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Medicine II: Orthopedics > Knee > Flashcards

Knee Flashcards

1
Q

Chondromalacia patella

A

Often called anterior knee pain and/or patellofemoral pain syndrome (PFPS).

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2
Q

What causes Chondromalacia patella?

A

It is due to the softening or degeration of the articular cartilage on the under surface of the patella.

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3
Q

Symptoms and PE of Chondromalacia patella:

A

Anterior knee pain that becomes worse after prolonged sitting, climbing, jumping, or running. Also a/w +/- catching sensations. Able to hear/feel grinding “noises” of the knee. Mild swelling, tenderness and crepitus.

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4
Q

Labs and Tests for Chondromalacia patella

A

Initial studies are plain xrays→ most helpful views are standing AP, lateral, and Merchant or sunrise. Xrays and MRI will generally be negative.

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5
Q

Treatment of Chondromalacia patella

A

Treatment can be conservative, include activity modifications, and quadriceps/hamstring muscle strengthening activities. Can also use a knee sleeve/brace, NSAIDs, Ice/heat or do a knee arthroscopy/alignment procedure.

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6
Q

Malalignment of Patella

A

Almost always occurs laterally, Common in females in 20s

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7
Q

Mechanism of Malalignment of Patella

A

Mechanism of direct blow to patella and knee in flexed position or powerful contraction of quadriceps. Causes tearing of the restraining retinacular tissue and patellofemoral ligament. Valgus force and external rotation of tibia applied to flexed leg.

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8
Q

Presentation and Treatment of Malalignment of Patella

A

Patella almost always dislocated laterally. Immediate mobilization, strengthening, immobilization in cast for 6 weeks, rehab, arthroscopy, sx or patellar realignment

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9
Q

Pain associated with Malalignment of Patella

A

Pain and apprehension when patella is pushed, fleck of bone present on medial side

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10
Q

Bursae

A

Bursae lie between the skin and bondy prominences or between tendons, ligaments and bone. They are lined by synovial tissue, which produces a small amount of fluid to decrease friction between adjacent structures.

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11
Q

Prepatellar Bursistis

A

Trauma and/or chronic pressure or friction causes thickening of the synovial lining. Swelling is outside the knee.

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12
Q

Symptoms and Common Findings of Prepatellar Bursistis

A

Localized swelling (extraarticular), pain with direct pressure and sometimes with activity. Usually full ROM of knee, +/- tenderness upon palpation.

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13
Q

Imaging for Prepatellar Bursistis

A

Can take but not needed; AP, Lateral, Sunrise

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14
Q

Treatment for Prepatellar Bursistis

A

NSAIDS, Ice, Rest, Compression, Activity modification, Aspiration/corticosteroid injection (increased risk of infection), bursectomy, I&D.

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15
Q

Collateral Ligaments

A

MCL and LCL. Ligaments stabilize the knee against medial and lateral stressors.

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16
Q

Cause of Collateral Ligament Injuries

A

Injuries caused by valgus/varus stress w/ or w/out rotation.

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17
Q

Symptoms and Exam for Collateral Ligament Injuries

A

Localized swelling or stiffness w/ tenderness. Pain with ambulation, +/- instability. May have joint line opening with valgus/varus stress test at 0 and/or 30 degress.

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18
Q

How is swelling noted in a MCL injury?

A

Effusion

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19
Q

How is swelling noted in a LCL injury?

A

Extra-articular

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20
Q

Tests for Collateral Ligament Injuries

A

Ap/lateral, usually negative but may show avulsion. +/- MRI depending on degree of injury or to rule out meniscal injury.

21
Q

Treatment for Collateral Ligament Injuries

A

MCL isolated tears are usually treated non-operatively. Severity of LCL injury determines treatment. Rest, Ice/heat, NSAIDs, possible crutches, knee immobilizer and/or brace. When in combination with other ligament /capsule tear usually requires operative repair.

22
Q

Test for an Isolated MCL Sprain

A

Valgus Stress Test

23
Q

Cruciate Ligaments

A

ACL and PCL. ACL keeps tibia from slidding forward too far in relation to femur. PCL keeps the tibia from slidding too far back in relation to the femur.

