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CAM III > Knee > Flashcards

Knee Flashcards

1
Q

What are traumatic causes of knee problems?

A 
Fracture
Tear
Sprain (ligaments)
Strain (tendons)
Dislocation
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2
Q

What are non-traumatic causes of knee problems?

A 
Arthritis
PF syndrome
Infection
Nerve irritation
Gout
Lesion/tumor
OA
Osgood schlatters
Tendonitis
Bursitis
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3
Q

What should you look for in HPI?

A 
WB status
Swelling/effusion
Constant/intermittent
Mechanical sx
Prior problems
Timing
Instability
Tx
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4
Q

Common traumatic dxs of knee

A 
ACL/PCL tear
MCL/LCL strain or tear
Meniscus tear
Fxs
Contusions
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5
Q

Pt hx of ACL injury

A 
"Popping" sound at the time of injury
Rapid swelling +++
Pain
Instability
Non WB
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6
Q

PE of ACL

A 
Effusion
Pain
Decreased ROM
Uncomfortable
-Lachman's test
-Anterior drawer
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7
Q

Lachman’s test

A 
Best for ACL
Bend about 25 degrees
Grasp thigh
Shuck tibia anterior
Pos test= no end point/laxity
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8
Q

Anterior drawer test

A

Knee at 90 degrees
Stabilize foot
Pull tibia forward
If over 6 mm anterior translation = pos

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9
Q

Diagnostic for ACL injury

A

Xrays usually neg

MRI ****

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10
Q

Tx for ACL injury

A 
Refer
-Most full tears need sx intervention
NSAIDs/ice
Elevation
Immobilizer
\+/- crutches
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11
Q

PCL characteristics

A

Much less common
Usually MVA
Dashboard injury

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12
Q

Collateral ligament injuries

A 
MCL tears more common than LCL
Direct blow
Lower leg is forced sideways
Swelling
Pain
Instability
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13
Q

Varus stress

A

Rupture of lateral collateral ligament

This is rare but can occur when a motorcycle fall on the medial side of the knee

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14
Q

Valgus stress

A

Rupture of medial collateral ligament. This shifts the forces to the lateral condyles and leads to a torn meniscus and torn ACL impaction of the lateral femoral condyle or wedge fracture of the lateral tibial plateau

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15
Q

Type I MCL/LCL injury

A

Microscopic tear

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16
Q

Type II MCL/LCL injury

A

Partial tear

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17
Q

Type III MCL/LCL injury

A

Complete- may require surgery

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18
Q

Meniscus injury

A

Usually twisting type injury
C/o mechanical sx
Swelling
Pain c WB

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19
Q

Meniscus function

A

Load distribution
Joint stability
Shock absorption

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20
Q

PE of meniscus injury

A 
Effusion
Pain
Decreased ROM
Joint line tenderness
Pos McMurrays test
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21
Q

Dx and tx of meniscus injury

A 
X-rays usually neg
MRI is diagnostic test
Look for "bowtie" in nl meniscus
Refer
-Can give symptomatic tx but need referral
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22
Q

Fractures

A 
Associated with trauma
NWB or painful WB
Depends on involvement/severity etc
Dx via X-ray
Stress fracture may only be seen on MRI
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23
Q

When to get an Xray

A 
Age 55 or older
Isolated pain over patella
Pain over fibular head
Unable to WB 4 steps
Only use for injuries <7 days only
Only one of these criteria makes Xray necessary
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24
Q

RF of OA

A 
Age
Obesity
Hx of trauma
FHx
Decreased strength
25
Q

HPI of OA

A 
Pain
Stiffness or decreased ROM
Creaking/popping
"Theater" sign (hurts when standing after sitting for a long time)
Usually no significant swelling
26
Q

Dx of OA

A 
Dx is made by Xray (WB AP view a must)
Joint space narrowing
Osteophytes
Sclerosis
Cysts
Any one of these 4 things is pos sign
27
Q

OA tx

A 
Weight reduction
PT
OTC
Bracing
Steroid injections
Visco-supplementation
TKA
28
Q

