Diagnosis

Question 1

Traumatic Arthritis

Answer 1

Capsular pattern,
Pain,
Swelling,
Decrease in activity tolerance

Question 2

Hemarthrosis

Answer 2

Patient history,
Physical examination, Severe pain,
Rapid swelling (3-4 hrs), Associated with hemophilia and OA flap tear of meniscus

Question 3

Monoarticular Steroid-Sensitive Arthritis

Answer 3

Capsular pattern,

Patient history

Question 4

Septic Arthritis

Answer 4

Spread of infection into joint capsule,

Leukocyte count of synovial fluid

Question 5

Discoid Meniscus

Answer 5

Congenital defect-more prone to injury, Meniscus half-moon or full circle shaped rather than crescent shaped

Question 6

Medial Coronary Ligament Injury

Answer 6

History of rotation trauma,

Painful lateral rotation, Local tenderness

Question 7

Medial Collateral Ligament (MCL) Injury

Answer 7

History of trauma→ Acute cases: capsular pattern and local tenderness;
Chronic cases: limitation in a non-capsular pattern

Painful valgus and lateral rotation

Question 8

Intra-articular Adhesions

Answer 8

Typically seen s/p surgery or after sprain, Knee stiffens progressively and painlessly in flexion but normal with extension, Pathology is palpable and clicking is present

Question 9

Subsynovial Hematoma

Answer 9

History of local blow, Marked limitation of flexion,

Normal extension

Question 10

Medial Collateral Bursitis

Answer 10

Middle-aged,
Nocturnal pain,
Non-capsular pattern, Painful valgus and external rotation, Hardish swelling

Question 11

Medial Meniscus Injury

Answer 11

Locking/manipulative unlocking,

Symptoms of sprained coronary ligament

Question 12

Patellar Bursitis

Answer 12

Pain with activity,
Swelling,
Tenderness,
Warmth in the anterior knee

Question 13

Popliteal (Baker’s) Cyst

Answer 13

Can result from trauma, Must rule out DVT

Question 14

Adherent Vastus Intermedius

Answer 14

Limited knee flexion, Normal extension, Follows femur fracture

Question 15

Chronic Non-adherent Ligamentous Lesion

Plica Mediopatellaris

Answer 15

Vague medial pain, Sometimes twinges, Painful arc,

Local thickening and tenderness

Question 16

Loose Body

Answer 16

Middle-aged individual,
Twinges-usually on walking downstairs,
Non-capsular pattern, Typical end-feel,
“Sprain without a sprain”

Question 17

Plica Synovialis Syndrome

Answer 17

Aggravation of pain with loading activities (stairs)

Question 18

Patellar Bursitis

Answer 18

Pain with activity,
Swelling,
Tenderness,
Warmth of anterior knee

Question 19

Patellofemoral Pain Disorders

Answer 19

Dull pain,
Pain during sitting, Increased Q angle, Hypertrophied lateral bands,
Crepitus during squatting

Question 20

Patellofemoral Arthrosis

Answer 20

Anterior pain while walking upstairs, Crepitus,

Sometimes pain during sitting

Question 21

Sprain of the Anterior Cruciate Ligament–

Anterior Insertion

Answer 21

Trauma→
Acute stages: capsular pattern;
Chronic stage: Exclusively a positive anterior drawer test

Question 22

Sprain of the Posterior Cruciate Ligament–

Anterior Insertion

Answer 22

Trauma→
Acute stages: capsular pattern;
Chronic stage: Exclusively a positive posterior drawer test

Question 23

Suprapatellar Tendinitis

Answer 23

Painful resisted extension,

Tenderness at the upper border

Question 24

Infrapatellar Tendinitis

Answer 24

Painful resisted extension,

Tenderness at the lower pole

Question 25

Infrapatellar Tenosynovitis

Answer 25

Painful resisted extension, Crepitus, Local tenderness

Question 26

Quadriceps Expansion Tendinitis

Answer 26

Painful resisted extension, | Lateral or medial tenderness

Question 27

Medial Quadriceps Expansion Tendinitis

Answer 27

Pain during exertion, Resisted extension painful, Local tenderness

Question 28

Pes Anserine Tendinitis

Answer 28

Resisted flexion and internal rotation painful

Question 29

Lateral Coronary Ligament Injury

Answer 29

Often mistaken for meniscal lesion, Pain with twisting, Joint line tenderness

Question 30

Lateral Collateral Ligament (LCL) Injury

Answer 30

Patient history of varus forces at the knee, | Tenderness with palpation (knee at 20 degrees)

Question 31

Lateral Meniscus Tear

Answer 31

Locking and manipulative unlocking, Symptoms of sprained lateral coronary ligament Squatting and twisting concordant sign

