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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
Symptoms/signs meniscal injury
Knee clicking, catching, locking (cant fully extend due to foreign body in joint) Pain - localised to joint line Giving way sensation
26
Menisci injury swelling?
Swelling may be delayed Reactive effusion or not at all (avascular menisci except at periphery)
27
What is acutie haemoarthrosis a sign of in menisci injury?
RARE Indicates tear in peripheral vascular aspect Or injury to Anterior cruciate ligament
28
What is chronic effusion (increased synovial fluid) a sign of?
Synovitis (inflammation of synovial membrane) in menisci injury
29
Menisci injury signs and symptoms
Locking, reduced motion from loose meniscal fragments between articulating surfaces
30
Treatment of menisci injuries
Acute tears - surgically (menisectomy or repair) Chronic degenerative - conservative managemet
31
Collateral ligament injury causes
Sporting - football | Acute varus/valgus strain
32
What do the collateral ligaments work with?
The posterior cruciate ligament - prevent excessive posterior motion of tibia in regards to femur
33
Varus strain
``` Medial angulation (force from medial to lateral) Lateral collateral ligaments resist ```
34
Valgus strain
``` Lateral angulation (force from lateral to medial) Medial collateral ligaments reisist ```
35
Which collateral ligament is more suceptible to injury?
Medial collateral | But lateral collateral has higher chance of causing knee instability
36
Why does lateral collateral ligament play more important role in stabilising knee?
Medial tibial plataeu is deeper and more stable than lateral tibial plataeu Lateral side needs support
37
Unhappy triad
Anterior cruciate ligament Medial collateral ligament Medial menisci
38
Collateral ligment injury symtoms/signs
Swelling Pain Unstable feeling of joint Giving way
39
What attaches to medial collateral ligament
Medial menisci (both injured in unhappy triad with ACL)
40
Anterior and posterior cruciate ligament injury common?
Very common | ACL more weak - more common injury
41
ACL tear cause
Quick deceleration Hyperextension Rotational injury - sport (NO OTHER PLAYERS) Or large force at back of knee, slight flexion
42
ACL signs and symptoms
Feel popping sensation Immediate swelling Instability - tibia slides anteriorly under femur (giving way) HEAR IT
43
Sudden sensation of knee giving way in ACL injury is called
Anterolateral rotatory instability | Usually prevents medial rotation of tibia
44
ACL treatment
Low functioning demands - no treatment, use muscles to stabilise joint Active people - surgival reconstruction
45
PCL cause
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
PCL treatment
Conservative management Bracing Rehabilitation
47
Tests to detect PCL and ACL tear
Anterior and posterior drawer tests Lachmans test (ACL only)
48
Dislocation of knee joint cause
Uncommon High energy trauma 3/4 ligaments must be damaged
49
Associated injuries with knee discloation
Arterial injury - popliteal artery (very immobile artery stuck under soleus muscle) = haematoma/thrombotic occulusion
50
Treatment of knee dislocation
Reduction | Magnetic resonance angiography - assess vascularity (see if popliteal artery affected)
51
Swellings around knee
Bony - osgood schlatters Soft tissue - localised (enlarged popliteal lymph node) generalised (lymphoedema) Fluid
52
Fluid inside joint known as
Effusion - NEVER NORMAL
53
Fluid outside joint
Soft tissue haematoma
54
Acute effusions
< 6 hours after injury
55
Delayed effusion
> 6 hours after injury A day after = Reactive synovitis sign (more synovial fluid)
56
ACL effusion
Haemoarthrosis - bleeding into joint space
57
Acute knee effusions
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
Pre patellar bursitis
Housemaids knee | Leaning forwards when cleaning - trauma to infront of patella
59
Infrapatellar bursitis
Two bursae - deep and superficial Superficial most affected Below patella Kneeling - clergymans knee (upright kneel)
60
Suprapatellar bursitis
Extension of synovial cavity (above patella) Knee effusion = swelling of suprapatellar bursa Sign of significant pathology in knee
61
Causes of knee effusion (suprapatellar bursitis)
``` Osteoarthritis Rheumatoid arthritis Infection Gout/psuedogout Repetitive microtrauma to joit (running on soft or uneven surfaces) ```
62
Semimembranosous bursa
Consequence of indirect swelling of joint Attached to posterior capsule of joint If Effusion - fluid can move from knee to bursa
63
Semi membranosous bursa known as
Poplitieal cyst/bakers cyst
64
Osgood Schlatters disease what is it?
Inflammation of apophysis (insertion) of patellar ligament into tibial tuberosity
65
OSD occurs in
Teenagers who play sport
66
Signs and symptoms OSD
Intense knee pain during running/jumping | Swelling
67
Treatement OSD
Rest and ice Skeletal maturity resolves - apophysis fuses But bony prominences remain
68
Osteoarthritis of knee symtoms/signs
Pain (bending, kneeling, squatting) Stiffness (after periods of rest/inactivity) swelling Symptoms worsen after prolonged rest (getting up from bed)
69
Deformity OA
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
Loss of cartilage in OA
Bone rubs on bone | Crepitus (grating sound)
71
Signs X ray of OA
Osteophytes Joint space narrowing Sclerosis
72
Risk factors OA
Age, female?, previous trauma, obesity, family history, other condition that affects joints
73
OA treatment
``` Streghtening exercises (strengthen vastus medialis) Analgesia Weight loss Activity modification Total knee replacement - ULTIMATELY ```
74
Septic arthritis
Invasion of joint space with microorganisms | Bacteria usually - Staphyloccocus aureus
75
At risk of septic arthritis
Prosthetic joints - during surgery or infection spread from other source via blood (Polymethacrylate cement used prevents immune response = increased infection risk)
76
Consequence of septic arthiritis
Damage to articular cartilage (Proteases or immune host response) Neutrophils stimulate cytokines = hydroplysis of collagen and proteoglycans
77
Septic arthritis symptom triad
Fever Pain Reduced motion (Redness, swelling, warmth, tenderness, limit motion)
78
Investigations spetic arthritis
Aspiration of joint | Sent for urgent MCS
79
Physical findings septic arthritis
``` Draining sinus (tract between infection and overlying skin) Pus and blood leave via tract ```

MSK 2023 (55 decks)

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