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F3 E2 Shea > Knee 1 > Flashcards

Knee 1 Flashcards

1
Q

Condition?

  • Friction irritation due to repetitive A-P movement of the iliotibial band over the lateral femoral condyle (e.g. cross country running, cycling)
  • Faulty biomechanics
A

Iliotibial Band “Friction” Syndrome

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2
Q

ITB Friction Syndrome

  • Inflammation of the ITB at the point wher it passes over what?
A

Passes over lateral epicondyle of the femur

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3
Q

3 predisposing factors to ITB “Friction Syndrome”

A
  • Tight IT band
  • Genu varum (bowlegged)
  • Foot pronation → internal tibial rotation
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4
Q

Clinical Presentation of what?

  • Localized tenderness over lateral femoral condyle (esp. w/ palpation at 30˚ knee flexion)
  • Pain with active knee flexion / extension (walk with “stiff” knee)
  • No limitation of end range active or passive knee flexion/extension
  • No weakness with resisted knee range of motion
  • No pain or instability with collateral ligament laxity testing
A

Iliotibial Band “Friction” Syndrome

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5
Q

What test? / For what Condition?

  • Pt supine
  • Knee is flexed to 90°
  • Pressure applied to lateral femoral condyle
  • Knee is passively extended
    • c/o pain at 30° similar to that during activity
A

Noble Compression Test

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6
Q

Tx for ITB “Friction” syndrome?

A
  • NSAIDs
  • Ice WITH motion
  • Activity Modification
  • Therapy:
    • improve gluteal & iliotibial band flexibility
    • gluteal (hip abductor strength)
    • evaluate biomechanics
  • If fail conservative –> corticosteroid injection (risky bc/ tendon rupture)
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7
Q

Which condition?

  • MC from repetitive contact/trauma
  • Repetitive contact
  • Carpet / tile layers
  • Grappling sports (wrestling)
  • Trauma
  • Fall
  • Forceful contact with hard object (coffee table)
A

Prepatellar Bursitis

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8
Q

Prepatellar Bursitis

  • Tightness at end range of active & passive knee flexion
  • Restricted ROM should be pain free
  • Should not have pain w/ _____ of the patella
  • What special test will be positive?
A
  • lateral compression of the patella
  • Patellar Ballotement is +
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9
Q

Tx for Prepatellar Bursitis

A
  • Aspiration/injection
  • Compression
  • Ice
  • NSAIDs
  • Surgical excision (if recurrent problems)
  • Prevention (Knee pads)
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10
Q

Aspiration / Injection for Prepatellar Burisitis Treatment

  • 3 things you do to eval for Infection?
  • Post aspiration care:
    • no direct water exposure for ___ hours
    • Continuous compression for __ hours/ day for ___ days
  • During the first 7 days:
    • ice daily
    • avoid pressure/contact
    • No repetitive LE exercise
A
  1. Visualize fluids for clarity, color, viscosity
  2. Leukocyte count
  3. Culture & gram stain
  • no water: 48-72 hours
  • compression: 48 hrs / 5 - 7 days
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11
Q

2 types of Infectious Arthritis

A
  • Non-gonococcal acute bacterial arthritis (septic)
  • Gonococcal arthritis
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12
Q

Infectious Arthritis - Non-gonococcal

  • MC etiology?
  • MC organism?
  • RFs? (7)
A
  • MC etiology: Hematogenous
  • Organism: Staph aureus
  • RFs:
    • •Immunosuppression
  • Diabetes Mellitus
  • Sickle cell anemia
  • Prosthetic joint
  • Previous or pre-existing arthritis
  • Trauma
  • Bacteremia
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13
Q

Clinical Px of what condition?

  • Acute onset of monoarticular inflammatory arthritis (knee MC)
  • Erythema, swelling/effusion, warmth and pain
  • Limited function
  • +/- fever
  • +/- leukocytosis
A

Infectious Arthritis - Non-gonococcal

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14
Q

Infectious Arthritis - Non-gonococcal

  • Mainstay of dx?
    • Analysis consistent w/ what?
  • Blood cultures positive in what %?
  • Imaging?
A
  • Mainstay: synovial fluid analysis w/ wide bore needle (16 G)
  • Analysis: Bacterial Infection
    • >50,000 WBCs
    • >75% PMNs
    • Low glucose
      • culture
  • 50% of blood cultures are +
  • Imaging usually NOT very helpful
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15
Q

Which condition?

  • > 60 years
  • High prevalence of RA
  • Average of 4 joints (Knee, elbow, shoulder and hip predominate)
  • Staph and Strep most common (Blood cultures positive in 75%)
  • Synovial fluid culture positive in 90%
  • Poor prognosis (32% mortality (compared to 4% with monoarticular disease)
A

Polyarticular infectious arthritis (Non-gonococcal)

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16
Q

IV drug users w/ Non-gonoccoal Infectious Arthritis

  • What 3 joints are affected?
  • # 1 MC organism?
  • # 2 MC organism?
A
  • sternoclavicular, costochondral, pubic symphysis
  • #1: S. aureus
  • #2: pseudomonas
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17
Q

Tx for Non-Gonococcal Infectious Arthritis?

