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DSA 18 Knee Pain Flashcards

1
Q

What is the origin and innervation of the hamstrings?

A

origin; ischial tuberosity
innervation: tibial division of sciatic nerve (the biceps femoris short head gets the fibular division of the sciatic nerve)

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2
Q

What are the Pes tendons and where do they attach?

A

Goose’s Foot- sartorius, gracilis, semitendinosus ; attach to the superior medial part of the tibia

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3
Q

Describe the Lachman’s Test

A

a. flex knee to ~25 deg, mm relaxed (Hams), hold inferior femur (ant) and superior tibia firmly (post), then induce anterior displacement of tibia on femur noting degree of displacement and end-feel
b. increased displacement or soft end feel indicate + test; compare to nl side

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4
Q

Describe the Anterior Drawer test

A

a. knee flexed 80-90 deg, hip ~45 deg, foot stabilized on table, hamstrings relaxed
b. grab superior tibia bimanually over posterior area,palpating hamstrings to ensure relaxation; draw tibia anterior
c. > 5mm of anterior tibial translation is + test
d. if PCL also torn, tibia will translate more if starting at an abnormal post position

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5
Q

Describe the posterior drawer test

A

.a. knee flexed 80-90 deg, hip ~45 deg, foot stabilized on table, hamstrings relaxed

b. grab superior tibia bimanually over posterior area,palpating hamstrings to ensure relaxation; draw tibia posterior
c. > 5mm of anterior tibial translation is + test

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6
Q

Describe McMurrays test

A

McMurray - flex knee and hip ~ 90 deg, int (med) or ext (lat meniscus) rotate tibia; introduce a valgus (med) or varus force (lat meniscus) and extend knee. Popping, clicking a/o pain is a positive test.

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7
Q

Describe J sign

A

“J sign” - refers to lateral patellar deviation during terminal knee extension

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8
Q

Listnonoperative tx modalities (4)

A

meds, PT, Splinting/casting, OMM

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9
Q

Give the hx for an ACL injury (6)

A
  1. Noncontact pivoting injury (decelerate and rotation, hyperextension, valgus position, can be a direct blow)
  2. Pop
  3. Immediate hemarthrosis (4-12 hours)
  4. Knee felt like shiting
  5. Stopped playing/unable to continue
  6. Knee instability with cutting and pivoting
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10
Q

What are the specific tests for making the dx of an ACL injury (3)

A
  1. Lachmans (most sensitive)
  2. anterior drawer
  3. Pivot shift
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11
Q

What will you see on an xray with an ACL tear?

A

Segond fx

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12
Q

What will you see on an MRI with an ACL tear?

A

ligament tear and bone bruise pattern of lateral femoral condyle and tibial plateau

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13
Q

What is the hx for an MCL tear? (6)

A
  1. noncontact external rotation
  2. hit from side of lateral knee
  3. pop
  4. minimal swelling (less than ACL)
  5. Medial knee pain
  6. Instability
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14
Q

List PE findings for MCL tear (2)

A
  1. pain along medial epicondyle or proximal tibia

2. swelling medially

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15
Q

With an MCL tear there is opening to (varus/valgus) stress and what degree of flexion isolates the MCL?

A

opening to Valgus stress and 30 degrees

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16
Q

What is dx on xray for MCL tear?

A

Pellegrini Stieda Lesion

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17
Q

What is the hx for an LCL tear? (3)

A
  1. lateral knee pain
  2. instability
  3. Hit to lower leg (just above ankle area) making tibia go toward midline (a varus force)
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18
Q

With an LCL tear you finding opening to (varus/valgus) stress? and what degree of flexion isolates the LCL?

A

Varus stress and 30 degrees

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19
Q

Injury to the peroneal nerve causes loss of what motor and sensory functions?

A

supplies movement and sensation to the lower leg, foot and toes.

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20
Q

With an LCL tear the pt may have numbness in what nerve distribution?

A

peroneal

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21
Q

What factor is different in treating MCL and LCL surgically?

A

timing is more important in LCL, you want to get to those quickly

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22
Q

What is the hx for a PCL tear? (6)

A
  1. Dashboard injury
  2. fall on flexed knee with foot plantar flexed
  3. pain
  4. swelling
  5. stiffness
  6. instability (less than with ACL)
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23
Q

What is the best test for dx a PCL tear?

