Knee Clinical Presentations Cont. Flashcards
CPG PFPS
- A → use reproduction of retropatellar/peri-patellar pain during squat as diagnostic test for PFPS
- B → make the diagnosis of PFPS using the 3 criteria of:
- presence of retropatellar or peri-paterllar pain
- reproduction of pain with squatting, stair climbing, prolonged sitting, or other functional activities loading PFJ in flexed position
- exclusion of all other conditions
- C → use of patellar tilt test in presence of hypomobility to support diagnosis
Osteoarthropathy of knee epidemiology
- Joint most commonly affected by OA
- Murphy et al., 2008
- lifetime risk of symptomatic knee OA = 44.7%
- hx of knee injury increases lifetime risk to 56.8%
- incidence increased to 2/3 among obese
- Radiography
- joint space loss
- osteophytes
- sclerosis
Hx of Knee osteoarthropathy
- Insidious onset
- Hx of trauma/prior knee surgery
- family hx
- obesity
- knee hypermobility
- joint shape abnormality
- extreme physical activity levels
- age > 50 yrs
- female
symptomology of knee osteoarthropathy
- retropatellar pain
- aggravated by
- w/b activities
- squatting
- stairs
- prolonged sitting
- crepitus
physical exam findings for knee osteoarthropathy
- antalgic gait
- swelling/warmth at knee
- TTP joint lines
- painful/limited knee ROM (flexion, extension)
- painful/limited MMT
what is arthrofibrosis?
- dense proliferative intra-articular and extra-articular scar tissue formation with related limitations in knee ROM
- inflammation present
- may lead to degenerative joint changes
Hx for arthrofibrosis
- traumatic injury/knee surgery
- progressive increase in pain and knee ROM limitations
symptomology for arthrofibrosis
- stiffness (worse in morning)
- knee swelling
- creptius
- diffuse knee pain
physical exam findings for arthrofibrosis
- limited knee ext in static stance or stance phases of gait
- limited/painful knee ROM
- PROM with firm end-feel
- hypomobile patellofemoral glides (multi-directional)
- knee effusion/swelling
- inhibited/weak/painful knee ext
what is genu recurvatum?
hyperextension of the knees (>10º)
epidemiology of genu recurvatum
- females > males
- correlated with:
- joint laxity
- hx knee injury
- poor muscular control (CVA)
- excessive stress on posterior knee structures
genu recurvatum may predispose someone to ______
- ACL injury
- compressive injury anteriomedial tibiofemoral joint
- tensile loading posteriolateral joint supporters
- posterior corner capsulo-ligamentous avulsion injuries
Hx for genu recurvatum
- forced knee extension injury
- jump landing in extension
- force to anteriomedial proximal tibia
- noncontact hyperextension with planted foot
- concomitant PCL injury
symptomology of genu recurvatum
- C/O knee instability
- anteriomedial knee pain vs posteriolateral knee pain
physical exam findings for genu recurvatum
- postural exam (visual inspection) → knee hyperextension
- tibial ER
- genu varum/valgum
- tibial varum
- excessive pronatio n
- impaired propioception at knee
- edema, ecchymosis
- TTP locally
- Neurovascular screening, exam necessary
- antalgic gait
- hypermobility posterior glide with posteriolateral bias (with ER of tibia)
Patellar Tendinopathy general info
- aka Jumper’s knee
- caused by an eccentric overload
- microtrauma
- failed healing response
- average 32 months pain/functional limitations
- 53% of affected athletes quit sport
Hx for patellar tendinopathy
- basketball and volleyball players
symptomology of patellar tendinopathy
- anterior knee pain
- aggravated with jumping/extensor mechanism
physical exam findings for patellar tendinopathy
- TTP patellar tendon/inferior pole of patella
- painful squat
- pain end-range flexion ROM
- pain resisted > active knee extension
what is ITB Friction syndrome?
- At the knee
- increased compression on soft tissue structures between lateral femoral condyle and ITB
- thickening of burase
ITB friction syndrome correlates
- prominent femoral epicondyle
- leg length discrepancy
ITB friction syndrome Hx
- long distance runners
- downhill skiers,
- Jumping sports
- weight lifters
- cycling
- Insidious/progressive onset
Symptomology of ITB friction syndrome
- lateral knee pain
- aggravated with activity/repetitive knee flexion/extension and stairs
physical exam findings for ITB friction syndrome
- local TTP
- distal ITB
- Gerdy’s tubercle
- lateral femoral condyle
- (+) Ober test
- Potentially painful hip ABD MMT
what is Hoffa’s syndrome?
- hypertrophy/inflammation of infrapatellar fat pad
- impingement between femoral condyles and tibial plateau (knee extension)
Hx for Hoffa’s syndrome
- trauma vs repetitive extension microtrauma
Hoffa’s syndrome symptomology
- anterior (infrapatellar) knee pain
- aggravated by activities that require (repetitive) knee extension
physical exam findings for Hoffa’s syndrome
- pain knee extension ROM
- Local TTP
- medial and lateral patellar tendon
what is Plica Syndrome?
- irritated suprapatellar, mediopatellar infrapatellar and lateral patellar plicae
- Normal structures; inflammation and hypertrophy in pathologic situations
- during development synovial folds compartmentalize the knee
- typically resorbs during month 3-4 of embryonic development; plica remains if this does not occur
suggested clinical diagnosis for plica syndrome
- Supportive hx
- failure with conservative management
- arthroscopic observation of fibrotic plica with impingement in patellofemoral joint during knee flexion
- no other likely diagnostic hypothesis (Dx of exclusion)
epidemiology of Plica Syndrome
- symptomatic → from very common to non-existent (controversial)
Hx for plica syndrome
- microtrauma
- any age
- greatest risk at adolescence
- intial knee injury with secondary inflammation to plicae
symptomology of plica syndrome
- anterior knee pain
- clicking/catching/locking/giving way
- aggravated with
- activity
- prolonged standing and sitting
- squatting
physical exam findings for plica syndrome
- hypertrophied plica without effusion
- TTP (local)
- painful knee flexion ROM
- less pain with active extension
- painless extension PROM (likely)
what is a Baker’s cyst?
swelling at posterior knee
painful with synovial effusion
may rupture
Hx for Baker’s cyst
- intra-articular effusion
Symptomology of Baker’s cyst
- posterior knee pain
physical exam findings for Baker’s cyst
- local swelling proximal to popliteal fossa
- pain knee flexion/extension ROM
- prominence of cyst increases with resisted knee flexion
List the types of bursitis possible at the knee
- superficial and deep infrapatellar (nun’s knee)
- direct mechanical irritation
- prepatellar
- recurrent anterior knee trauma
- superficial pes anserine
- structures between MCL/pes anserine
- swimmers/distance runners
physical exam findings for bursitis at the knee
local TTP
local swelling
potential area for entrapment of the superficial fibular nerve
- trauma posteriolateral knee (fibrosis)
- compartment syndrome
motor distribution of the superficial fibular nerve
- fibularis longus and brevis
sensory distribution of the superificial fibular nerve
- distal 2/3 lateral leg/ankle/dorsal foot
other clinical indicators for the superficial fibular nerve
- hx direct trauma/iatrogenic
- neurodynamic tension test, sensitized with supination
