Knee Classification/Diagnosis Flashcards
Viscerogenic pain referral
-septic joint
OA/DJD body chart/location of symptoms
- chronic or recurrent swelling of knee; stiffness present in AM which gets slightly better with movement; history of knee pain
- general knee pain, usually intermittent but can also be constant
- deep ache
Meniscal Injury body chart/location of symptoms
- recurrent swelling to the knee may or may not have a MOI; localized pain with palpation; has feeling of “giving away” or “locking” during gait & stairs
- may complain of sharp pain
Ligament Injury body chart/location of symptoms for ACL
-knee pain; rapid edema & swelling within 12 hours of MOI
PCL ligament injury body chart/location of symptoms
-no/little inflammation of the knee; may have posterior or diffuse knee pain
MCL ligament injury body chart/location of symptoms
-often torn on conjunction with ACL & medial meniscus; alone in isolation will cause edema & pain over the medial aspect of the knee
LCL ligament injury body chart/location of symptoms
-not commonly torn; pain over the lateral aspect of the knee
Which ligament is commonly torn in conjunction with the ACL?
a. LCL
b. MCL
c. PCL
d. none of the above
b. MCL
Patellofemoral Dysfunction body chart/location of symptoms
-deep achy pain in the knee; may or may not have swelling
Body chart/location of symptoms for Iliotibial Band Syndrome
Can be felt:
- lateral from ITB rubbing on femoral condyle - causing local ache at lateral knee; crepitus or popping along the lateral knee
- medial knee causing sprain of MCL due to excessive rotation of tibia
- subpatellar due to patella being pulled laterally by ITB attachment
What is the most common cause of iliotibial band syndrome?
-felt laterally in the knee from ITB rubbing on the femoral condyle causing a local ache at the lateral knee; crepitus or popping along the lateral knee.
Patellar Tendonitis body chart/location of symptoms
-inflammation of patellar tendon; pain is felt directly over the patella or below it
Baker’s Cyst body chart/location of symptoms
-posterior ache/pain in the popliteal fossa; can become a palpable mass of tissue
Pre-Patellar Bursitis body chart/location of symptoms
-pain over the anterior aspect of the patella
Neurodynamic considerations for body chart/location of symptoms for knee pain
- pt may complain of symptoms near the vulnerable anatomical site, which can include entire limb
- may c/o pulling like a tight string, catches of pain/tightness or symptoms such as bizarre clumps of pain, crawling, antlike, dry, woody, & dragging
- report of sensations of swelling burning or electricity
If a patient complains of “catches of pain & tightness” what does that suggest is going on neurodynamically?
-extra-neural sensitization
If a patient complains of “sensations of swelling, burning or electricity” what does that suggest is going on neurodynamically?
-intra-neural sensitization
Activity Limitations for OA/DJD?
- walking
- going up/down stairs
- squatting
- prolong sitting
- sitting to standing
Meniscal injury agg factors?
- going up/down stairs
- may feel like their knee will “buckle” or “give out”
- squatting
- weight-bearing
Ligament injury agg factors?
- walking
- weight-bearing
- running
- jumping
- pivoting
Agg factors with patellofemoral dysfunction?
- running
- running downhill (eccentrically loading the quadriceps)
- going down stairs
- prolonged sitting
Iliotibial Band Syndrome agg factors?
- single leg squats
- walking
- running
Patellar tendonitis agg factors?
- jumping
- squatting
- running
Baker’s Cyst agg factors
- walking
- stairs
- knee flexion of any kind
Pre-patellar bursitis agg factors
- knee extension & flexion are painful
- any activity where it requires being on your knees directly
Ease factors for knee OA/DJD
-NSAIDS, non-weight bearing
Meniscal injury ease factors
-avoiding provocative movements, NSAIDS
Ligament injury ease factors
-ice, rest, avoiding weight bearing on the extremity
Patellofemoral dysfunction ease factors
-rest, avoiding stairs
Iliotibial band syndrome ease factors
-stretching, rest, NSAIDS
Ease factors for patellar tendonitis
-avoiding jumping, eccentrically loading the quadriceps
Bursitis ease factors
-ice, NSAIDS, rest
OA/DJD profile/history
-overweight, older adult, family history of OA, weakness in gluteal muscles causing medial stress to knee; poor gait biomechanics
-may see genu varus at knee
-women > men
> 55 yrs old
Profile/history of meniscal injury
- chronic knee trouble, pain with squatting & stairs; will complain of pain with sit to stand
- MOI usually involved slight flexion, compression (wt bearing through joint) with a rotational movement
Which meniscus is more commonly torn?