A

Posterior drawer

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24
Q

What are some PE findings in PCL tear? (2)

A
  1. bruising over anterior tibia

2. posterior sag

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25
What are the 2 settings for meniscal tears?
1. acute/traumatic | 2. chronic/degenerative
26
Acute Traumatic meniscal tear hx (7)
1. axial load and rotation 2. pain 3. swelling 4. clicking/catching 5. locking knee and twist to unstick 6. loss of motion, especially extension if large tear 7. acute ACL tears associate with lateral meniscal tears
27
Chronic/degenerative meniscal tear hx (4)
1. insidious onset of pain and swelling 2. may or may not know of any injury 3. locking or catching 4. pain along joint line
28
What is the best PE test for meniscal tear?
joint line tenderness
29
List 4 PE test that look for meniscal tears
1. joint line tenderness 2. McMurray 3. Apley 4. Thessally
30
When do you want to operate on a pt with a meniscal tear?
1. symptomatic locking and catching | 2. young pt (especially with ACL surgery)
31
What is a hx for a patella tendon rupture? (3)
1. pt younger than 40 2. felt pop (missing steps, playing bball, jumping) 3. can't extend knee
32
What are the PE findings in a pt with a patella tendon rupture (6)
1. unable to extend knee 2. unable to hold leg in air (straight leg raise) 3. high riding patella 4. hemarthrosis 5. defect below patella 6. possible bruising anterior knee
33
What is the treatment for a patella tendon rupture?
surgery
34
What is the hx for a quadricep tendon rupture? (3)
1. pt older than 40 2. felt pop (missed steps) 3. can't extend the knee
35
If a pt has bilat quadricep tendon rupture what should you think of? (3)
1. gout 2. diabetes 3. steroid use
36
What are the PE findings in a pt with quadriceps tendon rupture (6)
1. unable to extend knee 2. unable to hold leg in air (straight leg raise) 3. low riding patella 4. hemarthrosis 5. defect above patella 6. possible bruising anterior knee
37
What is the tx for quadriceps tendon rupture?
Surgery
38
Patella dislocation is most common in what population?
females in their 20's
39
What is the insertion and innervation of the Gastroc/Soleus complex?
Insertion: posterior surface of calcaneus Innervation: Tibial nerve (S1 and S2)
40
Patella dislocation PE findings (3)
1. pain along medial retinaculum and adductor tubercle 2. apprehension to lateral pressure of patella 3. possible J sign when flex and extend the knee
41
What ligament attaches at the adductor tubercle?
medial patellofemoral ligament
42
Why is an MRI helpful in a patella disolcation?
helps distinguish between this and an ACL injury
43
How do you reduce a patellar disolcation?
extend the knee and push the patella over
44
What is the ligament that hold the patella from going out laterally?
medial patellofemoral ligament
45
Patella sleeve fx are common in what age group and are usually d/t what?
8-12 y/o and d/t a fall
46
What are the PE findings in a patella sleeve fx?
extensor tendon lag/ inability to SLR and swelling and tenderness around the knee
47
What are the xray findings on a patella sleeve fx
small fleck of bone inferior patella
48
What bones make up the acetabulum?
ischium, ilium, pubis
49
What is the blood supply to the femoral head?
profundus femoris (deep femoral artery)
50
What muscles attach to the: ASIS, AIIS, Trochanters?
.
51
What is nl ROM for the hip in 1. Flexion 2. extension 3. Abduction 4. Adduction 5. External rotation 6. Internal Rotation
1. Flexion- 125 2. extension- 30 3. Abduction- 45 4. Adduction - 20 5. External rotation- 45 6. Internal Rotation - 35
52
What is Ober's test?
a. pt lat recumbent (affected leg up) b. uninvolved leg flexed at hip and knee (stability) c. flex involved knee to 90 degrees and abduct and extend thigh at hip (ITB passes post. greater trochanter) d. Allow involved leg to adduct (lowering); normally hip will pass anatomical neutral e. If a contracture is present in tensor fascia latae or ITB, hip will remain abducted ; this is a positive test.
53
What is Thomas test?
a. pt supine, one leg at edge of table (slight extension) b. pt brings contralateral leg toward chest c. + test if in extended leg there is any of following i. flexion w/o knee extension (iliopsoas) ii. abduction (tensor FL) iii. knee extension (rectus fem.) iv. lateral rotation of tibia (biceps fem)
54
Femoral neck fx are more common in pt over what age?
50 y/o
55
