Knee Flashcards
Pain persists + interferes w/ weight bearing
Pain/popping/catching with any twisting or pivoting
meniscus tears
History of trauma w/ subsequent knee “locking or catching”
Most common cause of knee joint pain
meniscus tears
PE: swelling + loss of extension
Joint line tenderness, effusion
→ McMurray’s test (pain/click = +)
→ Apley’s test (pain = +)
XR, MRI, arthroscopy
meniscus tears
meniscus tears tx
Ice
Quadriceps exercises
Crutches
NSAIDs
Analgesics
Referral (locked knee or lack of full extension, persistent pain/swelling, giving way) + arthroscopy
Hemarthrosis
“Giving way”
Usually swollen
anterior cruciate injury
Traumatic injury and may be associated with injury of meniscus or medial collateral
→ moving backward
anterior cruciate injury
PE: swelling, palpation causing effusion + pain, ROM painful
Anterior drawer (tibia sliding forward = +)
Lachman’s
Pivot shift
XR: avulsion
PE is key
MRI
anterior cruciate injury
anterior cruciate injury tx
RICE → rest, ice, compression, elevation
Knee immobilizer
Crutches
NSAIDS
Therapy
Surgery
Direct trauma to proximal tibia when flexed knee is decelerated rapidly
→ moving forward
Dashboard injury
posterior cruciate injury
tibia sag test is helpful for
posterior cruciate injury
Tx for posterior cruciate ligament
surgery
Able to ambulate
Swelling or stiffness, pain and tenderness
Localized ecchymosis
collateral ligament injuries
MCL
valgus force
LCL
varus force
Evaluate normal knee first
PE: swelling, ecchymosis, with tenderness at origin + insertion of ligament
ROM
Valgus + varus stress tests at full extension and 30 degree flexion
XR: AP + lateral XR (usually negative, but possible avulsion)
collateral ligament injury
Grades of collateral ligament injuries
Grade I = localized tenderness over ligament, little or no laxity
Grade II = significant laxity but definite end point reached
Grade III = laxity with no end point
How do you treat a collateral ligament injury?
Grade I = RICE + NSAIDS
Grade II = hinged brace 4-6 weeks and crutches
Grade III = hinged brace, gradual return
Rehab, refer for possible surgery
Refer if hemarthrosis or ligamentous instability
What is another name for bursitis of the knee
housemaid’s knee
worse when first rising, better with motion, worse at night
Tendinous or ligamentous bursitis
superficial, lies between skin + patella and with kneeling activities
Prepateller bursitis
under conjoined insertion of hamstring on medial flare of knee with localized tenderness
pes anserine bursitis
pain on lateral femoral condyle
IT band bursitis
warm swollen tender fluid filled mass over patella
prepatellar bursitis
How do you treat bursitis of the knee?
NSAIDS
ICE
Modalities (US)
Reduction of activities
Stretching of tendons
Corticosteroids
Drain fluid (prepatellar)
Anterior knee pain- inferior to the patella
→ night pain, pain with sitting, squatting, kneeling
Increased with climbing stairs
patella/quadriceps tendonitis
Overuse syndrome “jumper’s knee”
patella/quads tendonitis
PE: pain
Quadriceps atrophy
→ straight leg raise test to rule out rupture
Check ACL + PCL
MRI can be helpful
patella/quads tendonitis
How do you treat patella/quad tendonitis?
Rest, knee immobilizer, NSAIDs
Avoid corticosteroids + fluoroquinolones (cause rupture)
Refer all possible tendon ruptures
Pain, swelling, and tenderness around tibial tubercle
Relieved by rest
osgood-schlatter disease
Osgood-schlatter disease is common in
adolescent males
Repetitive injury, burst of growth
osgood-schlatter disease
XR: irregular ossifications or fragmentation laterally
osgood-schlatter disease
How do you treat osgood schlatter disease?
Avoid activity triggering symptoms
Ice
Immobilization for severe symptoms
Parental reassurance
Pain + inability to extend knee after direct blow
patella fracture
PE: hemarthrosis w/ swelling + unable to extend knee
XR: AP + lateral
Extensor mechanism usually intact if only 2 main fragments <6mm apart
patella fracture
patella fracture Tx
Immobilize in extension for 6 weeks (3-4 weeks ROM)
If <5mm separation + <2mm displacement
Extension intact
Surgery if not
knee giving way or popping out
patella dislocation
a patella dislocation is often
secondary to an acute injury
with a patella dislocation always
evaluate for other injuries
+ apprehension test
How do you treat a patella dislocation?
RICE, immobilization, full weight bearing
Quadricep exercises important
Pain worse with sitting with knee flexed (+ theatre sign) or going down stairs
patellofemoral pain syndrome
patellofemoral pain syndrome is common in
female athletes
“Chondromalacia patella”
MC anterior knee problem
patellofemoral pain syndrome
XR usually negative, sunrise films may show lateral displacement of patella
Patellar compression + entrapment signs (weak quads)
patellofemoral pain syndrome
How do you treat patellofemoral quad syndrome?
NSAIDS, ice, quad exercises, + avoid triggering activities
Surgery if no improvement
Aching pain at rest, worse with weight bearing
osteochondritis dissecans
Avascular necrosis of subchondral bone
→ medial femoral condyle usually involved
Traumatic
osteochondritis dissecans
PE: decreased ROM, may feel loose body
XR: AP + lateral
Half moon lesion in subchondral bone
osteochondritis dissecans
osteochondritis dissecans tx
Refer for possible surgery + lower weight bearing
tibial plateau/femoral condyle fractures are called
knee intra-articular fractures
How do you treat a knee intra-articular fracture?
ORIF
