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Orthopedic Diagnosis > Knee > Flashcards

Knee Flashcards

1
Q

how many articulating surfaces in the knee

A

3

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2
Q

how many distinct joints?

A

2

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3
Q

how many joint capsules

A

1

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4
Q

what are the two joints called

A

patellofemoral and tibiofemoral

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5
Q

what should be done at every visit

A

observation

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6
Q

what types of swelling occur at the knee

A

localized and generalized

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7
Q

localized swelling indicates

A

bursal

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8
Q

generalized swelling indicates

A

intra-articular (synovitis)

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9
Q

what test can be used for generalized swelling (synovitis) of the knee

A

bounce home

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10
Q

tibia has a slight varus/valgus angulation in comparison to the femur?

A

valgus

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11
Q

bowlegged

A

genu varus

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12
Q

knock knee

A

genu valgus

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13
Q

hyperextension of the knee

A

genu recurvatum

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14
Q

genu recurvatum more popular in what gender

A

females

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15
Q

people who have lax or long ligaments tend to have

A

genu recurvatum

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16
Q

if person has long ligament the recurvatum will be present

A

in elbow as well

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17
Q

two types of lax ligaments

A

acquired (gymnast) and gen isolated (golfer)

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18
Q

tibiofemoral joint is made up of

A

distal end of femur and proximal end of tibia

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19
Q

what separates the two femoral condyles

A

intercondylar eminece

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20
Q

what type of joint is the knee

A

ginglymoid (modified hinge joint)

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21
Q

the knee joint is complex and geometrically incongruous this lends

A

little inherent stability to the joint

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22
Q

knee joint stability is dependent on

A

static restraints f jt capsule
ligaments
menisci
dynamic restraints of quads/ hamstrings/ gastroc

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23
Q

where do the femoral condyles project

A

posteriorly from femoral shaft

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24
Q

largest bone in the body

A

femur

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25
Q

intercondylar eminences are attachment points for

A

ACL and PCL

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26
Q

which condyle is smaller

A

Lateral

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27
Q

why is the lateral condyle smaller?

A

less weight and downward foce

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28
Q

why is the medial condyle larger

A

it bears the main amount of the body weight

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29
Q

lateral condyle is ____shaped and faces ______

A

ball shaped and outward

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30
Q

what shape is the medial condyle and where does it face

A

elliptical faces in

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31
Q

what originates on the lateral condyle

A

popliteus

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32
Q

what originates on the posterior lateral epicondyle

A

lateral head of gastrocnemius and LCL

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33
Q

what originates on the medial epicondyle

A

insertion of adductor magnus, medial head of gastroc, and MCL

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34
Q

anterior-posterior width medial femoral condyle

A

bigger than lateral by about 1.7cm

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35
Q

articular surface of the medial femoral condyle

A

longer than lateral

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36
Q

proximal tibia has what

A

two plateaus

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37
Q

what separates the plateaus

A

intercondylar eminence

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38
Q

tibial plateaus are concave in what direction

A

medial to lateral

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39
Q

anterior posterior direction medial tibial plateau is

A

concave

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40
Q

anterior posterior direction lateral tibial plateau is

A

convex

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41
Q

the convexity of lateral plateau produces

A

more asymmetry and increase in lateral mobility

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42
Q

how much more surface area is there in medial plateau

A

50%

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43
Q

how much thicker is the articular surface of medial side

A

3x

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44
Q

what attaches to these plateaus

A

meniscus

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45
Q

patello femoral joint complex articulation dependant of what types of restraints for function

A

dynamic and static

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46
Q

posterior surface of the patella include how many facets

A

up to 7 (11)

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47
Q

what type of bone is the patella

A

sesmoid

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48
Q

what side of the knee is more prone to injury

A

medial

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49
Q

where is the patella embeded

A

in the tendon of quadriceps femoris superiorly and patella tendon inferiorly

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50
Q

in flexion patella fixed or mobile

A

fixed

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51
Q

in extension patella fixed or mobile

A

mobile

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52
Q

some basic functions of patella

A

articulation low friction
protect distal femur and quads from attritional wear
improve cosmetic appearance of the knee
improve moment arm of quads
decrease anterior-posterior tibiofemoral shear stress on knee

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53
Q

Q angle

A

bisection of two line
1-ASIS>patella
2- patella>tibial tubercle

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54
Q

most common Q angle range for women

A

15-17

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55
Q

most common Q angle range for men

A

8-14

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56
Q

any angle greater than 20 degrees

A

abnormal

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57
Q

and increased Q angle can be called

A

bayonet sign

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58
Q

patellofemoral athralgia

A

when knee flexed at 30 degrees tibia fails to derotate normally- patella tendon fails to line up with anterior crest of tibia

