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Ortho/Rheumatology > Disorders of the Knee > Flashcards

Disorders of the Knee Flashcards

1
Q

Originates in the tibia just anterior to the area b/t the tibial eminences and runs obliquely to the lateral femoral condyle?

A

ACL - Anterior Cruciate Ligament.

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2
Q

Function is primary restraint to anterior translation of the tibia or prevents the tibia from sliding out in front of the femur; also rotational stability.

A

ACL

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3
Q

Originates on lateral border of the medial femoral condyle and inserts on the posterior rim of the tibia?

A

PCL - Posterior Cruciate Ligament.

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4
Q

Function is primary restraint to posterior translation of the tibia or prevents the tibia from sliding posterior in relation to the femur.

A

PCL.

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5
Q

Function is primary restraint to valgus force?

A

MCL - Medial Collateral Ligament.

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6
Q

Function is primary restraint to varus stress/force?

A

LCL - Lateral Collateral Ligament.

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7
Q

What is Genu Valgum?

A

Aka Knock Knee or Valgus Knee.

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8
Q

What is Genu Varum?

A

Aka Bow-Legged or Varus Knee.

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9
Q

What is Ballottement?

A

A medical sign which indicates increased fluid in the suprapatellar pouch over the patella at the knee joint (effusion).

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10
Q

Important bony landmarks of the medial aspect of the knee?

A
  • Medial femoral condyle.
  • Medial joint line - tenderness can signify meniscal pathology.
  • Pes anserine bursa.
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11
Q

Important bony landmarks of the lateral aspect of the knee?

A
  • Lateral joint line - tenderness can signify meniscal pathology.
  • Lateral Femoral condyle
  • Head of the fibula.
  • Gerdy’s tubercle - insertion site of the IT Band.
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12
Q

Important bony landmarks to the anterior knee?

A
  • Tibial tubercle/tuberosity.
  • Patella:
  • -Superior patellar border.
  • -Inferior patellar border.
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13
Q

Important soft tissue structures of the knee?

A
  1. Medial and Lateral Collateral ligaments.
  2. Pes anserine; the attachment point for the Sartorius, Gracilis, Semitendinosus.
  3. Patellar Tendon.
  4. Quadriceps tendon.
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14
Q

Limitation in flexion can be related to…

A

Loose body, DJD, meniscal pathology, effusion.

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15
Q

Limitation in extension can be related to…

A

Loose body, DJD, meniscal pathology, effusion, weakness in the quadriceps muscle group or tendon rupture.

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16
Q

Name all the grades of the Manual Muscle Test?

A
  • Grade 5: Complete ROM against gravity w/FULL resistance.
  • Grade 4: Complete ROM against gravity w/SOME resistance.
  • Grade 3: Complete ROM against gravity w/NO resistance.
  • Grade 2: Complete ROM when gravity is omitted.
  • Grade 1: Evidence of muscle contractility w/NO joint ROM.
  • Grade 0: No muscle contractility.
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17
Q

What special test is Gold Standard for evaluating ACL instability?

A

Lachman’s.

*Other test: Anterior Drawer test.

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18
Q

The Valgus Stress test evaluates…

A

The stability/instability of the Medial Collateral Ligament

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19
Q

The Varus Stress test evaluates…

A

The stability/instability of the Lateral Collateral Ligament.

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20
Q

Gold Standard special test to evaluate Meniscus pathology?

A

McMurray’s Test.

-Others: Apley’s compression and distraction.

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21
Q

Test for evaluating subluxation or dislocation?

A

Apprehension test for the knee.

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22
Q

Sural nerve motor function and sensory distribution?

A

Motor - foot plantar flexion.

Sensory - Lateral Heel.

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23
Q

Saphenous nerve motor function and sensory distribution?

A

Motor - none.

Sensory - medial leg and ankle.

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24
Q

Superficial Peroneal nerve motor function and sensory distribution?

A

Motor - foot eversion.

Sensory - dorsum of the foot.

