Approach to Knee Complaint

Question 1

Signs & Sxs of Ligamentous Disruption (tear) or Fracture

Answer 1

• swelling is immediate or <2 hours
• unable to walk or bear weight

Question 2

Signs & Sxs of Sprain or Meniscus Injury

Answer 2

• swelling appears >2 hours
• able to stand, walk, bear weight within a few minutes

Question 3

How to access internal/external rotation of Tibia

Answer 3

• knee flexed to 90
• thumbs on each side of tibial tuberosity, grasping the calf,
• induce internal/external rotation of tibia on the femur
• 10 degrees in each direction
• compare bilaterally

Question 4

Fibular head glides ___ with foot pronation

Answer 4

Anteriorly

Question 5

What directions make up foot pronation?

Answer 5

Dorsiflexion, eversion, abduction

Question 6

What directions make up foot supination?

Answer 6

Plantarflexion, inversion, adduction

Question 7

Fibular head glides ___ with foot supination

Answer 7

Posteriorly

Question 8

Osgood-Schlatter Disease/Syndrome

Answer 8

• superficial portion of the tuberosity is pulled away which results in formation of two separate bone fragments
• most common between ages 8-15
• not typically bilateral (<30%)
• typically occurs during growth spurt
• occurs with increase activities like sports which causes microtrauma to the patellar ligament insertion onto the tibial tuberosity
• report of pain with climbing stairs or squatting
• clinical dx – point tenderness over tibial tubercle, all other ligament and structural testing

Question 9

Osteoarthritis

Answer 9

• chronic inflammatory disease
• loss of articular cartilage
• osteophytes appear at insertion site of tendons or ligaments
• soft tissue components react including thickening of joint capsule
• Typical findings: boney enlargement or deformity at the joint margins, stiffness lasting <30 minutes, crepitus is common
• Risk factors: age, obesity, varus/valgus deformity, previous trauma

Question 10

Prepatellar Bursitis

Answer 10

• chronic microtrauma from repetitive activity or pressure OR acute fall or injury directly on patella
• presents with local swelling, tenderness, erythema, warmth over patella
• pain with AROM or compression
• PE findings: erythema and edema at site of bursa, tender - Evaluation: aspiration of bursa for cell count with differential, C&S, assess for crystals
  ***must eliminate infectious etiology!