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Ortho Knee > Examination and Diagnosis > Flashcards

Examination and Diagnosis Flashcards

1
Q

pop

A

ACL injury

sometimes a meniscus injury

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2
Q

swelling immediately

A

ACL

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3
Q

Locking

A

meniscus (internal derangement)

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4
Q

Buckling

A

pain, nerve damage, quad weakness

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5
Q

traumatic injury: MOI=

varus/valgus without rotations

A

collateral ligaments
epiphyseal fracture
patellar dislocation

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6
Q

traumatic injury: MOI=

varus/ valgus with rotation

A

collatera ligs
cruciate ligs
collaterals + patellar dislocation
meniscus

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7
Q

A/P force with knee flexed or fall on flexed knee (foot in DF)

A

osteochontral fracture

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8
Q

traumatic injury: MOI=

A/P blow with knee flexed or fall on flexed knee (foot in PF)

A

PCL

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9
Q

traumatic injury: MOI=

Contact hyperextension

A

ACL/PCL

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10
Q

traumatic injury: MOI=

non- contact hyperextension

A

ACL

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11
Q

traumatic injury: MOI=

non- contact deceleartion

A

ACL

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12
Q

traumatic injury: MOI=

non- contact rotation with varus or valgus load meniscus

A

meniscus

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13
Q

traumatic injury: MOI=

non-contact rotation with compression load

A

meniscus

osteochondral fracture

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14
Q

traumatic injury: MOI=

hyperflexion

A

meniscus

ACL

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15
Q

traumatic injury: MOI=

forced medial rotation

A

lateral meniscus

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16
Q

traumatic injury: MOI=

forced lateral rotation

A

medial meniscus
MCL
ACL

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17
Q

traumatic injury: MOI=

dashboard injury

A

PCL
patellar fracture
tibial plateau fracture

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18
Q

What types of injuries present with a sudden, traumatic onset of pain?

A 
sprains 
strains
contusions
fractures
subluxations/dislocation
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19
Q

What types of injuries present with a gradual, non- traumatic onset?

A

DJD (morning pain)
PF joint dysfunctoin
pain with prolonged sitting or descending stairs

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20
Q

immediate swelling vs delayed::

A

hemarthrosis vs inflammatory effusion

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21
Q

If knee feels like its “giving way”, could be what?

A

ligamentous or patellar injury

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22
Q

If knee feels like its “catching”, could be what?

A

PF maltracking vs meniscal injury

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23
Q

Acute knee pain could be what?

A 
fracture
lig injury
meniscal injury
patellar subluxation
muscle strain
contusion
infection
chronic rheumatologic conditions
exacerbation of osteoarthritis
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24
Q

What are the Ottawa knee rules for recent fall or trauma?

A

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

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25
Q

What do you look for an in an anteroposterior view x ray?

A

denerative arthritis

joint space loss

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26
Q

What do you look for in a lateral view x ray?

A

osgood-schlatter disease (fx of apophysis)
epiphysitis
tibial tubercle

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27
Q

What do you look for in a skyline (sunrise) view ex ray?

A

lateral patellar displacement

shape of patella

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28
Q

What are blood tests that can be done?

A 
ESR= erythrocyte sedimentation rate
CRP= C-reactive proteins (inflammatory marker)
Rheumatoid factor
ANA Profile (for lupus)
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29
Q

What’s being checked in arthrocentesis?

A

synovial fluid

30
Q

What are some functional outcome scales?

A

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)

31
Q

What’s the camel sign for?

A

patella alta

32
Q

In pt seated observation, you see enlarged tibial tubercle. What could this be?

A

Osgood-Schlatter disease

33
Q

In pt seated observation, you see enlarged fat pat. What could this be?

A

hoffa syndrome

34
Q

Soft tissue inspection: Muscle contours for

A

atrophy

asymmetry

35
Q

Soft tissue inspection: Swelling for

A

generalized edema
metabolic or vascular disorders
venous thrombosis
reflex sympathetic dystropy

36
Q

Soft tissue inspection: Localized edema for

A

articular effusion (swelling of supra-patellar pouch)

37
Q

Soft tissue inspection: Extra articular effusion for

A

pre-patellar bursa

38
Q

Localized erythema could be what?