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59
Q

sup/inf>flex/ext patella moves

A

5-7cm

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60
Q

if the patella tracks abnormally

A

muscular imbalance

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61
Q

the bad tracking and imbalance is probably because of

A

VMO and vastis lateralis

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62
Q

normal patellar posture for exerting deceleration forces in a functional 45 degrees patella should be

A

squarely against anterior femur

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63
Q

if patella is lower than normal

A

patella baja

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64
Q

if patella is higher than normal

A

patella alto

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65
Q

what in the largest synovial capsule in the body

A

knee

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66
Q

the synovial memb is strange why

A

it excludes cruciate ligaments but is within the jt capsule

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67
Q

cruciate ligaments are considered

A

extrasynovial but intra articular

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68
Q

repetitive micro trauma on the knee causing traction apophysitis at the tibial tuberosity.
with or without avulsion

A

Osgood-Schlatter’s

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69
Q

Osgood-Schlatter’s is most common

A

preadolescent during growth spurt

70
Q

predisposing factors for Osgood-Schlatter’s

A

tight hamstrings
tight achilles
tight quads

71
Q

Osgood-Schlatter’s is more common in what gender

A

males

72
Q

what ages does Osgood-Schlatter’s effect

A

10-15

73
Q

when is pain with Osgood-Schlatter’s most prominant

A

going up or down stairs

74
Q

Osgood-Schlatter’s has a history

A

single violent injury or repetitive flexion-extension movement

75
Q

what four major ligaments are important in static stability of the knee

A

ACL, PCL, MCL, LCL

76
Q

Primary restraint of knee anterior translation

A

ACL

77
Q

Primary restraint of knee posterior translation

A

PCL

78
Q

Primary restraint of knee valgus rotation

A

MCL

79
Q

Primary restraint of knee varus rotation

A

LCL

80
Q

Primary restraint of knee lateral rotation

A

MCL, LCL

81
Q

Primary restraint of knee medial rotation

A

ACL, PCL

82
Q

cruciate ligaments restrict what type of motion

A

normal rather than abnormal

83
Q

what is one of the most important ligaments to knee stability

A

ACL

84
Q

is there a need to xray osgood schlaters

A

no

85
Q

what is the treatment for osgood schlaters

A

conservative, stop activity, self limiting, anti inflammatories (food)

86
Q

longer thinner cruciate ligament

A

ACL

87
Q

shorter broader cruciate ligament

A

PCL

88
Q

MOI or ACL rupture

A

sudden deceleration
abrupt change direction/speed/velocity
closed kinetic chain (foot on ground)

89
Q

90-95% total restrain to posterior translation of tibia on femur

A

PCL

90
Q

MOI for PCL tear

A

excessive hyperflexion

hyperextension

91
Q

common injury causing PCL tear

A

dashboard injury

92
Q

broad and fas shaped collateral ligament

A

Medial Collateral ligament

93
Q

difficult portion of MCL to palpate

A

posterior taut in extension blend with capsule and medial border of meniscus

94
Q

aka for MCL

A

tibial collateral lig

95
Q

primary function of MCL

A

stabilizer of medial side knee against valgus forces

96
Q

Primary function of the LCL

A

resist varus forces

97
Q

aka for LCL

A

fibular collateral ligament

98
Q

how does the LCL differ from the MCL

A

develops independently

remains free from joint capsule and lateral meniscus

99
Q

what separates LCL from inner structures of the knee

A

popliteus tendon

100
Q

secondary restrains of the knee

A 
hamstrings
quadriceps
patellar lig
oblique popliteal ligaments
fabella
structures in the posterior-lateral and posterior- medial corners of the knee
101
Q

what type of cartilage are the menisci made up of?

A

fibrocartilage

102
Q

medial meniscus is shaped how

A

like a C

103
Q

larger thicker meniscis

A

medial

104
Q

wider in what direction

A

posteriorly than anteriorly

105
Q

rounder O-shaped meniscus

A

laterl

106
Q

more mobile meniscus

A

lateral

107
Q

which has two meniscofemoral ligaments attaching to it

A

lateral

108
Q

tear occurs in line with the circumferential fibers of the meniscus

A

longitudinal tear

109
Q

extra long longitudinal tear that has flapped up

A

buckethandle tear

110
Q

bucket-handle tear may displace into the intercondylar notch, where it may cause true locking of the knee joint.