Question 32

Lateral Meniscus Cyst

Answer 32

Secondary to meniscal tear or degenerative changes, | Palpable

Question 33

Quadriceps Lesion

Answer 33

High-impact, landing MOI

Question 34

Strained Iliotibial Band

Answer 34

Palpation of distal end of IT band is concordant

Question 35

Ruptured Quadriceps

Answer 35

Heavy load applied to partially flexed knee -- poor jumping/landing mechanism, Inability to completely extend knee, Indentation superior to patella, Difficulty walking, Bruising may be present

Question 36

Patellar Fracture

Answer 36

MOI of trauma (fall, MVA) or forceful quad contraction

Question 37

Patellar Tendon Rupture

Answer 37

``` Inability to extend knee, Weak tendon, Trauma to tendon, Pain, Swelling, Indentation at inferior patella, Patella may move superiorly ```

Question 38

L3 Nerve Root Lesions

Answer 38

Pain and numbness radiating into gluteal region and anterior thigh (Possibly in the posterior thigh)

Question 39

Femoral Nerve Lesions

Answer 39

Patient history of hip fractures, thigh lacerations, psoas abscess, DM, tumor, surgical history

Question 40

Hamstring Lesions

Answer 40

MOI of sudden sharp pain, Swelling, Tenderness, Possible bruising

Question 41

Biceps Femoris Tendinitis

Answer 41

Pain with resisted knee flexion, Tenderness at insertion point Lateral location rules out other hamstring muscles

Question 42

Lesions of Pes Anersinus

Answer 42

Patient history of acute trauma to medial knee, Physical exam indicated pain in proximal-medial tibia

Question 43

Strained Popliteus Muscle

Answer 43

Pain w/ resisted knee flexion & lateral rotation, Hamstrings may be tight - difficult extension; Acute: hyperextension mechanism, Chronic: runners most common

Question 44

Gastrocnemius Lesions

Answer 44

Must be able to rule out DVT, Posterior-medial calf pain, MOI of forceful plantarflexion accompanied by audible pop after feeling as if something was thrown at patient (Achilles rupture), Swelling, Bruising, Absence of tendon upon palpation of achilles tendon (Achilles rupture)

Question 45

Apophysitis

Answer 45

Boys from 10-15 y.o., | Local pain and tenderness

Question 46

Recurrent Dislocation

Answer 46

Attacks of collapsing, swelling, and anteromedial pain, Positive apprehension test, Decreased Q angle

Question 47

Crystal Synovitis

Answer 47

Associated with metabolic disorders, Over 60 y.o., Aspiration

Question 48

Rheumatoid Arthritis

Answer 48

Physical exam reveals a capsular pattern, pain, swelling, warmth, and stiffness; Rheumatoid factor lab work-up

Question 49

Early Arthrosis

Answer 49

Capsular pattern, | Review patient history

Question 50

Bucket-Handle Meniscal Lesion

Answer 50

Joint line tenderness

Question 51

Posterior Lesion

Answer 51

Joint line tenderness

Question 52

Loose Bodies In Adolescents

Answer 52

Middle-aged, Twinges- usually while walking downstairs, Non-capsular pattern, Typical end-feel, “Sprain without a sprain”

Question 53

Loose Bodies Complicating Arthrosis

Answer 53

Middle-aged, Twinges- usually while walking downstairs, Non-capsular pattern, Typical end-feel, “Sprain without a sprain”

Question 54

Advanced Arthrosis

Answer 54

Capsular pattern, | Review patient history

Question 55

Posterior Capsular Strain

Answer 55

MOI includes hyper-extension and external rotation

Question 56

Iliotibial tract Bursitis

Answer 56

Tenderness upon palpation; Occurs as a result of repetitive motion, Over 40 y.o.

Question 57

Lesions at tibial tuberosity | Osgood-Schlatter's or Avulsion injuries

Answer 57

Osgood-schlatter's (OS) occurs as a result of repetitive quadriceps contraction with running or jumping, usually occurs in adolescents, males more prevalent Avulsion injuries have similar qualities to OS, but generally patients have difficulty ambulating and occurs suddenly

Question 58

Lesion of Upper Tibiofibular Joint

Answer 58

Painful resisted flexion, disappearing with knee in extension

Question 59

S1 Nerve Root Lesion

Answer 59

Spinal involvement MOI, EMG testing, Reflex testing, Dermatome/Myotome examination

Question 60

S2 Nerve Root Lesion

Answer 60

Spinal involvement MOI, EMG testing, Dermatome testing in the popliteal fossa

Question 61

Rotatory Instability

Answer 61

Standing posture can include genu varum or hyperextension, possible neurological symptoms (30% of cases)