A

inflammatory process

39
Q

Ecchymosis could be what?

A

contusion
ligementous damage
recept patellar dislocation

40
Q

Extensor lag can cause what? what is it?

A

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

41
Q

Inability to extend knee could be due to what?

A 
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
42
Q

How much tibial rotation is there?

A

30 degrees medial

40 degrees lateral

43
Q

Excessive medial tibia movement could be what?

A

possible torn ACL

44
Q

Excessive lateral tibia movement could be what?

A

possible torn PCL

45
Q

What’s a special test for MCL?

A

valgus stress at 0 and 30 degrees flexion

46
Q

What’s a special test for LCL?

A

Varus stress at 0 and 30 degrees flexion

47
Q

What’s a special test for PCL?

A

Posterior drawer

Sag sign

48
Q

What’s a special ACL test?

A

Lachman’s
Anterior Drawer
Pivot shift

49
Q

What’s a special meniscus test?

A

McMurray
Apley
Joint Line Tenderness

50
Q

What is the primary ligamentous strain and secondary restraints for anterior translation?

A

ACL

MCL, LCL, capsule, popliteus corner, semimembranosus corner, ITB

51
Q

What is the primary ligamentous strain and secondary restraints for posterior translation?

A

PCL

MCL, LCL, capsule, popliteus tendon, ant/post meniscofemoral ligaments

52
Q

What is the primary ligamentous strain and secondary restraints for valgus rotation (medial gapping)?

A

MCL

ACL, PCL, posterior capsule, semimembranous corner

53
Q

What is the primary ligamentous strain and secondary restraints for varus rotation (lateral gapping)?

A

LCL

ACL, PCL, posterior capsule, popliteus corner

54
Q

What is the primary ligamentous strain and secondary restraints for lateral rotation?

A

MCL, LCL

Popliteus corner

55
Q

What is the primary ligamentous strain and secondary restraints for medial rotatin?

A

ACL, PCL

ant/post meniscofemoral ligaments, semimembranous corner

56
Q

Gold standard for one plane anterior instability?

A

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.

57
Q

Anterior drawer test

A

(+) >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

58
Q

tests for one plane posterior instability tests

A 
posterior sag sign
reverse lachman test
posterior drawer test
active drawer test
godfrey (gravity) test

implicates PCL

59
Q

Test for complete rupture of ACL/ dynamic subluxation?

A

Lateral pivot shift test

+) = clunk between 20-40 degrees flexion (subluxation –> reduction

60
Q

posterior rotary instability tests

A

houghston’s posteromedial drawer sign

61
Q

Meniscal Tests

A

Thessaly’s
Apley’s
McMurry’s

62
Q

Plica stutter test

A

seated with knee flexed to 90- actively extend knee.

palpate patela- if jumps at 60-45 degrees (+)

63
Q

Difference with examination with motion limitation of plica and internal derangement with meniscus

A

End feel-
meniscus- springy end feel and block of motion
plica- can’t really block motion, but will feel pain

64
Q

Test for patellafemoral pain?

A

Clarke’s sign
(+) = retropatellar pain
30, 60, 90 degrees of flexion

Eccentric step down test

Zohler’s sign
pull down patella
active quad contraction

65
Q

What’s normal patellar tilt?

A

Females 15 degrees

Males 10 degrees

66
Q

Test for dislocation of patella

A

apprehension test (knee flexed to 30 degrees!)

67
Q

test for ITBand fricion syndrome

A

noble compression test

68
Q

Test for OCD (osteochondritis Dessiecans)

A

wilson test

69
Q

What nerve roots is patellar reflex testing?

A

L3- L4

70
Q

What nerve roots is medial hamstring reflex testing?

A

L5-S1

71
Q

What might be the reason for burning medial knee pain agrivated by walking, standing, and quad exercises?

A

saphenous nerve irritation

Ortho Knee (6 decks)

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