Knee Flashcards
What are traumatic causes of knee problems?
Fracture Tear Sprain (ligaments) Strain (tendons) Dislocation
What are non-traumatic causes of knee problems?
Arthritis PF syndrome Infection Nerve irritation Gout Lesion/tumor OA Osgood schlatters Tendonitis Bursitis
What should you look for in HPI?
WB status Swelling/effusion Constant/intermittent Mechanical sx Prior problems Timing Instability Tx
Common traumatic dxs of knee
ACL/PCL tear MCL/LCL strain or tear Meniscus tear Fxs Contusions
Pt hx of ACL injury
"Popping" sound at the time of injury Rapid swelling +++ Pain Instability Non WB
PE of ACL
Effusion Pain Decreased ROM Uncomfortable -Lachman's test -Anterior drawer
Lachman’s test
Best for ACL Bend about 25 degrees Grasp thigh Shuck tibia anterior Pos test= no end point/laxity
Anterior drawer test
Knee at 90 degrees
Stabilize foot
Pull tibia forward
If over 6 mm anterior translation = pos
Diagnostic for ACL injury
Xrays usually neg
MRI ****
Tx for ACL injury
Refer -Most full tears need sx intervention NSAIDs/ice Elevation Immobilizer \+/- crutches
PCL characteristics
Much less common
Usually MVA
Dashboard injury
Collateral ligament injuries
MCL tears more common than LCL Direct blow Lower leg is forced sideways Swelling Pain Instability
Varus stress
Rupture of lateral collateral ligament
This is rare but can occur when a motorcycle fall on the medial side of the knee
Valgus stress
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
Type I MCL/LCL injury
Microscopic tear
Type II MCL/LCL injury
Partial tear
Type III MCL/LCL injury
Complete- may require surgery
Meniscus injury
Usually twisting type injury
C/o mechanical sx
Swelling
Pain c WB
Meniscus function
Load distribution
Joint stability
Shock absorption
PE of meniscus injury
Effusion Pain Decreased ROM Joint line tenderness Pos McMurrays test
Dx and tx of meniscus injury
X-rays usually neg MRI is diagnostic test Look for "bowtie" in nl meniscus Refer -Can give symptomatic tx but need referral
Fractures
Associated with trauma NWB or painful WB Depends on involvement/severity etc Dx via X-ray Stress fracture may only be seen on MRI
When to get an Xray
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
RF of OA
Age Obesity Hx of trauma FHx Decreased strength
HPI of OA
Pain Stiffness or decreased ROM Creaking/popping "Theater" sign (hurts when standing after sitting for a long time) Usually no significant swelling
Dx of OA
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
OA tx
Weight reduction PT OTC Bracing Steroid injections Visco-supplementation TKA
Tendonitis
Quad, Achilles, patellar, etc
Over use injury
Recurring pain c activity
Improves with rest
PE of tendonitis
Pain with palpation over tendon
Possible swelling
Possible heat
Nl motion (pain)
Tx of tendonitis
Rest Ice NSAIDs Rehab Compression/bracing PRP
Osgood Schlatter
Overuse injury (only in children) Apophysitis of tibial tubercle Running/jumping type sports
HPI of Osgood Schlatter
During growth spurt
Worse with activity
Better with rest
Often bilateral
PE of Osgood Schlatter
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
TX for Osgood Schlatter
Activity modification Rest NSAIDs Ice with activity Bracing PT/stretching Reassurance
Bursitis
Bursa- fluid filled sac Overuse or trauma Pain c activity, swelling Bursa's job is to decrease friction Found throughout the body
PE of bursitis
Pain over bursa
Swelling
+/- redness
Tx for bursitis
\+/- aspiration NSAIDs Compression therapy Activity modification Refer for sx
Patella Femoral Syndrome
Anterior knee pain
Increases with activities
Worse c sitting/squatting, inclines/stairs
Associated c changes in activity levels
PE of patella femoral syndrome
J sign
Pain with patellar grind
No effusion
Crepitus
Tx of patella femoral syndrome
Activity modification PT- VMO strengthening Bracing NSAIDs Weight loss
What are the four leg compartments?
Anterior
Lateral
Deep posterior
Superficial posterior
Compartment syndrome
Elevated intracompartmental pressures
Compromised nerves and blood flow
Crush injury
HPI of compartment syndrome
Pain out of proportion **
Pain with passive stretch
Swelling
**Can also be exertional
Osteomyelitis
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
S/sx of osteomyelitis
Fever Pain Redness/swelling Draining Ulcers/recent infection
Dx of osteomyelitis
Early X-rays will be nl Bone scan if needed confirmation Wound culture CBC/CMP ESR CRP Blood culture
Tx for osteomyelitis
IV abx
-Start Abx right away…do NOT wait for cultures
Surgical debridement
-Most need I and D
Septic arthritis
Sudden severe pain (often no trauma)
Swelling
Redness
Warmth
RF for septic arthritis
STI
Illness
TKA
Surgery
PE of septic arthritis
Look for source of infection -Tooth abscess -STD -Wound Effusion Pain c AROM and PROM Erythema
H. influenzae in septic arthritis
Peak age of incidence in children
Gram neg coccobacilli
N. gonorrheae in septic arthritis
Peak age of incidence in young adults
Gram neg diplococci
Salmonella in septic arthritis
Peak age of incidence in young with sickle cell anemia
Gram neg rods
S. aureus in septic arthritis
Peak age incidence in adults
Gram pos cocci in clusters
E. coli in septic arthritis
Peak age incidence in adults
Gram neg rods
Pseudomonas in septic arthritis
Peak age incidence in adults
Gram neg rods
Aspiration for septic arthritis
CBC ESR CRP Blood cultures UA
Tx for septic arthritis
IV abx
I and D
