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Ortho > Knee > Flashcards

Knee Flashcards

1
Q

Osteoarthritis generally occurs in what population?

A

Older; over 65, but can also occur in athletes who stress the knee’s articular cartilage under greater than normal forces

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2
Q

What test confirms osteoarthritis?

A

X-ray

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3
Q

Osgood-Schlatter disease generally occurs in what population?

A

Children between the ages of 9-14. It occurs in more boys than girls. Children who participate in sports are more highly at risk, and it generally happens after a growth spurt.

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4
Q

What is Osgood-Schlatter disease?

A

A bony outgrowth

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5
Q

Acute pain

A

3-4 weeks

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6
Q

Subacute

A

12 weeks

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7
Q

Chronic pain

A

anything longer than 3 months

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8
Q

Mechanism of Injury: medial collateral ligament with possible posterior medial capsule, medial meniscus and ACL.

A

Valgus force (from the outside in)

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9
Q

Terrible Triad is what?

A

MCL, ACL, Medial meniscus

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10
Q

Mechanism of injury: anterior cruciate often associate with meniscal tears

A

Hyperextension

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11
Q

M.O.I- PCL

A

Flexion and posterior translation

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12
Q

M.O.I- LCL with possible posterior lateral capsule and the posterior cruciate

A

Varus force ( Force from the inside-out)

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13
Q

M.O.I.- medical meniscal injuries. The medial meniscus bears most of the compressive forces, as compared to the lateral meniscus when weight bearing. Pivoting or twisting can tear the meniscus

A

Torsion injuries while weight bearing

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14
Q

Anterior knee pain may be due to:

A

Patella femoral problems, bursa (prepatella, infrapatella) pathology, tendinosis, Osgood-Schlatters

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15
Q

Osis implies

A

pathology

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16
Q

It is implies

A

inflammation

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17
Q

Pain during an activity is seen in…

A

structural abnormalities such as patella subluxation or patella tracking disorders

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18
Q

Pain after an activity indicates…

A

inflammatory disorders such as a synovial plica irritation or paratendonitis (inflammation of the sheath that surrounds the tendon), leading to jumpers knee (patella tendinosus)

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19
Q

Pain in the knee with ankle movement indicates

A

Superior tibiofibular joint problems

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20
Q

Aching pain may indicate

A

degenerative changes

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21
Q

Sharp “catching” pain usually indicates…

A

a mechanical problem such as patella femoral tracking

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22
Q

Stiffness/tightness indicates

A

swelling and/or arthritic changes or patella femoral dysfunction

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23
Q

Clicking in the knee could indicate

A

improper tracking of the patella in its groove or a loose body in the joint space

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24
Q

A pop at the time of injury could indicate

A

ligament tear of the ACL or fracture

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25
Q

If a patients knee “gives way” this indicates

A

instability of the knee d/t a meniscus pathology

Patella subluxation- if present with rotation or stopping
undisplaces osteochondritis dissecans- floating bone d/t poor blood supply

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26
Q

Knee locking at end range means

A

loose body or meniscal problem

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27
Q

localized swelling may be caused by…

A

an inflamed bursa

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28
Q

Patellofemoral dysfunction can cause recurrent swelling with..

A

ascending or descending stairs

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29
Q

Genu-Valgum means

A

Knock-knee

30
Q

Genu-Varum means

A

Bowleg

31
Q

Assessing Varum vs. Valgum

A

patient stands with patella facing forward and the medial meniscus as close together as possible.

  • if the knees touch and the ankles do not, the patient has genu-valgum. (3.5-4 inches between the ankles is considered excessive)
  • If 2 or more fingers fit between the knees when the ankles are together the patient has genu-varus
32
Q

Normal knees should exhibit what degree of valgus?

A

6

33
Q

Genu recurvatum means

A

hyperextensive knees, when patient’s knee extends back more than 0 degrees, they may be more prone to PCL tears

34
Q

Baker’s cyst assessment and definition

A

Baker’s cyst is a herniation of the synovial tissue through a weakening in the posterior capsule wall.

Assess by looking for inflammation from behind.

35
Q

Osgood-Schlatter assessment and definition

A

Done seated, looking for swelling of the tibial tubercle, can also look for swelling of the pea anserine (tender to touch)

36
Q

Which collateral and/or cruciate ligament has 2 layers?

A

Medial collateral ligament.

37
Q

The medial and lateral cruciate ligaments lie more posteriorly or anteriorly?

A

POSTERIORLY

38
Q

Which is the strongest ligament win the knee?

A

Posterior Cruciate Ligament- it prevents posterior movement of the tibia on the femur

39
Q

Valgus Stress Test

A

First start with the patient’s leg in full extension. Place one hand on the lower shin and the other palm goes to the joint like of the knee, cupping from the underneath/side. You are applying valgus force to test the Medial portion of the knee. Then you put the leg in slight flexion (20-30 degrees) so that the leg is unlocked and do the same test again. They test different fibers of the MCL.

Positive: pain is felt at the MCL and/or soft end feel. Compare to unaffected side.

