Approach to a Patient with Knee Complaint

Question 1

What are the characteristics of a ligamentous disruption or fracture?

Answer 1

swelling is immediate or less than 2 hours following incident; pt is unable to walk or bear weight

Question 2

what are the characteristics of a sprain or meniscus injury?

Answer 2

swelling appears more than 2 hours after onset; pt is able to stand, walk, and bear weight within a few minutes

Question 3

How do you test the ROM of the internal/external rotation of the tibia?

Answer 3

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

Question 4

What is the normal ROM degree of the internal/external rotation of the tibia?

Answer 4

10 degrees

Question 5

what is the normal ROM degree of the fibular head motion?

Answer 5

~30 degrees

Question 6

What is a normal strength test grade?

Answer 6

5/5

Question 7

What is a normal DTR grade?

Answer 7

2/4

Question 8

what is a normal pulse grade?

Answer 8

2/4

Question 9

How is edema graded?

Answer 9

0-4+

Question 10

Who is most likely to get Osgood-Schlatter Disease/Syndrome?

Answer 10

ages 8-15, during a growth spurt, increase in activities such as sports

Question 11

How would you make a clinical diagnosis of Osgood-Schlatter Disease/Syndrome?

Answer 11

if there is point tenderness over the tibial tubercle, all other ligament and structural testing is negative

Question 12

How would osteoarthritis in the knee present on a radiograph?

Answer 12

uneven joint space and osteophytes (bony spurs)

Question 13

What are typically findings of OA?

Answer 13

boney enlargement or deformity at the joint margins, genu varum deformity and stiffness lasting less than 30 minutes

Question 14

If a patient presents with local swelling, tenderness, erythema, and warmth as well as pain with AROM or compression-what might they have?

Answer 14

prepatellar bursitis

Question 15

How does a patient with patellofemoral pain syndrome present?

Answer 15

crepitus under the patella with AROM and PROM, a positive grind test, and possible quadriceps weakness

Question 16

How would you treat chondromalacia patella?

Answer 16

RICE and quadriceps strengthening

Question 17

How does Iliotibial band syndrome present?

Answer 17

pain over the lateral aspect of the knee (above the joint line); may occur with increase activity

Question 18

How would you diagnose Iliotibial band syndrome?

Answer 18

no warmth or erythema, pain with palpation over the lateral femoral condyle, normal ligamentous testing, positive OBER’s test on effected side

Question 19

What is the test used to clinically diagnose a displaced patella?

Answer 19

the apprehension test

Question 20

What causes an injury to the ACL?

Answer 20

sudden rotation or hyperextension injuries; or a direct hit

Question 21

What are the tests performed when ACL injury is suspected?

Answer 21

anterior drawer test or Lachman test

Question 22

What is the most commonly injured knee ligament?

Answer 22

ACL

Question 23

if a patient reports that his leg was planted and then caused to hyperextend or valgus deformation, what would you suspect?

Answer 23

ACL injury

Question 24

If there was a no contact injury to the ACL, what most likely occurred?

Answer 24

the patient suddenly deceleration with a change in direction

Question 25

What is the classic presentation of ACL injury?

Answer 25

sudden onset of severe knee pain with a large effusion developing within 2 hours; patient reports “popping sensation” or knee instability

Question 26

How is an acute meniscal tear typically caused?

Answer 26

if there is a sudden change in direction in which the knee is twisted or rotated while the corresponding foot is planted

Question 27

What is the classic presentation of a meniscal injury?

Answer 27

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

Question 28

What is the unhappy triad?

Answer 28

Medial collateral ligament injury, ACL, and medial meniscus injury

Question 29

What typically causes an unhappy triad?

Answer 29

when the foot is planted, a valgus deformity, rapid deceleration, and rotation

Question 30

How would you diagnose a meniscal injury?

Answer 30

if there is medial or lateral joint line tenderness, loss of smooth passive motion of knee, inability to fully extend knee

Question 31

What special tests are used to check for meniscal injury?

Answer 31

McMurray’s test, Bounce Home test, Apley Grind

Question 32

How would you test for effusion in the knee?

Answer 32

Fluid wave, bulge sign, bounce home test

Question 33

If there is negative joint line tenderness, what diagnosis is most likely eliminated?

Answer 33

Meniscus and collateral ligament injury