24
Q

Cause of an ACL injury

A

Tears usually result from a rotational or hyperextension force

25
Q

Symptoms and Exam for an ACL injury

A

May report sudden pain and giving way. Decrease in ROM usually inhibiting continued activity. Increase in pain and swelling with in 24 hrs. INTRA-ARTICULAR EFFUSION.

26
Q

Special Tests for an ACL Injury

A

Anterior Drawer and Lachmans Tests

27
Q

Treatment for and ACL Injury

A

Initially control pain and swelling. Increase ROM, In young individual, protect the meniscus. Discuss surgical options: ACL- if younger pt, then reconstruct. PCL- try non-operative management.

28
Q

Cause of a PCL Injury

A

Tears usually result from a posteriorly directed force

29
Q

Symptoms and Exam for a PCL Injury

A

Pain +/- instability. Decreased ROM. INTRA-ARTICULAR SWELLING with in 24 hrs of injury

30
Q

Which Cruciate Ligament Injury is most common?

A

ACL

31
Q

Which is the most common PCL injury?

A

MVA

32
Q

Special Tests for PCL injury

A

Posterior Drawer Test and Pos Sag Sign

33
Q

Imaging for ACL injury

A

AP, lateral, notch (tunnel) and MRI. SEGOND SIGN- avulsion fracture of lateral capsular margin of tibia, seen on X-ray only.

34
Q

Imaging for PCL injury

A

AP, lateral, notch (tunnel) and MRI

35
Q

Function of Medial and Lateral Meniscus

A

Help spread the force of weight bearing over a larger area.

36
Q

Meniscal Tears

A

Can predispose knee to degenerative changes, can occur alone or in a/w ligament injuries

37
Q

Symptoms and Exam for Meniscal Tears

A

Swelling and stiffness, motion may be limited. Pain at medial/lateral joint line. Mild-large effusion present. Pain with forced flexion and circumduction with possible click or pop.

38
Q

Imaging for Meniscal Tears

A

AP, lateral, and sunrise X-rays. Radiographs are usually negative. MRI is highly sensitive and specific for meniscal tears.

39
Q

Treatment for Meniscal Tears

A

Absence of mechanical symptoms and degenerative in nature: Ice, Rest, NSAIDs, steroid injection, possible arthroscopy.

Tears in young individuals should be surgically repaired.

40
Q

Osteoarthritis of the Knee

A

Progressive articular cartilage degeneration can involve one or all components of the knee.

41
Q

What part of the Knee is most likely to develop OA?

A

Medial compartment is most oftenly involved

42
Q

Who is most likely to develop OA of the knee?

A

Usually in pts >55, can be traumatic or non-traumatic

43
Q

Symptoms and Exam for Osteoarthritis of the Knee

A

Buckling or giving way with stiffness and intermittent joint swelling. Difficulty standing from a seated position and difficulty with stairs. Possible deformity, often with a mild effusion. Joint line tenderness and crepitus with decreased ROM.

44
Q

Imaging for OA of the knee

A

Weight bearing AP, Lateral and sunrise

45
Q

Treatment for OA of the Knee

A

NSAIDs, Intra-articular injections, Ice/heat, exercise, mechanical aids, total knee arthroplasty

46
Q

Patella Dislocation

A

Almost always occurs laterally, due to a direct blow to patella and knee in flexed position or powerful contraction of quadriceps. Causes tearing of the restraining retinacular tissue and patellofemoral ligament

47
Q

Knee Dislocation

A

Considered an orthopedic emergency. Most often caused by MVA and vehicle-pedestrian accidents. Anterior and posterior dislocations are common types. ACL and PCL are disrupted in most cases with varying degree of injury to other knee structures.

48
Q

Neuromuscular Injuries in a/w Knee Dislocation

A

Neuromuscular injuries are common, ex: popliteal artery and/or peroneal nerve.

Medicine II: Orthopedics (9 decks)

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