40
Q

Varus Stress Test

A

First start with the patient’s leg in full extension, standing at the top of the table, bottom hand grabs the shin/ankle with the palm over the leg and the top hand’s palm goes to the medial side of the knee, same as the valgus- right at the joint line, Position the leg in slight lateral rotation and apply force not the medial portion of the knee. Do the test again with the leg in slight flexion (20-30 degrees)

Positive: Pain is felt at the LCL and.or soft end feel.

41
Q

Varus Stress Test

A

First start with the patient’s leg in full extension, standing at the top of the table, bottom hand grabs the shin/ankle with the palm over the leg and the top hand’s palm goes to the medial side of the knee, same as the valgus- right at the joint line, Position the leg in slight lateral rotation and apply force not the medial portion of the knee. Do the test again with the leg in slight flexion (20-30 degrees)

Positive: Pain is felt at the LCL and.or soft end feel.

42
Q

Lachman’s test

A

Patient lies supine, bend their knee to about 30 degrees flexion, position hand just below the tibial plateau, other hand stabilizes the femur and here you place one knee underneath the leg that is bent. You want to create anterior force of the tibia to test the ACL. Slight bend in the knee pull forward

Positive: Pain may be deep in the knee depending on the degree of the tear, also a soft end feel may be present

If the PCL is torn, it may lead to a false positive and there may also be posterior sag.

43
Q

Anterior/Posterior Drawer Test

A

Bend the patient’s knee and softly sit on their foot to stabilize the lower leg, position fingers behind the leg and the thumbs rest over the joint line, on the tibial tuberosity, draw the tibia forward. You can also push back to test the PCL.

Positive: as you bring the tibia forward there will be a mushy end feel and also pain. A 6 mm degree or anterior translation would occur compared to the healthy side.

44
Q

Bulge Test

A

Tests minimal effusion of the eyes of the knee.

Positive: a bulging over the medial eye of the knee

45
Q

Patella Palpation

A

Make sure there is a bolster under the knees- move the patella back and forth medially and laterally.
The patella should move in either direction half its width.
Positive: point tenderness would indicate a positive finding

46
Q

Prognosis for ligament injuries that don’t involve full rupture are…

A

GOOD

47
Q

Meniscal injurires prognosis

A

Meniscal tears in an avascular region require surgery, this is most common. If they happen in a vascular area may heal with time.

48
Q

Jing deficiency involves..

A

Hyperextensible joints

49
Q

Specific points for LCL

A

GB33, GB34, GB41

50
Q

Specific points for MCL

A

SP9, SP10, GB34

51
Q

Specific points for ACL

A

ST35 (angled toward cruciate), BL40

52
Q

HIPS: meniscus lesions

A

Pain and tenderness along the joint line (a few mm below Xi Yan)

Pain with walking up or down stairs
Not always significant pain

MRI is needed

53
Q

Points for medial meniscus

A

SP8, SP9, SP10, BL40, GB34, Medial Eye

54
Q

Points for lateral meniscus

A

ST34, 36, BL39, GB34, ST35, lateral eye of the knee

55
Q

Overuse syndromes include

A

patella femoral dysfunction, IT band friction syndrome,

56
Q

HIPS: patella femoral dysfunciton

A

Pain worse with movement or when sitting,descending or ascending stairs, getting out of a chair,

Commonly presents with a weak VMO and taught IT band, main culprit is usually Gluteal control

57
Q

HIPS: IT band friction syndrome

A

Tenderness over the lateral epicondyle or over the tibia. Pain is worse with knee in full extension and better with 5 degrees of knee flexion. Worse with up or down stairs

58
Q

Points for IT band syndrome

A

SP 10 (VMO IZ), retinaculum needling, strengthen glutes, Glute IZ, GB321, 34, 41, roll IT band, tuna, etc.

59
Q

TCm dx for IT band syndrome

A

LV/SP blood deficiency

60
Q

TCM diagnosis for Meniscus lesions

A

Jing/KD deficiency

61
Q

HIPS: anterior knee pain

A

can be unknown, if osteoarthritis pain will be felt int he entire knee.

62
Q

Points for Anterior knee pain

A

SP 9 to SP 10, ST 36, ST 34, LI11, PC6,

63
Q

TCM dx for anterior knee pain

A

bi syndrome, kd deficiency, blood deficiency

64
Q

HIPS: prepatella, suprpatella, pes anserine bursitis

A

repetitive inflammation processess, improper body mechanics

65
Q

DX of pre patella etc.

A

WInd heat invasion, febrile heat

66
Q

VMO IZ needling

A

Perpendicular

1-1.5 cun

67
Q

Eyes of the knee

A

Perpendicular to the skin but towards the center of the knee
0.5-1 cun

68
Q

Tibialis anterior IZ

A

Perpendicular to skin

0.5 - 1

69
Q

Peroneal Longus IZ

A

Perpendicular

0.5-1

70
Q

Mortons neuroma

A

Perpendicular to the metatarsal, superior to the heads

0.5-1

71
Q

Plantarfascia needling

A

perpendicular, division of the red and white skin.

1-1.5

Ortho (4 decks)

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