A
  • Joint aspiration and irrigation
  • Start IV antibiotics - do not wait on culture results

•Empiric = Vancomysin + 3rd generation cephalosporin (Ceftriaxone)

Targeted:

  • MSSA = Nafcillin
  • MRSA = Vancomysin

•Serial synovial fluid analysis are utilized to confirm clearance of infection

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18
Q

Gonococcal - Infectious Arthritis

  • Infection w/ what organism?
  • Occurs in otherwise healthy people
  • ____ arthritis in sexually active adult
  • Greater in men or women?
  • More common during menses & pregnancy
A
  • Neisseria gonorrhoeae
  • migratory
  • Women
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19
Q

Clinical Px of what Condition?

  • Migratory non-symmetric polyarthralgias of wrist, knee, ankle, elbow for 1-4 days
  • Tenosynovitis
  • Necrotic pustules on palms and soles
  • Fever occurs in less than half
  • Less than one fourth have GU symptoms
  • <50% develop purulent arthritis (knee MC)
A

Gonococcal Infectious Arthritis

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20
Q

Labs of Gonococcal Infectious Arthritis

  • Elevated WBC in less than 1/3 of cases
  • Synovial fluid analysis
    • elevated ___
    • Gram stain positive in 25%
    • Culture + in 50%
  • Blood cultures positive in 40-70% of cases
  • Cultures of what 4 locations need to be done? And are often + w/o sxs
  • Imaging?
A
  • elevated WBCs
  • 4 locations for cultures:
    • urethra
    • throat
    • cervix
    • rectum
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21
Q

Tx for Gonococcal Infectious Arthritis?

A
  • Azithromycin 1 g orally as single dose + third gen cephalosporin (Ceftriaxone)
  • After improvement in 24-48 hours, patient must complete 7-14 day course of ceftriaxone IM daily

Prognosis: rapid response to abx

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22
Q

Which condition?

  • Overuse / repetitive stress (e.g. jumping activities)
  • Microtrauma / chronic inflammation of the patellar / quadriceps tendon
  • Common in athletes who repeatedly jump or place eccentric stress on the knee
  • Imbalance between frequent patellar tendon loading and short-term healing ability
A

Patellar / Quadriceps Tendonitis (-osis)

23
Q

Clinical Px of what condition?

  • Localized pain / tenderness on palpation
  • Persistent aching after activity
  • Pain with resisted knee extension (+/- weakness)
  • Pain / tightness at end range of active and passive knee flexion
A

Patellar / Quadricepts Tendonitis (osis)

24
Q

Tx for Patellar / Quad Itis or Osis?

  • Activity modification
  • NSAIDs
  • Ice
  • Patellar tendon strap
  • PT if not improving w/ self mgmt
A

Tendonitis

25
Q

Tx for Patellar / Quad Itis or Osis?

  • Activity modification
  • Physical therapy
  • Patellar tendon strap
  • NSAIDs NOT beneficial for long term management
A

Tendonosis

26
Q

Which condition?

  • 30-60 years old
  • MOA: Rapid eccentric overload – fall on partially flexed knee
  • MOA: Rapid concentric overload – basketball player jumping
  • Sensation of instability or “giving way”
  • Feel and/or hear a “pop”
A

Patellar / Quadriceps Tendon Rupture

27
Q

Clinical Px of what?

  • Significant pain at the time of injury but during exam they may have minimal to no pain with quadriceps contraction
  • Rapid large effusion
  • Defect indicating area of rupture may be palpable
  • Key to diagnosis is inability to extend knee against gravity or perform straight-leg raise
  • DO NOT assess prone passive knee flexion ROM
A

Patellar / Quadriceps Tendon Rupture

28
Q

Patellar / Quadriceps Tendon Rupture

  • R/o what with imaging?
  • Location of patella?
    • Patella tendon rupture?
    • Quadriceps tendon rupture?
A
  • r/o patellar fx
  • Patella: patella higher than usual
  • Quad: patella lower than usual
29
Q

What imaging do you order to confirm dx of Patellar/Quad Tendon Rupture?

A

MRI

30
Q

Tx for Patellar / Quaddriceps Tendon Rupture?

A
  • Straight leg immobilizer
  • Non-weight bearing
  • Partial tears <50% may be treated non-surgically
  • Surgical repair treatment of choice for complete rupture
  • Marked disability will develop secondary to deficient extensor mechanism
31
Q

Which condition?

Repetitive activity w/ faulty biomechanics

  • Vastus medialis oblique (VMO) weakness
  • Increased Quadriceps angle (Q angle)
  • Hyperpronation
  • Poor technique
A

Patellofemoral Pain Syndrome

(Overuse condition affecting the patellofemoral joint)

32
Q

Term? Condition?

  • Pathologic changes involving articular surface of patella and femoral condyle
A

Chondromalacia

  • Patellofemoral Pain Syndrome
33
Q

Patellofemoral Pain Syndrome - Quadriceps Angle (Q-angle)

  • Line from the ___ –> ____
  • 2nd line transects the center of the patella and the ____
  • Females: ___ in full extension
  • Males: ___ degrees in full extension
A
  • ASIS –> center of patella
  • tibial tuberosity
  • F: <22 degrees
  • M: <18 degrees
34
Q

Which condition?

