Examination and Diagnosis Flashcards
pop
ACL injury
sometimes a meniscus injury
swelling immediately
ACL
Locking
meniscus (internal derangement)
Buckling
pain, nerve damage, quad weakness
traumatic injury: MOI=
varus/valgus without rotations
collateral ligaments
epiphyseal fracture
patellar dislocation
traumatic injury: MOI=
varus/ valgus with rotation
collatera ligs
cruciate ligs
collaterals + patellar dislocation
meniscus
A/P force with knee flexed or fall on flexed knee (foot in DF)
osteochontral fracture
traumatic injury: MOI=
A/P blow with knee flexed or fall on flexed knee (foot in PF)
PCL
traumatic injury: MOI=
Contact hyperextension
ACL/PCL
traumatic injury: MOI=
non- contact hyperextension
ACL
traumatic injury: MOI=
non- contact deceleartion
ACL
traumatic injury: MOI=
non- contact rotation with varus or valgus load meniscus
meniscus
traumatic injury: MOI=
non-contact rotation with compression load
meniscus
osteochondral fracture
traumatic injury: MOI=
hyperflexion
meniscus
ACL
traumatic injury: MOI=
forced medial rotation
lateral meniscus
traumatic injury: MOI=
forced lateral rotation
medial meniscus
MCL
ACL
traumatic injury: MOI=
dashboard injury
PCL
patellar fracture
tibial plateau fracture
What types of injuries present with a sudden, traumatic onset of pain?
sprains strains contusions fractures subluxations/dislocation
What types of injuries present with a gradual, non- traumatic onset?
DJD (morning pain)
PF joint dysfunctoin
pain with prolonged sitting or descending stairs
immediate swelling vs delayed::
hemarthrosis vs inflammatory effusion
If knee feels like its “giving way”, could be what?
ligamentous or patellar injury
If knee feels like its “catching”, could be what?
PF maltracking vs meniscal injury
Acute knee pain could be what?
fracture lig injury meniscal injury patellar subluxation muscle strain contusion infection chronic rheumatologic conditions exacerbation of osteoarthritis
What are the Ottawa knee rules for recent fall or trauma?
Ask for X-ray if fits one of following criteria:
age >55
fib head tenderness
patellar tenderness
inability to flex knee to 90 degrees
inability to bear weight and walk 4 steps when examined and at time of injury
What do you look for an in an anteroposterior view x ray?
denerative arthritis
joint space loss
What do you look for in a lateral view x ray?
osgood-schlatter disease (fx of apophysis)
epiphysitis
tibial tubercle
What do you look for in a skyline (sunrise) view ex ray?
lateral patellar displacement
shape of patella
What are blood tests that can be done?
ESR= erythrocyte sedimentation rate CRP= C-reactive proteins (inflammatory marker) Rheumatoid factor ANA Profile (for lupus)
What’s being checked in arthrocentesis?
synovial fluid
What are some functional outcome scales?
Lower Extremity Functional Scale (all LE conditions)
WOMAC Scale (OA)
Lysholm Knee Scale (lig and meniscal injuries)
International Knee Documentation Committee Questionnaire (knee Lig injury)
What’s the camel sign for?
patella alta
In pt seated observation, you see enlarged tibial tubercle. What could this be?
Osgood-Schlatter disease
In pt seated observation, you see enlarged fat pat. What could this be?
hoffa syndrome
Soft tissue inspection: Muscle contours for
atrophy
asymmetry
Soft tissue inspection: Swelling for
generalized edema
metabolic or vascular disorders
venous thrombosis
reflex sympathetic dystropy
Soft tissue inspection: Localized edema for
articular effusion (swelling of supra-patellar pouch)
Soft tissue inspection: Extra articular effusion for
pre-patellar bursa
Localized erythema could be what?
inflammatory process
Ecchymosis could be what?
contusion
ligementous damage
recept patellar dislocation
Extensor lag can cause what? what is it?