A

displaced bucket handle

111
Q

innbebition

A

displace fluid

112
Q

how does meniscus lubricate

A

imbibe via movement

113
Q

generally at the junction of the posterior and middle thirds small flap tear occurs

A

parrot beak

114
Q

extend from the inner free margin toward the periphery

A

radial tear

115
Q

why are radial tears difficult

A

avascular, generally wont heal- most medial aspect

116
Q

function of meniscus

A 
load transmission
shock absorption
joint lubrication
joint stability
guide movement
117
Q

meniscectomy reduces shock-absorbing capacity by

A

20%

118
Q

triad of O’donoghue

A

terrible triad
unhappy triad
MCL, ACL, medial meniscus rupture

119
Q

what do bursae do

A

reduce friction and cushion the movement of one body part over another

120
Q

what are the main bursae of the knee

A 
deep infrapatellar
gastroc
pes anserine
prepatellar
superficial infra patellar
121
Q

prepatellar bursitis aka

A

housemaids knee

122
Q

MOI prepatellar bursitis

A

overuse
kneeling while leaned forward
direct blow

123
Q

clergyman’s knee

A

infrapatellar bursitis
swelling both sides of the patellar lig
kneeling leaned back on heels

124
Q

borders of popliteal fossa

A

superior lateral- biceps femoris
superior medial- semitendinosus/membranosus
inferior- 2 heads of gastroc

125
Q

what are within the borders of popliteal fossa

A

posterior tibial nerve, popliteal artery and nerve

126
Q

escaped synovial fluid enclosed in a membrane sac protruding through the joint capsule of the knee

A

bakers cyst

127
Q

bakers cysts cause what distally

A

pooling in the foot and ankle

128
Q

bakers cysts are associated with

A

RA

129
Q

baker cysts are considered

A

femoral tibial joint disorder

130
Q

two tests used to confirm

A

bowstring and bounce home

131
Q

pain in the region of the knee that feels like meniscal tear. when surgeons go looking it is a clear meniscus.
won’t find it unless you are looking for it

A

plica

132
Q

synovial mesenchymal reminant

A

plica

133
Q

major muscles that act on the knee

A 
quads
hamstrings
gastroc
popliteus
hip adductors
134
Q

lateral restraints of the patella

A

retinaculum

135
Q

which retinaculum is torn more often

A

lateral

136
Q

what tests can be done to ensure stability of the retiaculum

A

patellar apprehension test

137
Q

extension lag (last 10 degrees) of the knee is because of

A

weak quads

138
Q

knee extension comes with some amount of tibial rotation this is called

A

helfets helix

139
Q

how can it be determined extension lag is weak quads

A

circumferential mensuration three inches up from patella. atrophy

140
Q

how do you asses proper motion of the tibia at the knee

A

screw home method

two dots one on patella and one on tib tub

141
Q

completely locking the knee causes

A

deficant venous return cause people to pass out

142
Q

major vessels of the knee

A

femoral
popliteal
genicular

143
Q

major nerves

A

saphenous N
common peroneal N- palpate at fib neck
tibial N

144
Q

tests that relate to sciatic N issues

A 
SLR
Bragard
buckling
bowstring
lasegue
bechterew
anterior innominate/mazion/ advancement sign
toe walk
145
Q

biceps femoris action at the knee

A

flexion and external rotation

146
Q

bicep femoris nerve supply

A

sciatic

147
Q

bicep femoris N root derivation

A

L5, S1-2

148
Q

Semimembranosus nerve supply

A

sciatic

149
Q

Semimembranosus N root derivation

A

L5, S2-2

150
Q

semitendinosus N supply

A

sciatic

151
Q

semitendinosus N root derivation

A

L5 S1-2

152
Q

Gracilis action

A

knee flexion

153
Q

gracilis N supply

A

obturator

154
Q

gracilis N root derivation

A

L2-3

155
Q

Sartorius action

A

flexion knee

156
Q

sartorius N supply

A

femoral

157
Q

sartorius N root derivation

A

L2-3

158
Q

popliteus action

A

flexion knee

159
Q

popliteus N supply

A

tibial

160
Q

popliteus N root derivation

A

L4-5 S1

161
Q

Gastroc action

A

flexion knee

162
Q

gastroc N supply

A

tibial

163
Q

gastroc N root derivation

A

S1-2

164
Q

tensor fascia lata action

A

flexion and extension of knee

165
Q

tensor fascia lata N supply

A

sup glute

166
Q

tensor fascia lata N root derivation

A

L4-5

167
Q

rectus femoris
vastus medialis
vastus intermedius N supply
vastus lateralis

A

femoral

168
Q

rectus femoris
vastus medialis
vastus intermedius N root derivation
vastus lateralis

A

L2-4

169
Q

acute phase of intervention

A 
reduce pain swelling
control inflammation
regain ROM
min muscle atrophy
maintain fitness
170
Q

functional phase intervention

A

full painless ROM
restore normal jt kinematics
improve muscle strength
restore normal force couple relationships

Orthopedic Diagnosis (3 decks)

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