  • “Movie theater sign”
  • Pain w/ ascending and descending stairs
  • Pain w/ repetitive deep knee flexion
  • Pain at end range of active and passive knee flexion
  • Pain with resisted knee extension (+/- weakness)
  • J sign
    • patellar grind
A

Patellofemoral Pain Syndrome

35
Q

PFPS (patellofemoral pain syndrome) Treatment?

A
  • Activity modifications
  • NSAIDs

•Weight loss if obese****

  • VMO strengthening
  • Gluteal strengthening
  • Evaluate / correct technique
36
Q

Which condition?

  • Most commonly due to twisting injury to knee.
  • Only 10 % caused by direct trauma
  • Subluxation and dislocation may occur with minimal stress (e.g. minor twist with foot planted)
A

Patellar Dislocation

37
Q

4 RF of Patellar Dislocation?

A
  • Shallow patellofemoral articular groove
  • Patella alta
  • Excessive Q angle
  • Generalized ligamentous laxity
38
Q

Patellar Dislocation

  • Avg age range?
  • Rare over what age?
  • Which sex has higher incidence?
A
  • Avg: 16 - 20 yrs
  • Rare: >30 yrs
  • Females
39
Q

Patellar Dislocation

  • Severe pain, sometimes a “pop”
  • Pain and position of the patella contribute to patient being extremely uncomfortable
  • Knee held in a ____ position with a prominent _____ condyle
  • Reduced by gentle extension of the tibia, forceful ____ pressure on the patella is avoided
  • After reduction the patient has diffuse peri-patellar tenderness
A
  • flexed position / medial femoral
  • forceful medial
40
Q

Patellar Dislocation

•Subluxation or dislocation of the patella causes tearing of restraining _______ and ________, leading to pain, significant hemarthrosis, and loss of knee motion

A
  • medial retinacular tissue & medial patellofemoral ligament
41
Q

What test? What condition?

  • Knee in 30° flexion & gently displace patella laterally
  • Observe for guarding (reflexive quad contraction and/or reaching towards the knee) and visible apprehension
A

Patellar Apprehension Sign / Patellar Dislocation

42
Q

Patellar Dislocation

  • Post reduction x-rays may show____ or _____ of patella
  • ____should be ordered to assess severity of soft tissue injury & screen for osteochondral injury
A
  • lateral tilt or subluxation of patella
  • MRI
43
Q

Tx for Patellar Dislocation?

A
  • Knee Immobilizer after reduction
  • Stabilization brace post immobilization
  • PT to address biomechanical risk factors
  • Surgery if there is evidence of loose body on imaging studies or if patient has a history of recurrent dislocations
44
Q

MCL / LCL injuries

  • Which has greater incidence?
  • MC in males or females?
  • Result from what 2 mechanisms?
  • Use what 2 tests?
A
  • MCL > LCL
  • Males
  • Valgus or Varus mechanisms
  • Valgus/Varus stress tests (grade 1, 2, or 3)
45
Q

MCL Injury

  • Force directed to ___ aspect of knee leads to injury of medial collateral ligament
A

lateral

46
Q

Clinical Eval of which injury?

  • Instability - Abnormal opening of medial joint space
  • Valgus stress test knee fully extended
  • Valgus stress test knee flexed 30°
A

MCL injury

47
Q

What is the “unhappy triad” and what injury?

A

MCL injury

  • Medial collateral ligament tear
  • Medial meniscal tear
  • Anterior cruciate ligament tear
48
Q

What is the name of the MCL avulsion fx?

A

Steida’s Fracture

49
Q

LCL injury

  • Force directed to the ___ aspect of the knee
  • Results in injury to the lateral collateral ligament
  • Rare
A

medial

50
Q

Clinical eval of which injury?

  • Abnormal opening of lateral joint space
  • Varus stress test knee fully extended
  • Varus stress test knee flexed 30°
  • Check neurological function
A

LCL injury

51
Q

Collateral Ligament Tears

  • Pain w/ palpation
  • Swelling
  • ROM loss varies based on severity/amt of swelling
  • Is loss of knee flexion or extension more pronounced?
A

Loss of flexion is more pronounced

52
Q

Which grade of Collateral Ligament Tear?

  • Pain with stress testing but no laxity
  • RICE, short term NSAIDs and crutches as needed
A

Grade 1 (Interstitial)

53
Q

Which grade of Collateral Ligament Tear?

  • Pain and mild laxity with stress testing
  • Hinged brace and weight bearing as tolerated
  • Therapy
A

Grade 2 (Partial)

54
Q

Which grade of Collateral Ligament Tear?

  • Significant laxity and +/- pain with stress testing
  • Orthopedic surgery consult
  • Hinged brace and gradual return to full weight bearing over 4-6 weeks
  • Therapy
A

Grade 3 (complete)

F3 E2 Shea (14 decks)

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