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MSK 2023 > Disorders Of The Knee > Flashcards

Disorders Of The Knee Flashcards

1
Q

Standard X-ray series for knee

A

Anterior posterior
Lateral
Patella axial (‘skyline’)

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2
Q

Femoral shaft fracture cause

A

Young/healthy = High velocity trauma:
falls from height
Road traffic collisions

Older:
Osteoporitic bones/metastases/bone lesions = falling over

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3
Q

Fragment actions femoral shaft

A

Proximal - abducted (gluteus medius and minimus) and flexed (iliopsoas)

Distal: adducted (adductor magnus, gracilis) and extended (gastrocnemius)

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4
Q

Femoral shaft fracture complications

A

1500ml of blood loss per fracture

=Hypovolaemic shock

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5
Q

Femoral shaft treatment

A

Surgical fixation

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6
Q

Distal femoral fractures cause

A

Younger: high energy sporting injury (lots of displacement of fragments)

Elderly: fall from standing

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7
Q

Artery damage in distal femoral fractures

A

Popliteal artery - only if signnificant displacement

Assess neurovascular status of limb

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8
Q

Tibial plataeu fracture cause

A

High energy injuries

Axial (top to bottom) loaded with abnormal varus/valgus angulation

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9
Q

Tibial plataeu fractures affect

A

Articulating surface of the tibia within the knee joint

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10
Q

Types of tibial plateau fractures

A

Unicondylar - one condyle

Bicondylar - both tibial condyles

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11
Q

Most common tibial plateau fracture

A

Lateral tibial condyle

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12
Q

Post problems with tibial plateau fractures

A

Articular cartilage damaged (fracture fragments)

Post traumatic osteoarthititis in joint

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13
Q

What can tibial plataue fractures be associated with?

A

Meniscal tears

Anterior cruciate ligament (ACL) injuries

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14
Q

Patellar fractures causes

A

Direct impact (knee against dashboard)

Eccentic contraction of quadriceps (muscle contracting but joint extending)

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15
Q

Examination of patellar fractures

A

Palpable defect

Haemoarthrosis (blood in joint)

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16
Q

How do you know if extensor mechanism is affected in patellar fracture?

A

Patella is split distal to insertion of quadriceps tendon

Unable to perform straight leg raise (flexion of hip while keeping leg extended)

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17
Q

Displaced patellar treatment

A

Reduction and Surgical fixation

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18
Q

Undisplaced patellar fracture treatment

A

Protection while healing
Splinting and using crutches

(No surgical fixation)

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19
Q

Abnormalities in patella anatomy

A

Bipartite (two parts of patella)

May be mistaken as a patellar fracture but IS NOT

(Failure of union of secondary ossification centre)

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20
Q

Patellar dislocation why

A

Q angle between pull of quadriceps tendon and patellar ligament = lateral dislocation (ASIS to patella and patella to tibial tuberosity)

Usually held in place via vastus medialis fibres (vastus medialis obliquus)

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21
Q

Patellar dislocation cause

A

Trauma - twisting in slight flexion or direct blow

Athlectic teenagers most affected (sudden direction change - internal rotation)

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22
Q

Factors predispose patella dislocation

A

Ligamentous laxity
Weakness of quadriceps (especially Vastus medialis)
Shallow patellofemoral groove (flat lateral lip)
Long patellar ligament
previous dislocation

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23
Q

Treament patella dislocation

A

Extending knee manually
Manually reducing patella
Immobilisation while healing
Physiotherapy to strenghthen vastus medialis

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24
Q

Meniscal injuries cause

A

Most common

Sudden twisting of weight bearing knee, high degree of flexion

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25
Q

Symptoms/signs meniscal injury

A

Knee clicking, catching, locking (cant fully extend due to foreign body in joint)
Pain - localised to joint line
Giving way sensation

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26
Q

Menisci injury swelling?

A

Swelling may be delayed
Reactive effusion or not at all

(avascular menisci except at periphery)

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27
Q

What is acutie haemoarthrosis a sign of in menisci injury?

A

RARE
Indicates tear in peripheral vascular aspect
Or injury to Anterior cruciate ligament

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28
Q

What is chronic effusion (increased synovial fluid) a sign of?

A

Synovitis (inflammation of synovial membrane) in menisci injury

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29
Q

Menisci injury signs and symptoms

A

Locking, reduced motion from loose meniscal fragments between articulating surfaces

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30
Q

Treatment of menisci injuries

A

Acute tears - surgically (menisectomy or repair)

Chronic degenerative - conservative managemet

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31
Q

Collateral ligament injury causes

A

Sporting - football

Acute varus/valgus strain

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32
Q

What do the collateral ligaments work with?

A

The posterior cruciate ligament - prevent excessive posterior motion of tibia in regards to femur

33
Q

Varus strain

A 
Medial angulation (force from medial to lateral) 
Lateral collateral ligaments resist
34
Q

Valgus strain

A 
Lateral angulation (force from lateral to medial)
Medial collateral ligaments reisist
35
Q

Which collateral ligament is more suceptible to injury?

A

Medial collateral

But lateral collateral has higher chance of causing knee instability

36
Q

Why does lateral collateral ligament play more important role in stabilising knee?

A

Medial tibial plataeu is deeper and more stable than lateral tibial plataeu

Lateral side needs support

37
Q

Unhappy triad

A

Anterior cruciate ligament
Medial collateral ligament
Medial menisci

38
Q

Collateral ligment injury symtoms/signs

A

Swelling
Pain
Unstable feeling of joint
Giving way

39
Q

What attaches to medial collateral ligament

A

Medial menisci (both injured in unhappy triad with ACL)

40
Q

Anterior and posterior cruciate ligament injury common?

