(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
What is the MOI for traumatic meniscus injuries?
twisting of flexed (weight-bearing) knee
26
What are the signs of a traumatic meniscal injury?
- pain - +/- swelling - +/- locking
27
What are the signs of a traumatic meniscal injury?
- decreased ROM - block extension - +/- meniscal tests - joint tenderness
28
What is the Rx protocol for traumatic meniscal injury?
- acute (PRICE) - sub-acute (POLICE)
29
What is the role of the physio in traumatic meniscal injuries?
- ROM - strengthening - proprioception - RTP - advice and education
30
How do degenerative meniscal injuries occur?
- Older age (~50-70 years) - most are asymptomatic - insidious onset (gradual but harmful)
31
What are the risk factors for degenerative meniscal injuries?
- >60 years - work related kneeling / squatting - BMI >25
32
What are the symptoms of degenerative meniscal tears?
- pain - joint line tenderness - +/- locking - +/- swelling
33
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
34
What is the role of the anterior cruciate ligament (ACL)
- primary stabiliser - limits anterior tibial translation and IR
35
What happens when there is an ACL deficiency?
- anterior & rotatory instability
36
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)
37
What is a grade 1 ACL injury?
- no tear - min pain & swelling - no instability - firm end feel
38
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
39
What is a grade 3 ACL injury?
- fibres completely torn - min pain - variable swelling - instability - +ve tests - bleeding in the joint cavity
40
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
41
What are signs of an ACL injury?
- swelling - decreased ROM - arthrogenic muscle inhibition - limping gait - +ve anterior drawer & Lachmans
42
How is the anterior drawer test performed?
- supine w knee 45 degrees - shift tibia forward/anteriorly at joint line - +ve considerable mvmt
43
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)
44
What is the Tx for the acute phase of an ACL injury?
- PRICE/POLICE - Early exercise - ROM, strength, walking aid
45
What is the Tx during the sub-acute phase and onwards for an ACL injury?
- progressive - strength & power - proprioception & NM - speed and agility - RTP
46
How is the Post ACL reconstruction rehab structured?
- Timing & Structure - Modalities - Exercise Initiation - Strength & motor control - Return activities
47
What is the MOI for an MCL injury?
- abrupt turning - cutting/twisting - direct impact lateral knee
48
What are signs of an MCL injury?
- medial pain - hear/feel pop - decreased ROM - +ve valgus stress test - pain palpation
49
What is the Rx for an MCL injury?
- PRICE/POLICE - +/- brace - ROM - Endurance & Strength - Proprioception - RTP advice
50
What is ITB syndrome?
lateral knee pain
51
How does ITB syndrome occur?
- repetitive friction of the ITB sliding over lateral femoral epicondyle - compression syndrome - weakness ext rotators & abd
52
What are the symptoms of ITB syndrome?
- localised pain around lateral femoral condyle - +/- snapping, clicking sound - +/- swelling
53
What are the signs of ITB syndrome?
- +ve Obers/modified obers - local tenderness at inferior lateral femoral epicondyle
54
What is the Rx for ITB syndrome?
- soft tissue - ice/heat - hip strengthening & co-ordination - advice & educate - corticosteroid or NSAIDs