6-% increase in quad force to complete final 15 degrees of active extension
it is a quad insufficiency, usually post op or injury, result of swelling/mechanics/other post injury/post op causes
Inability to extend knee could be due to what?
weak quads femoral N. dysfuction HNP L3-L4 severe pain excessive swelling hamstring tightness excessive lig stiffness scarring in popliteal region lack of screw-home mechanism lack of anterior slide of tibia meniscal block patellar immobility
How much tibial rotation is there?
30 degrees medial
40 degrees lateral
Excessive medial tibia movement could be what?
possible torn ACL
Excessive lateral tibia movement could be what?
possible torn PCL
What’s a special test for MCL?
valgus stress at 0 and 30 degrees flexion
What’s a special test for LCL?
Varus stress at 0 and 30 degrees flexion
What’s a special test for PCL?
Posterior drawer
Sag sign
What’s a special ACL test?
Lachman’s
Anterior Drawer
Pivot shift
What’s a special meniscus test?
McMurray
Apley
Joint Line Tenderness
What is the primary ligamentous strain and secondary restraints for anterior translation?
ACL
MCL, LCL, capsule, popliteus corner, semimembranosus corner, ITB
What is the primary ligamentous strain and secondary restraints for posterior translation?
PCL
MCL, LCL, capsule, popliteus tendon, ant/post meniscofemoral ligaments
What is the primary ligamentous strain and secondary restraints for valgus rotation (medial gapping)?
MCL
ACL, PCL, posterior capsule, semimembranous corner
What is the primary ligamentous strain and secondary restraints for varus rotation (lateral gapping)?
LCL
ACL, PCL, posterior capsule, popliteus corner
What is the primary ligamentous strain and secondary restraints for lateral rotation?
MCL, LCL
Popliteus corner
What is the primary ligamentous strain and secondary restraints for medial rotatin?
ACL, PCL
ant/post meniscofemoral ligaments, semimembranous corner
Gold standard for one plane anterior instability?
Lachman
+ if mushy/empty end feel
false (-) if tibia is IR or femor or femur not stabilized
implicates the ACL (especially PL bundle). post oblique lig or arcuate popliteus complex.
Anterior drawer test
(+) >6mm translation. implicates ACL, post lateral capsule, posteromedial capsule, deep fibers of MCL, ITB, arcuate complex
false (-) if only ACL is torn or with hamstring spasm
fast (+) if there is a posterior sag sign
tests for one plane posterior instability tests
posterior sag sign reverse lachman test posterior drawer test active drawer test godfrey (gravity) test
implicates PCL
Test for complete rupture of ACL/ dynamic subluxation?
Lateral pivot shift test
+) = clunk between 20-40 degrees flexion (subluxation –> reduction
posterior rotary instability tests
houghston’s posteromedial drawer sign
Meniscal Tests
Thessaly’s
Apley’s
McMurry’s
Plica stutter test
seated with knee flexed to 90- actively extend knee.
palpate patela- if jumps at 60-45 degrees (+)
Difference with examination with motion limitation of plica and internal derangement with meniscus
End feel-
meniscus- springy end feel and block of motion
plica- can’t really block motion, but will feel pain
Test for patellafemoral pain?
Clarke’s sign
(+) = retropatellar pain
30, 60, 90 degrees of flexion
Eccentric step down test
Zohler’s sign
pull down patella
active quad contraction
What’s normal patellar tilt?
Females 15 degrees
Males 10 degrees
Test for dislocation of patella
apprehension test (knee flexed to 30 degrees!)
test for ITBand fricion syndrome
noble compression test
Test for OCD (osteochondritis Dessiecans)
wilson test
What nerve roots is patellar reflex testing?
L3- L4
What nerve roots is medial hamstring reflex testing?
L5-S1
What might be the reason for burning medial knee pain agrivated by walking, standing, and quad exercises?
saphenous nerve irritation
