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MED: Ortho/Rheum > Disorders of the Knee > Flashcards

Disorders of the Knee Flashcards

1
Q

what are the specialty tests of the knee:

A

Ligament Tests:

MCL: Valgus Stress Test
LCL: Varus Stress Test
ACL:
-Anterior Drawer Test
-Lachman’s Test
-Pivot Shift Test
PCL:
-Posterior Drawer Test
-Sag Test
Meniscal Tests:
-McMurray’s Test
--->Medial and Lateral
Extensor Mechanism Testing
--->Patellar Apprehension Test
---->Shrug Test
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2
Q

what is the mechanism of injury for a medial collateral ligament injury?

A

Valgus force applied to knee with external tibial rotation

Non-contact or from blow to lateral knee

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3
Q

what are the signs of a MCL injury?

A 
Medial knee pain
Localized swelling
Valgus instability if complete tear
Laxity with valgus stress test
MRI :Confirm diagnosis and evaluate for other pathology
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4
Q

how do you treat the different grades of an MCL injury?

A

Grades I and II:
Conservative – rehabilitation, ice, NSAID’s, crutches, functional bracing

Grade III:
Symptomatic immobilization
Conservative – rehabilitation, ice, NSAID’s, crutches, functional bracing

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5
Q

what is the MOI for an LCL injury?

A

Varus or twisting injury
Contact or non-contact
Hyperextension injury

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6
Q

what are the signs of an LCL injury?

A

Lateral knee pain
Localized swelling
Varus instability with twisting/pivoting activity

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7
Q

what could your radiographic LCL findings show you?

A

X-rays:

  1. Lateral Capsular Sign
    - -Avulsion of lateral tibia
    - -Associated with ACL injury
  2. Arcuate Sign
    - -Avulsion of proximal fibula
    - -Associated with posterolateral instability

MRI:
Confirm diagnosis and evaluate for other pathology

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8
Q

how will you do treatment for the different grades of LCLs tears:

A

Grades I and II
Conservative – rehabilitation, ice, NSAID’s, crutches

Grade III
Acute – primary repair
Chronic - reconstruction

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9
Q

what is the MOI for an ACL tear?

A

Mechanism of Injury:
Multiple – hyperextension, varus/internal rotation, valgus/external rotation
Contact or Non-contact

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10
Q

What are the signs/symptoms of an ACL tear?

A 
Acute:
Hear or feel a pop at injury
Large effusion within 2 hours 
Loss of ROM
May get autonomic symptoms (dizziness, sweating, nausea, faintness)
- POSITIVE LACHMAN

Chronic:
Instability with cutting, pivoting, twisting activities
- POS. LACHMAN, ANTERIOR DRAWER TEST, PIVOT SHIFT

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11
Q

What radiographic findings are present on X-ray and MRI?

A

X-rays
Usually normal
Avulsion of tibial spine in young patients

MRI
Confirm diagnosis and evaluate for other pathology

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12
Q

what are the treatments for surgical and non-surgical ACL

A 
Treatment:
1. Non-surgical
Acute symptom treatment 
Rehabilitation (hamstrings)
Bracing
LIFESTYLE CHANGE
2. Surgical 
Reconstruction not repair
Patellar tendon or hamstring autografts
Allograft
Rehabilitation
Return to twisting activity at 6-7 months
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13
Q

What is the MOI for an PCL injury?

A

Most commonly a direct blow to anterior proximal tibia
MVA dashboard injury
Fall on hard playing surface

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14
Q

what are the signs and symptoms of a PCL tear?

A

Acute:
Mild pain and swelling
Mild loss of ROM

Chronic:
Feeling of instability (femur sliding anteriorly off of tibia)

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15
Q

what will you see on PE with a PCL injury?

A

positive posterior drawer and positive sag test

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16
Q

what is the treatment

A

Always conservative to start
Ice, NSAID’s, rehabilitation (Quadriceps), +/- bracing

Surgical reconstruction if still having functional instability despite conservative treatment

17
Q

which is more common a medial or later meniscus tear?

A

Medial meniscus tears are more common than lateral meniscus tears

Lateral meniscus is more mobile

18
Q

how does a meniscal tear usually happen, MOI?

A

Mechanism of injury:
Twisting or squatting
Older patients don’t require a specific “episode” to tear a meniscus

19
Q

what are the signs of a meniscal injury?

A
  • Mild swelling
  • Joint line pain

Mechanical symptoms :

  • Locked knee
  • Catching sensation over a joint line

positive mcmurray’s test

20
Q

what is the treatment of a meniscal injury?

A
  • Meniscal tears do not heal
  • Arthroscopy
  • –>Usually requires meniscectomy
  • –>Occasionally can repair a meniscus if the tear is located in the peripheral (vascular) zone
21
Q

what are extensor mechanism injuries?

A

Includes quadriceps muscles, patellofemoral joint, and patellar tendon

22
Q

what are predisposing anatomical findings that cause extensor mechanism malalignment

A

Rotational abnormalities of femur (usually anteversion) and/or tibia
Increased Q-angle

23
Q

How does a patellar dislocation typically occur?

A

Mechanism of injury:

Valgus and/or twisting with strong quadriceps contraction

24
Q

What physical exam signs do you see with a patellar dislocation?

A

Physical Examination

Acute:
Possibly lateral displacement of patella
Effusion
Tender patella with manipulation
Loss of ROM

Chronic:
Patellar apprehension/laxity
Predisposing anatomic findings

25
Q

How do you treat a patellar dislocation?

A
  1. Extend knee if still dislocated
  2. Symptom treatment after acute episode
  3. Rehabilitation focused on patellar control
  4. Patellofemoral bracing
  5. 50% chance of recurrence
    Extensor mechanism reconstruction if becomes chronic and functionally disabling
26
Q

What is Patellofemoral Pain Syndrome?

A

Anterior knee pain that is not explained by a definable cause (i.e. patellar tendonitis…)
- usually do to overuse
- treatment is conservative: ice, NSAIDs
sometimes surgery needed

27
Q

What is the patellar tendonitis?

A

“Jumper’s knee”
Most commonly at tendon insertion to patella
Occasionally at patellar tendon insertion to tibia
usually due to overuse
treatment is conservative.

28
Q

What is Osgood-Schlatter’s Disease?

A
  • Painful enlargement of tibial tuberosity at distal patellar tendon insertion
  • Due to mechanical stress on growing tibial tuberosity apophysis
  • Occurs in preadolescence and early adolescence, usually during rapid growth period
  • painful enlargement, normally seen in overuse in kids
29
Q

What is the treatment for Osgood-Schlatter’s Disease?

A

Symptom treatment with ice, NSAID’s, activity modification, localized padding

Rehabilitation including simple modalities

Emphasis on stretching

Occasional surgical excision of loose ossicle

MED: Ortho/Rheum (12 decks)

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