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25
Q

Deep Peroneal nerve motor function and sensory distribution?

A

Motor - great toe flexion.

Sensory - First web space.

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26
Q

Tibial Nerve motor function and sensory distribution?

A

Motor - toe plantar flexion.

Sensory - sole of the foot.

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27
Q

Knee pain differential Diagnosis?

A

Osteoarthritis, Gout/Pseudogout, Baker Cyst, Trauma (ACL/PCL/MCL/LCL), Fx, Strain or Sprains, Septic Arthritis, Stress Fx, Inflammatory Arthritis, Cancer, so many more.

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28
Q

What is the difference between Articular and Periarticular?

A

Articular = within the joint.

Periarticular = around the joint.

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29
Q

Articular causes of knee pain?

A
  1. OA/DJD.
  2. Ligament Injuries.
  3. Cartilage Injuries.
  4. Meniscus Injuries.
  5. Fx – Tibial plateau, patella, etc.
  6. Knee Dislocation.
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30
Q

Periarticular causes of knee pain?

A
  1. Bursitis.
  2. Tendinopathy.
  3. Ligament Injuries.
  4. Muscular Injuries.
  5. Patella Dislocation/subluxation.
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31
Q

What is the difference between Inflammatory vs Non-Inflammatory?

A

Inflammatory = inflammation, infection, autoimmune.

Non-Inflammatory = overuse, traumatic.

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32
Q

Non-Inflammatory disorders of the knee?

A
  1. OA/DJD.
  2. Fx.
  3. Ligament Injuries.
  4. Meniscal tears.
  5. Muscle tears.
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33
Q

Inflammatory disorders of the knee?

A
  1. RA.
  2. Tendinopathy.
  3. Bursitis.
  4. Gout.
  5. Pseudogout.
  6. Infection.
  7. Periprosthetic infection.
  8. Septic Arthritis.
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34
Q

Most common x-ray views for the knee and why?

A
  1. A/P – standing more helpful to eval for OA.
  2. Lateral.
  3. Sunrise.

**Always need to x-ray views perpendicular to each other to evaluate knee pathology.

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35
Q

Evaluating and reviewing X-rays…

A

**Use a Systematic Approach.

  • -Evaluate bony integrity.
  • -Evaluate joint space.
  • -Evaluate alignment - varus vs. valgus.
  • -Evaluate position of patella.
  • -Evaluate fibular head for fracture.
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36
Q

How is the Sunrise view helpful in X-ray?

A

Helpful to evaluate the patella-femoral joint space.

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37
Q

What is a Flabella?

A

A small sesamoid, accessory bone found in 39% of humans that is embedded in the lateral tendon of the gastrocnemius behind the lateral condyle of the femur.

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38
Q

Useful when evaluating soft tissue? Evaluating bone?

A

MRI to eval soft tissues. CT to eval bone.

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39
Q

Useful when stress fractures are suspected or for abnormalities w/total knee arthroplasties?

A

Bone Scan.

40
Q

Treatment for most knee injuries?

A
  1. R.I.C.E
  2. NSAIDs
    - -caution w/Hx of GI bleed/ulcers, Hx of Heart disease.
    - -OTC vs Rx NSAIDs vs COX-2 Inhibitors.
  3. CS Injection - injection into the knee joint for inflammation.
  4. PT:
    - -Gait training.
    - -Proper strengthening.
    - -Modalities: US, electric stimulation, heat, massage.
41
Q

Procedure that involves aspiration of joint fluid, which can be diagnostic and therapeutic?

A

Arthrocentesis.

42
Q

What is the risk of Arthrocentesis?

A

Introducing the infection into the joint.

43
Q

What is Arthrocentesis used for?

A
  1. Inspecting joint fluid – color, clarity, thickness.
  2. Sent for testing – cell count, culture, sensitivity, gram stain, eval for crystals.
  3. Therapeutic for relief of pain from an effusion.
44
Q

Common indications for a Arthroscopy?

