Mech is us getting hit on lower lateral tibia Opening to varus stress at 30 degrees of flexion

Acute Knee & Hip Pain Flashcards by Ali Haselhorst

What is the hx of ACL injury?

Cutting/pivoting, knee shifted, pop, quick effusion in first few hours (key!)

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What will be found on PE of ACL injury?

Large tight effusion
Lachman’s is most sensitive test
Blocked extension consider large bucket handle meniscal tear

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Imgaging for ACL injury

MRI is best imaging
Segond fracture on X-ray (pathognomonic)

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Tx/management for ACL injury

Surgery for young and active or older with daily instability or fail conservative management
Must have full ROM and swelling decreased before surgery

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What does the PCL do?

Resist posterior stress on knee

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How is PCL usually torn?

Dashboard injury or direct blow to flexed knee

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What is the best test to evaluate a PCL tear?

Posterior drawer

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How does a pt present w/ PCL tear?

More subtle symptoms & usually patient doesn’t c/o of instability

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How is a PCL tear tx?

Nonoperatively

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How is LCL injured?

Mech is us getting hit on lower lateral tibia
Opening to varus stress at 30 degrees of flexion

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What nerve should be tested in a LCL injury?

Peroneal (fibular)–dorsiflexion of foot & sensation laterally

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What is the tx for LCL tear?

Subacute surgical repair or chronic reconstruction

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What is the hx of MCL tear?

Medial sided pain
Less swelling than ACL tears
Opening to valgus stress at 30 degrees F

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What is the Pellegrini Stieda lesion?

Post traumatic ossification near avulsion fracture of MCL near medial femoral condyle. See on X-ray

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What is the tx for MCL tear?

Hinge knee brace w/ early ROM

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What is the hx of a Meniscal tear?

Usually rotation & axial load
Clicking, catching or may have locked knee if large acute bucket handle tear
May be insidious onset in those over 40 yo
Best test is joint line tenderness****

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What test used to dx a Meniscal tear?

Apley & McMurray

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What is the tx of a meniscal tear?

Usually treat chronic first with nonop
Surgery for acute tears in young pt w/ possible repair esp w/ concomitant ACL surgery
Watch out for the locked meniscus w/ inability to fully extend

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What is the hx of a Patellar Tendon rupture?

Pts <40yo
Felt pop
Missing step of stairs
Playing basketball/jumping
Can’t extend knee

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What will be found on PE w/ a Patellar Tendon rupture?

Unable to extend knee
Unable to hold leg in air (straight leg raise)
High riding patella
Defect below patella
Hemarthrosis
Possible bruising anterior knee

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What are the dx tests for patella tendon rupture?

X-ray: high riding patella; r/o patella frature
MRI: not necessary unless confimatory necessary

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What is the tx for a patellar tendon rupture?

Operative repair

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What is the hx of a patellar dislocation?

Valgus force & external R of tibia to a F knee
Females in 2nd decade MC
Knee shifted medially or patella out laterally
Most are lateral

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What will be found on PE w/ Patellar dislocation?

Pain along medial retinaculum & adductor tubercle
Apprehension sign to lateral pressure of patella
J sign

What is J sign?

Inverted J path the patella takes in early F as the patella begins laterally subluxated & shifts medially to engage femoral groove

What are the dx tests for patellar dislocation?

* **X-ray**: osteochondral loose pieces/fractures * MRI: distinguish from ACL tear

What is the tx for a patella dislocation?

* Reduction maneuver: extend knee & push patella over\*\* * Nonop initially * Knee brace or cast w/ knee in extension or early ROM w/ brace * Sugrical if fails

Important points of Patella Sleeve Fracture

* 8-12 yo * Usually fall at playground, sports or bicycle * Distal pole of patella plus a large sleeve of articular cartilage * Often misdx esp w/. small piece * Key is extensor lag & inability to do straight leg raise * Urgent referral to orthopedic surgeon for open tx

Important points of Bipartite Patella

* Synchondrosis * Failure of complete fusion of the patella in childhood * Not a fracture * No Hx of trauma * Commonly seen on x-ray

What should you also examine in a pt w/ knee pain?

The hip! Hip pain often radiate to the knee esp in children! Always examine the hip!

What is a SCFE?

* Slipped capital femoral epiphysis * MC hip disorder in adolescence

What is the hx of a SCFE?

* Obese child 11-13yo * Painless limp * Acute or subacute pain 1+ month * Thigh, knee or hip pain

What will be found on PE of a SCFE?

* Loss of ABDuction & internal R * Acute--inability to bear wt

What are the dx test for a SCFE?

AP & Frog Leg Lateral

What is the tx of a SCFE?

Requires prompt surgical tx\*\*

Important points of Perthes dz

* 4-11 years old * Normal size * Aching thigh or knee pain * Loss of ABDuction & internal R * Avascular Necrosis * Usually self limiting

Important points of Hip Stress Fracture

* Female long distance runner * Pain worse w/ activity * Groin pain * High index--get MRI * If superior fracture must be non-wt bearing & go to surgery immediately

How will a pt w/ a Posterior Hip dislocation present?

Leg short, ADDucted & internally R

How will a pt present w/ an Anterior Hip dislocation?

Leg flexed, ABDucted & externally rotated

What is the tx for a hip dislocation?

Emergent reduction under conscious sedation in ER or general anesthia in OR

What is the biggest risk of waiting to reduce a hip dislocation?

Avascular necrosis

Tx for Intertrochanteric Hip Fracture

Open reduction internal fixation

What attaches to the iliac crest?

Abdominal muscles

What attaches to the ASIS?

Sartorius

What attaches to the AIIS?

Rectus femoris

What attaches to the pubic symphysis?

Adductor muscles

What attaches to the Greater Trochanter?

Gluteal muscles

What attaches to the Lesser trochanter?

Iliopsoas

What attaches to the Ischial Tuberosity?

Hamstrings

How do you tx a quad contusion?

* Place knee in mild F to dec bleeing * Use ace wrap around knee to hold it on sideline * Heat should be avoided that will open up BV & continue bleeding & inc risk of hematoma

What complication can occur from quad contusion?

Myositis ossifcans

Hx of Qaudriceps tendon rupture

* **\>40yo**\*\* * Felt pop * Can't extend knee * Miss a step of stairs * **If bilateral think**: gout, DM, steroid use\*\*

PE of Quadriceps tendon rupture

* Unable to extend knee * Unable to hold leg in air (straight leg test)\* * LOW riding patella * Defect ABOVE patella * Hemarthrosis * Possible anterior knee bruising

Imaging for quadriceps tendon rupture?

X-ray: low riding patella, r/o patella fx

Tx of quadriceps tendon rupture?

Surgical repair

What ligament is surgically reconstructed in a Patellar dislocation?

Medial petellofermoral ligament Holds patella from going out laterally & injured in a patella dislocation

Why do hip fx have a high risk of nonunion or avascular necrosis to the femoral head?

Injury to BS (median circumflex artery)

What can SCFE be a cause of?

Premature OA in young adults