Approach to a Patient with Knee Complaint Flashcards
What are the characteristics of a ligamentous disruption or fracture?
swelling is immediate or less than 2 hours following incident; pt is unable to walk or bear weight
what are the characteristics of a sprain or meniscus injury?
swelling appears more than 2 hours after onset; pt is able to stand, walk, and bear weight within a few minutes
How do you test the ROM of the internal/external rotation of the tibia?
have the patient’s knee flexed at 90 degrees, have your thumbs on each side of the tibial tuberosity-grasping the calf; induce internal/external rotation of the tibia on the femur
What is the normal ROM degree of the internal/external rotation of the tibia?
10 degrees
what is the normal ROM degree of the fibular head motion?
~30 degrees
What is a normal strength test grade?
5/5
What is a normal DTR grade?
2/4
what is a normal pulse grade?
2/4
How is edema graded?
0-4+
Who is most likely to get Osgood-Schlatter Disease/Syndrome?
ages 8-15, during a growth spurt, increase in activities such as sports
How would you make a clinical diagnosis of Osgood-Schlatter Disease/Syndrome?
if there is point tenderness over the tibial tubercle, all other ligament and structural testing is negative
How would osteoarthritis in the knee present on a radiograph?
uneven joint space and osteophytes (bony spurs)
What are typically findings of OA?
boney enlargement or deformity at the joint margins, genu varum deformity and stiffness lasting less than 30 minutes
If a patient presents with local swelling, tenderness, erythema, and warmth as well as pain with AROM or compression-what might they have?
prepatellar bursitis
How does a patient with patellofemoral pain syndrome present?
crepitus under the patella with AROM and PROM, a positive grind test, and possible quadriceps weakness
How would you treat chondromalacia patella?
RICE and quadriceps strengthening
How does Iliotibial band syndrome present?
pain over the lateral aspect of the knee (above the joint line); may occur with increase activity
How would you diagnose Iliotibial band syndrome?
no warmth or erythema, pain with palpation over the lateral femoral condyle, normal ligamentous testing, positive OBER’s test on effected side
What is the test used to clinically diagnose a displaced patella?
the apprehension test
What causes an injury to the ACL?
sudden rotation or hyperextension injuries; or a direct hit
What are the tests performed when ACL injury is suspected?
anterior drawer test or Lachman test
What is the most commonly injured knee ligament?
ACL
if a patient reports that his leg was planted and then caused to hyperextend or valgus deformation, what would you suspect?
ACL injury
If there was a no contact injury to the ACL, what most likely occurred?
the patient suddenly deceleration with a change in direction
What is the classic presentation of ACL injury?
sudden onset of severe knee pain with a large effusion developing within 2 hours; patient reports “popping sensation” or knee instability
How is an acute meniscal tear typically caused?
if there is a sudden change in direction in which the knee is twisted or rotated while the corresponding foot is planted
What is the classic presentation of a meniscal injury?
slon onset of pain with swelling or effusion developing over the next 24 hours, patients with untreated meniscal tears report “locking” or “catching” sensation of knee during extension
What is the unhappy triad?
Medial collateral ligament injury, ACL, and medial meniscus injury
What typically causes an unhappy triad?
when the foot is planted, a valgus deformity, rapid deceleration, and rotation
How would you diagnose a meniscal injury?
if there is medial or lateral joint line tenderness, loss of smooth passive motion of knee, inability to fully extend knee
What special tests are used to check for meniscal injury?
McMurray’s test, Bounce Home test, Apley Grind
How would you test for effusion in the knee?
Fluid wave, bulge sign, bounce home test
If there is negative joint line tenderness, what diagnosis is most likely eliminated?
Meniscus and collateral ligament injury