A

Meniscus pathology, loose bodies, scar tissue removal, ligament repair, cartilage repair vs. debridement.

45
Q

What is Arthroscopy?

A

A means to look within a joint; can be diagnostic and therapeutic.

46
Q

Two C-Shaped structures composed of fibrocartilage that act as cushions b/t the femur and tibia?

A

Meniscus.

47
Q

MC MOI of Meniscus Injuries?

A

Usually resulting from a “Twisting” Injury.

48
Q

Signs and Symptoms associated with a meniscus injury?

A
  1. Immediate pain localized to medial or lateral joint space.
  2. POPPING sensation during injury and after injury occurs.
  3. LOCKING, CATCHING, and GIVING WAY.
49
Q

Chronic Symptoms of a meniscus injury?

A
  1. Intermittent pain.
  2. Episodes of buckling, locking, catching, giving way.
  3. Pain increased going up and down stairs.
  4. Pain with squatting.
50
Q

PE findings with a Meniscus Injury?

A
  1. Inspection = effusion.
  2. Palpation = “tender along the medial or lateral joint line.”
  3. ROM = decreased.
  4. Strength = potentially decreased due to pain.
  5. Special Tests = “McMurray’s,” apley’s compression and distraction test, ballotable patella.
  6. Neurovascular = normal.
51
Q

Most important imaging for meniscus injuries?

A

MRI!

X-ray’s are usually normal.

52
Q

Treatment for Meniscus Injuries?

A

Conservative Management:
–NSAIDs, RICE, CS Injection.

Arthroscopy – meniscectomy vs. meniscal repair.

53
Q

Complications of Meniscectomy?

A
  1. Further injury w/more damage to the existing meniscus.
  2. Need for further surgery if meniscal repair fails.
  3. More pain after surgery.
  4. Possible early arthritis depending on how much of the meniscus is removed.
54
Q

Meniscectomy vs. Meniscus repair indications?

A

Meniscectomy for avascular region of the meniscus.

Meniscus repair for vertical and longitudinal tears in the periphery.

55
Q

Disorder involving a growing ‘Tibial Tuberosity’ in an adolescent?

A

Osgood-Schlatter Disease.

56
Q

What is an apophysitis?

A

Inflammation or stress injury to areas on or around growth plates in children and adolescents.

57
Q

What knee disorder is an apophysitis characterized by pain at the attachment of the patellar tendon to the tibial tubercle?

A

Osgood-Schlatter Disease.

58
Q

What is the MOI of Osgood-Schlatter Disease?

A

Repeated avulsion of the patellar tendon at the apophysis of the tibial tubercle.

59
Q

Signs and Symptoms of Osgood-Schlatter Disease?

A
  1. Swelling.
  2. Pain when ‘kneeling, jumping or running.’
  3. Unilateral or Bilateral.
60
Q

PE findings with Osgood-Schlatter Disease?

A
  1. Inspection = swelling of the tibial tubercle.
  2. Palpation = ‘tenderness over the tibial tubercle.’
  3. ROM = pain w/active ROM.
  4. Strength = ‘decreased strength w/extension.’
  5. Special Tests = none.
  6. Neurovascular = normal.
61
Q

Imaging studies for Osgood-Schlatter Disease?

A
  1. X-rays:
    - -Lateral view may demonstrate stress reaction or avulsion of the growth plate of the tibial tubercle.
  2. MRI:
    - -obtain if no improvement w/a period of rest.
62
Q

Treatment of Osgood-Schlatter Disease?

A
  1. Usually self-limiting as the pt continues to grow.
  2. REST, absolute decrease in stressful activities for several weeks.
  3. ICE after activities.
  4. NSAIDs.
  5. PT.
63
Q

Potential complications of Osgood Schlatter Disease?

A
  1. Avulsion Fx of the tibial tubercle requiring surgical fixation.
  2. “Chronic elevation of the tibial tubercle.”
64
Q

Recurrent subluxation or dislocation of the patella?