A

Very common

ACL more weak - more common injury

41
Q

ACL tear cause

A

Quick deceleration
Hyperextension
Rotational injury - sport
(NO OTHER PLAYERS)

Or large force at back of knee, slight flexion

42
Q

ACL signs and symptoms

A

Feel popping sensation
Immediate swelling
Instability - tibia slides anteriorly under femur (giving way)
HEAR IT

43
Q

Sudden sensation of knee giving way in ACL injury is called

A

Anterolateral rotatory instability

Usually prevents medial rotation of tibia

44
Q

ACL treatment

A

Low functioning demands - no treatment, use muscles to stabilise joint

Active people - surgival reconstruction

45
Q

PCL cause

A

Dashboard injury - road traffic accident
Knee flexed with large force applied
Tibia displaced posteriorly

Or football when player lands on flexed knee (ankle plantarflexed)

Hyperextension

46
Q

PCL treatment

A

Conservative management
Bracing
Rehabilitation

47
Q

Tests to detect PCL and ACL tear

A

Anterior and posterior drawer tests

Lachmans test (ACL only)

48
Q

Dislocation of knee joint cause

A

Uncommon
High energy trauma
3/4 ligaments must be damaged

49
Q

Associated injuries with knee discloation

A

Arterial injury - popliteal artery (very immobile artery stuck under soleus muscle)

= haematoma/thrombotic occulusion

50
Q

Treatment of knee dislocation

A

Reduction

Magnetic resonance angiography - assess vascularity (see if popliteal artery affected)

51
Q

Swellings around knee

A

Bony - osgood schlatters
Soft tissue - localised (enlarged popliteal lymph node) generalised (lymphoedema)
Fluid

52
Q

Fluid inside joint known as

A

Effusion - NEVER NORMAL

53
Q

Fluid outside joint

A

Soft tissue haematoma

54
Q

Acute effusions

A

< 6 hours after injury

55
Q

Delayed effusion

A

> 6 hours after injury

A day after = Reactive synovitis sign (more synovial fluid)

56
Q

ACL effusion

A

Haemoarthrosis - bleeding into joint space

57
Q

Acute knee effusions

A

Haemoarthrosis (blood in joint) - ACL rupture until proven otherwise (same colour as muscle on X ray)

Lipo-haemoarthrosis (blood and fat in joint) - fracture (fat released from bone marrow appears darker in patches on X ray)

58
Q

Pre patellar bursitis

A

Housemaids knee

Leaning forwards when cleaning - trauma to infront of patella

59
Q

Infrapatellar bursitis

A

Two bursae - deep and superficial
Superficial most affected
Below patella

Kneeling - clergymans knee (upright kneel)

60
Q

Suprapatellar bursitis

A

Extension of synovial cavity (above patella)
Knee effusion = swelling of suprapatellar bursa

Sign of significant pathology in knee

61
Q

Causes of knee effusion (suprapatellar bursitis)

A 
Osteoarthritis 
Rheumatoid arthritis 
Infection 
Gout/psuedogout 
Repetitive microtrauma to joit (running on soft or uneven surfaces)
62
Q

Semimembranosous bursa

A

Consequence of indirect swelling of joint
Attached to posterior capsule of joint

If Effusion - fluid can move from knee to bursa

63
Q

Semi membranosous bursa known as

A

Poplitieal cyst/bakers cyst

64
Q

Osgood Schlatters disease what is it?

A

Inflammation of apophysis (insertion) of patellar ligament into tibial tuberosity

65
Q

OSD occurs in

A

Teenagers who play sport

66
Q

Signs and symptoms OSD

A

Intense knee pain during running/jumping

Swelling

67
Q

Treatement OSD

A

Rest and ice
Skeletal maturity resolves - apophysis fuses
But bony prominences remain

68
Q

Osteoarthritis of knee symtoms/signs

A

Pain (bending, kneeling, squatting)
Stiffness (after periods of rest/inactivity)
swelling

Symptoms worsen after prolonged rest (getting up from bed)

69
Q

Deformity OA

A

Varus deformity (knees out, distal legs deviated towards midline)

Valgus deformity (knees in, distal legs deviate away from midline)

Fixed flexion (knee cant be extended)

70
Q

Loss of cartilage in OA

A

Bone rubs on bone

Crepitus (grating sound)

71
Q

Signs X ray of OA

A

Osteophytes
Joint space narrowing
Sclerosis

72
Q

Risk factors OA

A

Age, female?, previous trauma, obesity, family history, other condition that affects joints

73
Q

OA treatment

A 
Streghtening exercises (strengthen vastus medialis)
Analgesia 
Weight loss
Activity modification
Total knee replacement - ULTIMATELY
74
Q

Septic arthritis

A

Invasion of joint space with microorganisms

Bacteria usually - Staphyloccocus aureus

75
Q

At risk of septic arthritis

A

Prosthetic joints - during surgery or infection spread from other source via blood

(Polymethacrylate cement used prevents immune response = increased infection risk)

76
Q

Consequence of septic arthiritis

A

Damage to articular cartilage
(Proteases or immune host response)

Neutrophils stimulate cytokines = hydroplysis of collagen and proteoglycans

77
Q

Septic arthritis symptom triad

A

Fever
Pain
Reduced motion

(Redness, swelling, warmth, tenderness, limit motion)

78
Q

Investigations spetic arthritis

A

Aspiration of joint

Sent for urgent MCS

79
Q

Physical findings septic arthritis

A 
Draining sinus (tract between infection and overlying skin) 
Pus and blood leave via tract

MSK 2023 (55 decks)

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