EEI 10/14c MSK Differential Diagnosis Lab

Question 1

what are most important aspects of injury?

Answer 1

• mechanism of injury
• location of symptoms
• irritability
• degenerative/acute pain
• imaging?

Question 2

what are the different kinds of injuries we could have of the knee?

Answer 2

1. ligamentous
2. intra-articular
3. bony fracture/dislocation
4. muscular strain

Question 3

basic physical exam (cyriax)

Answer 3

1. AROM
2. PROM
3. Iso Res
4. Palpation
5. Special Tests
6. Recommendation

Question 4

what should we be able to palpate?

Answer 4

tibial plateau
fibular head
apex of patella
medial joint line 
patellar tendon
patellofemoral joint
patella mobility

Question 5

what does irritability tell you?

Answer 5

High or Low

-lets us know how vigorous we can be with the exam

Question 6

ottowa knee and ankle rules to define if we need imaging?

Answer 6

• bony tenderness
• no weight bearing without significant pain (4 steps)
• cannot flex greater than 90 degrees
• fibular head
• patella

Question 7

how do we know if it’s a contractile problem?

Answer 7

isometric test midrange will be positive

Question 8

how do we know if it’s a cartilage problem?

Answer 8

locking, catching, giving away, joint line tenderness

Question 9

how do we know it’s a ligament problem?

Answer 9

• tenderness to palpation of ligament
• immediate onset of swelling
• joint laxity (positive valgus/vargas test)

Question 10

what are some special tests to look out for in the knee?

Answer 10

• Look for joint play and provocation OR laxity (Valgus stress test)
• Anterior drawer tests
• EGE’s: squat down with toes in and out, look for reproduction of pain and joint clicking along medial joint line
• Thessaly: produces medial knee pain on the affected side, 1 leg 20 degrees flexion and twist
• Sensation
• Sweep Test
• Gait
• Jumping
• Balance