A

Patellar Instability.

65
Q

MOI of Patellar Instability?

A
  1. Deceleration and cutting motion in which the femur rotates internally and the tibia rotates externally. The quadriceps musculature contracts to maintain a linear force creating ‘lateral displacement of the patella.’
  2. Collagen Deficiency.
  3. Large Q-angle.
66
Q

Signs and Symptoms of Patellar Instability?

A

Pain, swelling, sensation of the knee giving way.

67
Q

PE findings of Patellar Instability?

A
  1. Inspection = ‘swelling,’ ecchymosis, abnormal Q-angle.
  2. Palpation = tender around the patella, stretchy skin.
  3. ROM = if acute, may have pain and decreased ROM.
  4. Strength = weakness w/extension.
  5. Special Tests = ‘++Apprehension Sign,’ +ballotable patella, +quadriceps contraction.
  6. Neurovascular = normal.
68
Q

Apprehension Test?

A

Testing for patellar subluxation/dislocation.

*Stabilize the patella and passively press laterally in an attempt to dislocate the patella. If the pt experiences pain and becomes apprehensive, positive sign.

69
Q

Quadriceps Contraction test?

A

Place thumb web space or thumb/index finger along the superior border of the patella. While pushing distally, have pt. contract quadriceps against resistance. Pain and/or crepitation considered ++ findings.

70
Q

Imaging studies for Patellar Instability?

A
  1. X-rays may demonstrate ‘bony loose body in sunrise view.’

2. MRI may demonstrate bony loose body, chondral defect, ‘medial patellofemoral ligament tear.’

71
Q

Treatment for Patellar Instability?

A
  1. PT.
  2. BRACING may be helpful to stabilize the patella.
  3. Referral to a geneticist.
72
Q

Surgery indications for Patellar Instability? Surgical risks?

A
  • Indicated to ‘repair or reconstruct the medial patellofemoral ligament.’
  • Some pt’s need bony osteotomies to correct for increased Q-angle.
  • Risks:
  • -DVT, potential Fx of patella, infection, hemarthrosis, failure of repair.
73
Q

Potential complications for Patellar Instability?

A

Recurrence of dislocation causing additional cartilage damage.

74
Q

What is the definition of a sprain? Tear?

A

Sprain = PARTIAL disruption of a ligament.

Tear = COMPLETE disruption of a ligament.

75
Q

What are the two most common knee ligament injuries that involve a complete tear?

Double check this.

A

MC = PCL and LCL.

ACL and MCL

76
Q

What is the most common and most debilitating ligament injury?

A

ACL – anterior cruciate ligament; which prevents anterior translation of the tibia on the femur.

77
Q

MOI of an ACL tear/injury?

A
  • Noncontact pivoting injury.
  • Hyperextension injury.
  • Valgus force.
78
Q

Signs and symptoms of an ACL tear/injury?

A
  1. Feeling or hearing a ‘POP’ followed by immediate disability and intense pain.
  2. Rapid swelling at the joint line (HEMARTHROSIS) is present.
  3. ‘Instability’ w/ambulation.
79
Q

PE findings associated w/ an ACL injury?

A
  1. Inspection = antalgic gait, ecchymosis, swelling.
  2. Palpation = swelling.
  3. ROM = decreased due to swelling.
  4. Strength = decreased w/flexion and extension.
  5. Special Tests: “+Lachman’s,” anterior drawer, +Pivot Shift, +Ballotable patella.
  6. Neurovascular = normal.
80
Q

Imaging studies used to diagnose and ACL injury?

A
  1. XR = effusion, possible ‘bony avulsion’ of the tibial spine.
  2. “MRI w/o Contrast” – ACL tear vs Sprain.
81
Q

Treatment of an ACL injury?

A
  1. RICE.
  2. NSAIDs.
  3. “Bracing: functional ACL brace.”
  4. Limitation of activity, but encourage ROM exercises.
  5. Crutches initially.
  6. PT.
  7. Non-operative vs ‘SURGERY.’
82
Q

Complications of an ACL injury?

