Knee, Ankle Trauma - Achilles tendonitis, Rupture, Sprain, Knee ligaments Flashcards
Achilles tendonitis
-presentation
-management
Gradual onset tendon pain, worse after activity
Morning pain and stiff
Rest, NSAIDS
Physio if symptoms persist beyond 7days
-Reduce precipitating activities
-Calf muscle eccentric exercises
Achilles tendon rupture
-presentation
-investigations
-management
Audible pop => sudden significant pain, inability to walk or continue sport
Simmond’s triad
-increased dorsiflexion
-feel gap in tendon
-gentle squeeze of tendon => no movement
US
ACUTE REFERRAL TO ORTHO
Conservative management -foot boot to ensure contact is maintained between the 2 sides of the tendon
Surgery
Ottawa Rules for Xray
-Ankle
Malleolar pain AND 1 of the following
-bony tenderness at malleolar zone (6cm below posterior border of fibula/tibia)
-can’t walk 4 weight bearing steps immediately after injury and in ED
Ankle sprain
-pathophysiology
-presentations and associations
-investigations
-management
Stretch/tear of ligament
Investigations according to Ottawa rules
Lateral collateral, ATFL most common - inversion injury
Pain, swelling, tender, bruising
Can weight bear unless severe
RICE
Syndesmosis - external rotation
Pain, swelling, tender, bruising
Weight bearing often painful
Non-weight bearing ankle support/cast until pain subsides
Surgery if widening of tibiofibular joint => operative fixation
Knee ligament and meniscus injuries
-how to test for them
ACL - twisting injuries
CRACK, pain, RAPID joint swelling
-anterior drawer, Lachman’s
Physio/surgery
PCL - dashboard injury, hyperextension
-posterior drawer
MCL - valgus stress, skiiing
-medial stress test
LCL
-lateral stress test
Menisci - twisting injuries (locking, giving way, POP), DELAYED SWELLING
-McMurray
-tender along joint line
Unhappy triad - lateral blow to knee
-ACL+MCL+meniscus
CONFIRM DIAGNOSIS WITH MRI
Weber classification
-describe it
FIbular fracture
A - below syndesmosis => CAM boot, weight bearing for 6wks
B - level of the tibial plateau => CAM boot, weight bearing for 6wks
C - above syndesmosis => surgical repair
Management of ankle fractures
NV compromise + obvious ankle injury => IMMEDIATE REDUCTION AND STABILISATION BEFORE XRAY
Weber A - Walker boot + full weight bearing for 6wks
Weber B, C - ORIF, syndesmosis repair if needed
-non weight bearing after surgery
-cast immobilisation until bony healing 6-8wks
Open fracture - debride, washout, IV ABx
-ORIF if small wound and low infection risk
-EF if significant wound, skin graftng needed, high skin infection risk
Young people with unstable high velocity injuries => surgical repair
Older adults, even with unstable injuries => conservative management
Chondromalacia patellae
-what is it
-risk factors
-presentation
-investigations
-management
Breakdown of cartilage underneath patella from continuous rubbing => runners knee
Physically active
Overweight
CAN LEAD TO OA IF UNTREATED
Pain and tenderness in front/side of knee
Worse
-after sitting for long periods of time
-when getting out of chair
-going up/down stairs
-kneeling, squatting
Xray - arthritis/trauma
MRI - for more detailed imaging
Analgesia - NSAIDs
RICE
Physiotherapy - strengthening and stretching exercises
Healthy weight
Consider surgery to realign patella if needed
Osgood Schlatter
-what is this
-risk factors
-presentation
Microtrauma of patella tendon => Inflammation where patella tendon attaches at tibial tuberosity
Physically active teens during growth spurt
-running
-jumping
-football
-gymnastic
Knee pain develops slowly => becomes more severe and continuous
Improved with rest
Worse on movement
May have visible tuberosity swelling
Clinical diagnosis but imaging used to exclude other causes
Will settle as growth spurt slows, no progressive pathology
Analgesia - paracetamol, NSAIDs, ice packs, compression
Physio - stretch to prevent muscle contraction
Activity modification
If symptoms persist despite measures/into adulthood
-reassess for alt diagnosis
-specialist physio or orthopedics
Patella dislocation
-why does this happen
-presentation
-investigations
-management
Patella moves out of femur groove from sudden twisting/direct lateral blow to knee => pop
Difficulty weight bearing
Immediate pain
Swelling
Limited ROM due to pain
MUST ALWAYS ASSESS NV STATUS AS PERONEAL NERVE CAN BE COMPROMISED
Xray knee to confirm dislocation and assess for other fractures/loose bodies in joint
Relocate patella with analgesia
Patella fracture
-MOI
-presentation
-investigations
-management
Direct trauma to knee - extensor mechanism intact
Indirect injury - quadriceps forcefully contracts against block to knee extension
Swelling, bruising
Pain, tenderness localised to kneecap
Assess straight leg raise - check for extensor involvement
Xray
Undisplaced with intact extensor - hinged knee brace for 6wks, with full weight bearing
Displaced OR loss of extensor mech - surgical
-tension band wire
-screws, wires
=> hinged knee brace for 6wks with full weight bearing
Osteochondritis dissecans
-what is it
-presentation
-investigations
-management
Bone and cartilage of a joint dies due to lack of blood flow
More common in children
Very active
Subacute presentation
Knee pain, swelling after physical activity
Knee catching/locking/giving away
Joint effusion
Tenderness on palpation of the articular cartilage
Xray - subchondral crescent/loose bodies
MRI - cartilage
Rest - no weight bearing, gradual reintroduction of activity
Avoid motion causing pain
Physio
Analgesia
Surgery if
-no change with rest and PT
-bone completely breaks away
Bursitis types
-common locations and MOI
-investigations
-management
Infrapatellar bursitis - kneeling
Prepatella bursitis - upright kneeling
Popliteal bursitis - bursa is connected to knee joint
-trauma/inflammation/infection to the knee => extra fluid fills bursa
-cyst can extend down into calf => pain
-increased tension of bursa on extension
May transilluminate
Xray - may find causative agent
MRI
Resolves with time
Treat underlying cause
Rest - avoid activities that aggravate pain
Analgesia
Physio - maintain mobility and strength
May drain cyst
Surgery - remove cyst
Juvenile idiopathic arthritis
-definition
-features
-investigations
-management
Arthritis in U16s, lasting 6wks+
Pauciarticular - U4 joints affected
-joint pain and swelling in medium joints
-limp
Stills - systemic onset
-fever
-salmon pink rash
-LN
-arthritis
-uveitis
-anorexia, weight loss
ANA positive
RF negative
NSAIDs
DMARDs
Biologicals
Physio
Iliotibial band syndrome
-what is it
-presentation
-investigations
-management
ITB rubs against hip/knees
Exercising more than used to
-runners
-cyclists
Sharp pain on outside of knee
Tender, swelling
Worse at specific distances in exercise
Clinical diagnosis
Rest - avoid activity that triggers pain
Analgesia - ice
Physio