-medial meniscus is more commonly torn due to valgus stress placed at the knee
ACL mechanism of injury/history
-mechanism of injury is usually non-contact; involved a rotational stress of the tibia when the foot planted & pronated, force when the knee is extended causing an anterior translation of the tibia on the femur; often have quadriceps dominance over the hamstrings; increased Q angle; women > men
PCL mechanism of injury/history
-mechanism of injury is usually from falling on a flexed knee (dashboard injury) or trauma; will have visible posterior sag; no inflammation will be present
MCL mechanism of injury/history
-usually torn with a valgus stress to the knee, return from a jump, or rotational stress with the knee extended or slightly flexed; can also be torn with tibia plateau fractures
LCL mechanism of injury/history
-mechanism of injury is a varus stress to the knee
Possible reasons for patellofemoral dysfunction
- patella alta; genu valgus; increased Q angle greater than 17 degrees; weakness in the gluteus medius muscle causing excessive internal rotation of the femur on the tibia; tight ITB; pronated feet (also associated with medial tibial rotation
- insidious onset; sudden change in activity
Iliotibial band syndrome history/mechanism of injury
- overuse injuries (runners, downhill running)
- training errors or poor biomechanics
- weakness in gluteus medius muscle at the hip leading to excessive internal rotation of the femur
Patellar tendonitis history/mechanism of injury
-history of overuse in eccentrically loading the quadriceps muscles (running, jumping, squatting)
-pain is increased during or following the sport or activity that stretched the tendon
-pain at mid to full squat range
gait observation: watch for excessive or late pronation
Baker’s Cyst history/mechanism of injury
-chronic, ache or pain in the posterior leg, usually in athletes
Pre-patellar history/mechanism of injury
-usually from a fall or excessive kneeling (cleaning)
ROM findings for OA/DJD
- capsular pattern is present
- extension > flexion
Meniscal injury ROM
-loss of knee flexion & extension
ROM findings for a ligament injury
-knee flexion, extension
Patellofemoral dysfunction ROM findings
-knee extension may be painful at end range
ROM findings for iliotibial band syndrome
-abduction, adduction of the thigh
Patellar tendonitis ROM
-knee extension (provoked in squat position best)
Baker’s Cyst ROM
-knee flexion will be painful
Pre-patellar bursitis ROM
-knee flexion or extension
Special tests for meniscal injury
- McMurray Test
- Apley’s Test
- Functional test of squat & rotation
ACL special tests
- Anterior Drawer Test
- Lachman’s
PCL special tests
-Posterior Drawer Test; Posterior sag sign
MCL/LCL special tests
- Valgus Stress
- Varus Stress
Patellofemoral dysfunction special tests
-Clarke’s Sign
Special test for knee instability
-Apprehension test
Iliotibial band syndrome special tests
-ITB Noble’s Test; Ober’s test
Special tests for patellar tendonitis
-squat observation; look for internal rotation of the tibia or genu valgus
OE palpation findings for OA/DJD
-medial knee joint line may be painful upon palpation
Palpation findings for meniscal injury
-tender to palpation over meniscus
Ligament injury palpation findings
-MCL/LCL are on the outer border of the knee & palpable on the side corresponding with their name
OE palpation findings for patellofemoral dysfunction
-pain with compression of the patella into the femoral condyles
Iliotibial band syndrome palpation findings
-tightness palpable in the lateral leg; in women may notice a decrease in the normal curvature of the hips due to this tightness
Patellar tendonitis palpation findings in the OE
-palpation over the patellar tendon; infra patellar region
Baker’s Cyst palpation
-painful palpation over the posterior cyst in the popliteal fossa
Pre-patellar palpation
-anterior patella; if chronic will see thickening of the bursa wall which will be palpable