A
  1. Re-injury.
  2. Instability.
  3. Traumatic arthritis.
83
Q

Prevents lateral translation of the tibia on the femur?

A

MCL

84
Q

MC MOI for a MCL injury?

A
  1. Most commonly from a direct blow to the planted leg from the outside or VALGUS FORCE>
  2. Also, severe outward twist to a planted leg.
85
Q

Signs and symptoms of a MCL injury?

A
  1. ‘POP’ is heard followed by intense pain located along the ‘medial aspect of the knee.’
  2. Swelling occurs rapidly and the knee ‘feels unstable’ to the pt.
86
Q

PE findings associated w/ a MCL injury?

A
  1. Inspection = antalgic gait, ecchymosis, swelling.
  2. Palpation = swelling, tender along the MCL.
  3. ROM = decreased due to swelling.
  4. Strength = possibly decreased w/flexion and extension.
  5. Special tests = “+Valgus stress test.”
  6. Neurovascular = normal.
87
Q

Imaging studies to diagnose a MCL injury?

A
  1. XR = effusion, possible ‘bony avulsion’ from the distal femur or proximal tibia.
  2. MRI – GOLD STANDARD
    - -Differentiate a MCL tear vs Sprain.
88
Q

Treatment and possible complications for a MCL Injury?

A

Treatment:

  1. RICE.
  2. ‘BRACING – hinged knee brace.’
  3. PT.
  4. Surgery.

Complications:

  1. Instability.
  2. Traumatic arthritis.
89
Q

Osteoarthritis of the knee is caused by?

A

‘Articular Cartilage Deterioration’ and bony overgrowth of the joint surfaces (bone spurs/osteophytes) caused by trauma, genetic, anatomy, age.

90
Q

Signs and Symptoms of Osteoarthritis of the knee?

A
  1. ‘Pain MC first thing in the morning’ and can be characterized as ‘stiffness,’ which improves w/activity.
  2. Swelling.
  3. ‘Difficulty going from seated to standing.’
  4. Pain.
91
Q

PE findings of Osteoarthritis of the knee?

A
  1. Inspection = antalgic gait, effusion, ‘joint enlargement’ secondary to osteophyte formation.
  2. Palpation = swelling, ‘tender along the joint lines, crepitation.’
  3. ROM = decreased due to swelling or osteophytes.
  4. Strength = possibly decreased w/flexion and extension.
  5. Special tests: +Valgus stress, +Varus stress.
  6. Neurovascular = normal.
92
Q

Most common imaging for Osteoarthritis?

A

XR!

  • -‘Joint space narrowing.’
  • -‘Osteophyte’ formation.
  • -Sclerosis.
  • -Valgus or varus deformity.
93
Q

Treatment for Osteoarthritis of the knee?

A
  1. RICE.
  2. Activity and lifestyle modification.
  3. NSAIDs, ‘Analgesics.’
  4. PT.
  5. ‘CS Injections’
  6. “Hyaluronic acid/viscosupplementation injections.’
  7. Surgical intervention:
    - -‘Total Knee Arthroplasty (TKA).
    - -Unicompartmental knee arthroplasty.
94
Q

A total knee arthroplasty is indicated MC for?

A

Patient’s w/BI- or TRI- compartmental knee arthritis.

95
Q

Unicompartmental knee arthroplasty is indicated for?

A

Reserved for pt’s w/moderate to severe arthritis in only ‘ONE COMPARTMENT.’

96
Q

Potential complications with Osteoarthritis of the knee?

A
  1. ‘Synovial Reaction’ to Hyaluronic:
    - -acid/viscosupp injections causing effusion and pain.
  2. Unicompartment and total knee arthroplasties:
    - -Spacer has only a 15-20 yr longevity.
    - -‘May become loose or infected causing need for removal.’

Ortho/Rheumatology (15 decks)

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