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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
What do you look for an in an anteroposterior view x ray?
denerative arthritis | joint space loss
26
What do you look for in a lateral view x ray?
osgood-schlatter disease (fx of apophysis) epiphysitis tibial tubercle
27
What do you look for in a skyline (sunrise) view ex ray?
lateral patellar displacement | shape of patella
28
What are blood tests that can be done?
``` ESR= erythrocyte sedimentation rate CRP= C-reactive proteins (inflammatory marker) Rheumatoid factor ANA Profile (for lupus) ```
29
What's being checked in arthrocentesis?
synovial fluid
30
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)
31
What's the camel sign for?
patella alta
32
In pt seated observation, you see enlarged tibial tubercle. What could this be?
Osgood-Schlatter disease
33
In pt seated observation, you see enlarged fat pat. What could this be?
hoffa syndrome
34
Soft tissue inspection: Muscle contours for
atrophy | asymmetry
35
Soft tissue inspection: Swelling for
generalized edema metabolic or vascular disorders venous thrombosis reflex sympathetic dystropy
36
Soft tissue inspection: Localized edema for
articular effusion (swelling of supra-patellar pouch)
37
Soft tissue inspection: Extra articular effusion for
pre-patellar bursa
38
Localized erythema could be what?
inflammatory process
39
Ecchymosis could be what?
contusion ligementous damage recept patellar dislocation
40
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
41
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 ```
42
How much tibial rotation is there?
30 degrees medial | 40 degrees lateral
43
Excessive medial tibia movement could be what?
possible torn ACL
44
Excessive lateral tibia movement could be what?
possible torn PCL
45
What's a special test for MCL?
valgus stress at 0 and 30 degrees flexion
46
What's a special test for LCL?
Varus stress at 0 and 30 degrees flexion
47
What's a special test for PCL?
Posterior drawer | Sag sign
48
What's a special ACL test?
Lachman's Anterior Drawer Pivot shift
49
What's a special meniscus test?
McMurray Apley Joint Line Tenderness
50
What is the primary ligamentous strain and secondary restraints for anterior translation?
ACL MCL, LCL, capsule, popliteus corner, semimembranosus corner, ITB
51
What is the primary ligamentous strain and secondary restraints for posterior translation?
PCL MCL, LCL, capsule, popliteus tendon, ant/post meniscofemoral ligaments
52
What is the primary ligamentous strain and secondary restraints for valgus rotation (medial gapping)?
MCL ACL, PCL, posterior capsule, semimembranous corner
53
What is the primary ligamentous strain and secondary restraints for varus rotation (lateral gapping)?
LCL ACL, PCL, posterior capsule, popliteus corner
54
What is the primary ligamentous strain and secondary restraints for lateral rotation?
MCL, LCL Popliteus corner
55
What is the primary ligamentous strain and secondary restraints for medial rotatin?
ACL, PCL ant/post meniscofemoral ligaments, semimembranous corner
56
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.
57
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
58
tests for one plane posterior instability tests
``` posterior sag sign reverse lachman test posterior drawer test active drawer test godfrey (gravity) test ``` implicates PCL
59
Test for complete rupture of ACL/ dynamic subluxation?
Lateral pivot shift test | +) = clunk between 20-40 degrees flexion (subluxation --> reduction
60
posterior rotary instability tests
houghston's posteromedial drawer sign
61
Meniscal Tests
Thessaly's Apley's McMurry's
62
Plica stutter test
seated with knee flexed to 90- actively extend knee. | palpate patela- if jumps at 60-45 degrees (+)
63
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
64
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
65
What's normal patellar tilt?
Females 15 degrees | Males 10 degrees
66
Test for dislocation of patella
apprehension test (knee flexed to 30 degrees!)
67
test for ITBand fricion syndrome
noble compression test
68
Test for OCD (osteochondritis Dessiecans)
wilson test
69
What nerve roots is patellar reflex testing?
L3- L4
70
What nerve roots is medial hamstring reflex testing?
L5-S1
71
What might be the reason for burning medial knee pain agrivated by walking, standing, and quad exercises?
saphenous nerve irritation

Ortho Knee (6 decks)

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