What PE findings do you have with a femoral neck fx?
shortened and external rotated leg and painful hip motion
56
When should you order an MRI for a femoral neck fx?
when a nondisplaced fx is suspected because it won't appear on xray
57
How should you manage femoral neck fx post op?
with bisphosphonates or vit D and calcium
58
Where do intertrochanteric fx typically occur?
along the line between the 2 trochanters
59
are intertrochanteric fx more likely or less likely to have nonunion and avascular necrosis than femoral neck fx?
less likely for nonunion and avascular necrosis because the more extracapsular the more cancellous bone
60
What is the hx for intertrochanteric fx? (4)
1. older pt than fem neck fx 2. low energy fall 3. pain in groin 4. unable to bear weight
61
Why are you more likely to tx intertrochanteric fx with internal fixation over arthroplasty?
because high likelihood of healing with larger area of cancellous bone
62
In which sex are stress fx more common?
female
63
What is the PE for a pt with stress fx? (4)
1. may be normal 2. slight atalgic gait 3. possibly pain with rotation of hip 4. PAIN WORSE WITH RUNNING OR JUMPING
64
What is the hx in a hip dislocation? (3)
1. younger, active pt 2. high energy trauma (falls from height, MVC, football) 3. Severe pain and shortening of leg
65
What are the signs for an anterior hip dislocation
flexed, abducted, externally rotated
66
what are the signs for a posterior hip dislocation
short, adducted, internally rotated
67
Describe the reduction maneuvers steps in Skinner text on pg 155-156
physician knee under pt knee to flexed hip and add tractions, then internally rotate, traction is most important it looks like on video
68
Why is it important to emergently reduce hip dislocations?
avascular necrosis
69
What is the hx for a pt with Slipped Capitus femoral epiphysis? (SCFE) (7)
1. subacute pain over 1+ month 2. aching pain 3. thigh or knee pain or hip pain 4. acute will have severe pain 5. obese child 6. limp 7. 11-13 y/o
70
What PE will a pt with SCFE have? (3)
1. loss of abduction and internal rotation 2. obligatory external rotation with flexion of hip 3. acute- inability to bear weight
71
The prognosis for SCFE depends on....
degree of slippage that worsens the longer the condition occurs
72
What is the pain cause of premature osteoarthritis in young adults?
SCFE
73
Give 3 reasons what SCFE occurs
1. thick growth plate cartilage 2. lack of sexual maturity 3. mechanical shear stress (obesity)
74
Describe the hx in a pt with Perthes
1. 4-10 y/o 2. painless limp 3. pain might be mild and radiate to thigh
75
What are some PE findings on a pt with Perthes (4)
1. atrophy of thigh 2. flexion contracture up to 30 degree 3. loss of abduction 4. loss of internal rotation
76
List the tx plan in a pt with Perthes (4)
1. pt less than 5 and those with little involvement need obs 2. maintain motion 3. braces if dz progresses 4. osteotomies if dz get bad
77
What might an xray in a pt with a previous quad contusion show?
myositis ossificans (Ca in muscle) can form and this might be mistaken for CA
78
Which quad muscle is most anterior?
rectus femoris
79
what are the muscles that make up the quad?
Rectus femoris Vastus intermedius vastus lateralis vastus medialis
80
What part of the pelvis does hip pointed affect?
iliac crest
81
What is the age range of pt with pelvis avulsions?
14-25 y/o
82
What is the tx for a pt with pelvic avulsion? (3)
1. Symptomatic treatment with rest and ambulation with crutches for about 4 weeks 2. 6-10 weeks return to sports 3. Surgery has not improved results unless great displacement
83
What is the origin, insertion and innervation of the rectus femoris?
Origin: anterior iliac spine and ilium superior to acetabulum Insertion: base of patella Innervation: femoral n (L2-L4)
84
What is the origin, insertion and innervation of the vastus lateralis?
Origin: greater trochanter and lateral lip of linea aspera of femur Insertion: base of patella Innervation: femoral n. (L2-4)
85
What is the origin, insertion, and innervation of the vastus medialis?
Origin: intertrochanteric line and medial lip of the linea aspera of femus Insertion: base of patella Innervation: Femoral n. (L2-L4)
86
What is the origin, insertion and innervation of the vastus intermedius?
Origin; anterior and lateral surfaces of shaft of femur Insertion: base of patella Innervation: femoral n (L2-L4)

MSS Year 2 (6 decks)

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