Approach to Knee Pain Flashcards
What direction does Fibular head move with foot pronation?
Anteriorly
What direction does Fibular head move with foot supination?
Posteriorly
What is crepitus
Palpatory sensation of “grinding” during range of motion.
What is Osgood-Schlatter Disease/Syndrome?
Commonly occurs with increase activities such as sports—running, cutting, jumping—which causes microtrauma to the patellar ligament insertion onto the tibial tuberosity.
Most common between ages of 8-15
How to test for Osgood-Schlatter Disease/Syndrome?
Point tenderness over the tibial tubercle
All other ligament and structural testing is negative
radiography unnecessary
Signs of knee Osteoarthritis
Boney enlargement or deformity at the joint margins, genu varum deformity, and stiffness lasting ≤ 30 minutes are typical findings in OA
Crepitus is common.
Risks of knee Osteoarthritis
Increasing age
Trauma
Obesity
Anatomic factors (Varus/valgus deformities)
What is Housemaids Knee?
Bursitis of the knee
Chronic microtrauma from repetitive activity or pressure
Presents with local swelling, tenderness, erythema & warmth
Signs of Knee Bursitis?
Redness (erythema) and swelling at the site of the bursa
Tenderness and warmth
Remaining exam: Ligaments intact
What is Patellofemoral Pain Syndrome\Chondromalacia Patella?
Pain on or around the patella Insidious onset
Diffuse, aching, anterior knee pain
Can be unilateral or bilateral
Aggravated by climbing stairs, ascending hills, squatting or sitting for prolonged period of time (“theater sign”)
May have associated crepitus (grinding) with above activities
How to test Patellofemoral Pain Syndrome?
Crepitus under the patella w/AROM & PROM
+ Patellar grind test
What is Iliotibial Band Syndrome
Pain over the lateral aspect of the knee (above the joint line)
How to test Iliotibial Band Syndrome ?
Appear symmetric No warmth or erythema Pain with palpation over the lateral femoral condyle Normal ligamentous testing Positive OBER’s test on effected side. Assess Fibular head for dysfunction
Patellar Subluxation (Dislocation) Test?
Apprehension test. They don’t want you to touch it
ACL Tear test?
Anterior Drawer test / lachman test
What causes ACL tear
Hyperextension or sudden rotation (valgus deformation)
Symptoms of ACL tear?
Sudden onset severe knee pain with large effusion developing within 2 hours typically from hemarthrosis
Patient can report “popping sensation” or knee instability (giving out)
Can have associated injuries to meniscus, joint capsule, articular cartilage, subchondral bone (bone bruise), and other ligaments
Meniscal Injuries symptoms?
Slow onset knee pain with swelling or effusion developing over the next 24 hours
Degree of pain related to severity of meniscal tear
Patients with untreated meniscal tears for weeks can report “locking” or “catching” of knee during extension
Others can report “popping” or “giving out” sensation or vague sense knee is not moving properly
Unhappy Triad is what?
ACL, MCL, and MEdial meniscus
How to test for meniscus?
McMurray Test and Apley Grind