Tendonitis

A

Quad, Achilles, patellar, etc
Over use injury
Recurring pain c activity
Improves with rest

29
Q

PE of tendonitis

A

Pain with palpation over tendon
Possible swelling
Possible heat
Nl motion (pain)

30
Q

Tx of tendonitis

A 
Rest
Ice
NSAIDs
Rehab
Compression/bracing
PRP
31
Q

Osgood Schlatter

A 
Overuse injury (only in children)
Apophysitis of tibial tubercle
Running/jumping type sports
32
Q

HPI of Osgood Schlatter

A

During growth spurt
Worse with activity
Better with rest
Often bilateral

33
Q

PE of Osgood Schlatter

A 
Pain over tubercle
Swelling
Stable
Good ROM (+/- pain)
If there are no other PE abnormalities but decreased ROM, then think something else
No need for Xray but to r/o fx
34
Q

TX for Osgood Schlatter

A 
Activity modification
Rest
NSAIDs
Ice with activity
Bracing
PT/stretching
Reassurance
35
Q

Bursitis

A 
Bursa- fluid filled sac
Overuse or trauma
Pain c activity, swelling
Bursa's job is to decrease friction
Found throughout the body
36
Q

PE of bursitis

A

Pain over bursa
Swelling
+/- redness

37
Q

Tx for bursitis

A 
\+/- aspiration
NSAIDs
Compression therapy
Activity modification
Refer for sx
38
Q

Patella Femoral Syndrome

A

Anterior knee pain
Increases with activities
Worse c sitting/squatting, inclines/stairs
Associated c changes in activity levels

39
Q

PE of patella femoral syndrome

A

J sign
Pain with patellar grind
No effusion
Crepitus

40
Q

Tx of patella femoral syndrome

A 
Activity modification
PT- VMO strengthening
Bracing
NSAIDs
Weight loss
41
Q

What are the four leg compartments?

A

Anterior
Lateral
Deep posterior
Superficial posterior

42
Q

Compartment syndrome

A

Elevated intracompartmental pressures
Compromised nerves and blood flow
Crush injury

43
Q

HPI of compartment syndrome

A

Pain out of proportion **
Pain with passive stretch
Swelling
**Can also be exertional

44
Q

Osteomyelitis

A

Infection in the bone
Infection leads to inflammatory response leads to abscess leads to bone destruction
Hematogenous spread/contact c infected tissue/direct spread by fx, bite wound, puncture, etc.
MC agent is S. aureus

45
Q

S/sx of osteomyelitis

A 
Fever
Pain
Redness/swelling
Draining
Ulcers/recent infection
46
Q

Dx of osteomyelitis

A 
Early X-rays will be nl
Bone scan if needed confirmation
Wound culture
CBC/CMP
ESR
CRP
Blood culture
47
Q

Tx for osteomyelitis

A

IV abx
-Start Abx right away…do NOT wait for cultures
Surgical debridement
-Most need I and D

48
Q

Septic arthritis

A

Sudden severe pain (often no trauma)
Swelling
Redness
Warmth

49
Q

RF for septic arthritis

A

STI
Illness
TKA
Surgery

50
Q

PE of septic arthritis

A 
Look for source of infection
-Tooth abscess
-STD
-Wound
Effusion
Pain c AROM and PROM
Erythema
51
Q

H. influenzae in septic arthritis

A

Peak age of incidence in children

Gram neg coccobacilli

52
Q

N. gonorrheae in septic arthritis

A

Peak age of incidence in young adults

Gram neg diplococci

53
Q

Salmonella in septic arthritis

A

Peak age of incidence in young with sickle cell anemia

Gram neg rods

54
Q

S. aureus in septic arthritis

A

Peak age incidence in adults

Gram pos cocci in clusters

55
Q

E. coli in septic arthritis

A

Peak age incidence in adults

Gram neg rods

56
Q

Pseudomonas in septic arthritis

A

Peak age incidence in adults

Gram neg rods

57
Q

Aspiration for septic arthritis

A 
CBC
ESR
CRP
Blood cultures
UA
58
Q

Tx for septic arthritis

A

IV abx

I and D

CAM III (12 decks)

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