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Musculoskeletal 2 > Knee - Bursitis & Ligaments > Flashcards

Knee - Bursitis & Ligaments Flashcards

1
Q

Keys to PE

A
  • pt supine on table
  • everything bilateral
  • perform same routine every time
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2
Q

Testing acronym

A

HOPS

  • history
  • observation
  • palpation
  • special tests
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3
Q

Observation

A
  • deformity
  • open wounds/abrasion
  • 3 Es: edema, effusion, ecchymosis
  • loss of contour
  • color change
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4
Q

Palpation

A
  • effusion vs. edema
  • crepitus during ROM
  • mechanical sx: catching, locking, popping
  • pain over anatomic landmark
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5
Q

what is dx until proven otherwise if mechanical sx on knee exam

A

meniscal tear

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6
Q

Special tests

A
  • Patellar apprehension
  • Meniscal injury (Apley’s, McMurray’s, Deep squat/Duck walk)
  • Ligamentous Laxity (Varus/Valgus stress, Lachman, ant/post drawer, pivot shift)
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7
Q

Bursitis

- describe

A

Inflammation of small, fluid-filled sacs at points of high-friction where tendon passes over bony prominence

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8
Q

Bursitis

- locations

A

many on knee
MC:
- pre-patellar
- Anserine (very common)

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9
Q

Bursitis

- classic presentation

A
  • someone who kneels on floor a lot - construction
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10
Q

Bursitis

- presentation

A
  • swelling
  • traumatic or chronic/insidious
  • little loss of fn
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11
Q

What is a baker’s cyst commonly associated with?

A

meniscal tear

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12
Q

Bursitis

- PE

A
  • “watery” feeling of swelling
  • extra-articular pain/swelling (except Anserine does not swell)
  • pain with active ROM
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13
Q

Bursitis

- work up

A
  • usually clinical dx
  • may need MRI
  • XR not helpful unless calcific
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14
Q

Bursitis

- Tx

A

Conservative:

  • RICE
  • abs if septic (gram+)

Invasive

  • Aspiration for pre-patellar
  • injection for anserine
  • bursectomy: recalcitrant swelling, infection, pain
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15
Q

Knee ligament Injuries

- four ligaments

A
  • Medial collateral ligament (MCL)
  • Lateral collateral ligament (LCL)
  • Anterior cruciate ligament (ACL)
  • Posterior cruciate ligament (PCL)
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16
Q

Ligament injury scale

A

I: stretching of fiber without tearing (intrasubstance or attachment)
II: partial tearing (usually intrasubstance)
III: complete rupture of ligament intrasubstance or avulsion from origin/insertion

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17
Q

MCL

  • classic case
  • description of injury force
  • how common?
A
  • football player struck on lateral aspect of knee when foot planted
  • valgus force placed on knee
  • most common ligament injury of knee
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18
Q

MCL

- presentation

A
  • medial-sided knee pain
  • effusion w/in 1-4 hrs
  • inability to bear weight or instability with weightbearing
  • “knee gave way” or “knee buckled”
19
Q

MCL

- PE

A
  • medial pain at origin (MC), mid-substance, insertion (least common)
  • laxity during valgus stress testing
20
Q

What is the common knee injury triad?

A

ACL
MCL
Medial meniscus

21
Q

MCL

  • how to grade
  • grades
A
  • always compare to contralateral side
    I: slight medial joint space opening, firm end point
    II: marked medial joint space opening, ed point present but not firm
    III: gross medial opening, no end point not medial soft tissue restraint
22
Q

MCL sprain

- workup

A
  • AP and lateral XR (look for avulsion which = sx)

- MRI (**PANCE answer)

23
Q

MCL sprain

  • Tx Grade I-III
  • Tx overall
A 
I-II: WBAT, ? crutches, hinged knee brace
II+ or III: WBAT, crutches, straight leg immobilizer
- RICE
- acetaminophen (no NSAIDs)
- narcotics?
- ortho referral
- mostly non-surgical
- PT
- 4-10 weeks disability
24
Q

When might an MCL sprain need sx?

A
  • multi-ligament injury

- MRI evidence of distal/insertional injury

25
Q

ACL

  • what is its purpose
  • classic case
A
  • rotational stability to the knee, prevents excess anterior tibial translation on the femur
  • “coming down from a jump and landed awkwardly”, “fell skiing and one ski stayed on”, “made a cut playing sport and knee buckled” and I felt/heard a POP
26
Q

ACL

- presentation

A
  • lrg effusion, onset w/in 4 hours
  • feeling unstable, “giving way” if can bear weight
  • loss of ROM in flexion/extension/both
27
Q

ACL special tests

A
  • Lachman (most sensitive and specific)
  • Anterior drawer

*there is grading in lecture but, personally, i’m ignoring it

28
Q

ACL

- workup

A

XR

  • often shows no injury
  • may see tibial spine avulsion
  • r/o tibial plateau fx, esp trauma cases

MRI

  • GS
  • best seen on sagittal view
29
Q

ACL

- Tx

A
  • Aspiration of hemarthrosis (risk infection)
  • WBAT on crutches
  • knee immobilizer brace
  • early ROM
  • PT: restore ROM or severe effusion
  • Ortho referral
  • ACL reconstruction (sx)
30
Q

What should you do if a pt declines nonoperative tx of ACL injury?

A

Counsel pt it can cause future damage to menisci and articular cartilage

31
Q

ACL reconstruction

- why?

A
  • ACL does not heal on own (lack of clot formation, insufficient vasculature, impaired cell migration)
  • return stability for athletic endeavors
  • maintain articular cartilage and meniscal viability = prevent OA
32
Q

PCL

  • purpose in body
  • classic case
A
  • 95% of resistance force to posterior tibial translation relative to femur
  • more vertical than ACL = provides less rotational stability, usually uninjured in rotational injury
  • front seat passenger in MVA and knee hit dashboard
33
Q

PCL

- presentation

A
  • same as ACL
34
Q

Which cruciate ligament is most commonly injured due to direct trauma?

A
  • PCL
  • ACL is usually non-contact
  • key to differentiating prior to exam is mechanism of injury!!
35
Q

PCL special tests

A
  • Posterior drawer

- Sag test/Godfrey’s 90-90 test

36
Q

PCL

- imaging

A

MRI is GS

37
Q

PCL

- Tx

A
  • Acute tx is same as ACL
  • Much less sx
  • brace in immobilizer for 4-6 weeks with PT
38
Q

When does PCL injury have a surgical indication

A
  • young and athletic
  • multi-ligament injury
  • chronic with symptomatic instability
39
Q

LCL

  • how common
  • mechanism of injury
  • classic case
A
  • least common of the 4 ligaments
  • varus load on knee: (uncommon bc physically hard to get to medial knee…)
  • football running back has lateral knee pain and swelling. Was hit on inside of knee when mid-stride
40
Q

LCL

- presentation

A
  • very similar to MCL sprain
  • knee effusion w/in four hours
  • lateral knee pain to palpation, proximal or distal to joint line
41
Q

LCL

- special test findings

A
  • laxity with varus stress test

- ligament pain to palpation with figure four position (book test)

42
Q

LCL

- imaging

A
  • MRI

- Best seen on coronal view

43
Q

LCL

- Tx

A
  • WBAT
  • Early PT and mobilization Grade I
  • Hinged knee brace grade II-III
44
Q

When is sx indicated for LCL sprain?

A

Other structures compromised or significantly retracted

Musculoskeletal 2 (14 decks)

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