move

24
Q

What is the function of the meniscus?

A
  • force transmission
  • shock absorption
  • stability
25
Q

What is the MOI for traumatic meniscus injuries?

A

twisting of flexed (weight-bearing) knee

26
Q

What are the signs of a traumatic meniscal injury?

A
  • pain
  • +/- swelling
  • +/- locking
27
Q

What are the signs of a traumatic meniscal injury?

A
  • decreased ROM
  • block extension
  • +/- meniscal tests
  • joint tenderness
28
Q

What is the Rx protocol for traumatic meniscal injury?

A
  • acute (PRICE)
  • sub-acute (POLICE)
29
Q

What is the role of the physio in traumatic meniscal injuries?

A
  • ROM
  • strengthening
  • proprioception
  • RTP
  • advice and education
30
Q

How do degenerative meniscal injuries occur?

A
  • Older age (~50-70 years)
  • most are asymptomatic
  • insidious onset (gradual but harmful)
31
Q

What are the risk factors for degenerative meniscal injuries?

A
  • > 60 years
  • work related kneeling / squatting
  • BMI >25
32
Q

What are the symptoms of degenerative meniscal tears?

A
  • pain
  • joint line tenderness
  • +/- locking
  • +/- swelling
33
Q

What is the treatment for degenerative meniscal tears?

A
  • based clinical signs & symptoms
  • advice / education / counselling
  • exercise rehab
  • corticosteroid injection
  • defer from mri and surgery unless suspicion
34
Q

What is the role of the anterior cruciate ligament (ACL)

A
  • primary stabiliser
  • limits anterior tibial translation and IR
35
Q

What happens when there is an ACL deficiency?

A
  • anterior & rotatory instability
36
Q

What is the MOI for an ACL?

A
  • non contact (70%)
  • pivoting/twisting with foot planted
  • cutting/ jumping / landing knee slight flex & valgus
  • hyperextension landing
  • hyperflexion (skiing)
37
Q

What is a grade 1 ACL injury?

A
  • no tear
  • min pain & swelling
  • no instability
  • firm end feel
38
Q

What is a grade 2 ACL injury?

A
  • partial/incomplete tear
  • moderate pain/swelling
  • possible instability
  • increased anterior translation but firm end feel
  • likely +ve tests
39
Q

What is a grade 3 ACL injury?

A
  • fibres completely torn
  • min pain
  • variable swelling
  • instability
  • +ve tests
  • bleeding in the joint cavity
40
Q

What are symptoms of an ACL injury?

A

LIMP
- Leg giving way
- Inability continue after injury
- Marked effusion
- Pop at time injury
Other
- appropriate MOI
- pain, swelling, instability

41
Q

What are signs of an ACL injury?

A
  • swelling
  • decreased ROM
  • arthrogenic muscle inhibition
  • limping gait
  • +ve anterior drawer & Lachmans
42
Q

How is the anterior drawer test performed?

A
  • supine w knee 45 degrees
  • shift tibia forward/anteriorly at joint line
  • +ve considerable mvmt
43
Q

How is the Lachman test performed?

A
  • supine w knee 20-30 degrees
  • shift/glide tibia anterior in front femur
  • +ve significant gliding anterior motion with soft end feel (little resistance)
44
Q

What is the Tx for the acute phase of an ACL injury?

A
  • PRICE/POLICE
  • Early exercise
  • ROM, strength, walking aid
45
Q

What is the Tx during the sub-acute phase and onwards for an ACL injury?

A
  • progressive
  • strength & power
  • proprioception & NM
  • speed and agility
  • RTP
46
Q

How is the Post ACL reconstruction rehab structured?

A
  • Timing & Structure
  • Modalities
  • Exercise Initiation
  • Strength & motor control
  • Return activities
47
Q

What is the MOI for an MCL injury?

A
  • abrupt turning
  • cutting/twisting
  • direct impact lateral knee
48
Q

What are signs of an MCL injury?

A
  • medial pain
  • hear/feel pop
  • decreased ROM
  • +ve valgus stress test
  • pain palpation
49
Q

What is the Rx for an MCL injury?

A
  • PRICE/POLICE
  • +/- brace
  • ROM
  • Endurance & Strength
  • Proprioception
  • RTP advice
50
Q

What is ITB syndrome?

A

lateral knee pain

51
Q

How does ITB syndrome occur?

A
  • repetitive friction of the ITB sliding over lateral femoral epicondyle
  • compression syndrome
  • weakness ext rotators & abd
52
Q

What are the symptoms of ITB syndrome?

A
  • localised pain around lateral femoral condyle
  • +/- snapping, clicking sound
  • +/- swelling
53
Q

What are the signs of ITB syndrome?

A
  • +ve Obers/modified obers
  • local tenderness at inferior lateral femoral epicondyle
54
Q

What is the Rx for ITB syndrome?

A
  • soft tissue
  • ice/heat
  • hip strengthening & co-ordination
  • advice & educate
  • corticosteroid or NSAIDs

MsK Lower Limb (8 decks)

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