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MSK 2 > Knee Clinical Presentations Cont. > Flashcards

Knee Clinical Presentations Cont. Flashcards

1
Q

CPG PFPS

A
  1. A → use reproduction of retropatellar/peri-patellar pain during squat as diagnostic test for PFPS
  2. 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
  3. C → use of patellar tilt test in presence of hypomobility to support diagnosis
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2
Q

Osteoarthropathy of knee epidemiology

A
  1. Joint most commonly affected by OA
  2. 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
  3. Radiography
    • joint space loss
    • osteophytes
    • sclerosis
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3
Q

Hx of Knee osteoarthropathy

A
  1. Insidious onset
  2. Hx of trauma/prior knee surgery
  3. family hx
  4. obesity
  5. knee hypermobility
  6. joint shape abnormality
  7. extreme physical activity levels
  8. age > 50 yrs
  9. female
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4
Q

symptomology of knee osteoarthropathy

A
  1. retropatellar pain
  2. aggravated by
    • w/b activities
    • squatting
    • stairs
    • prolonged sitting
  3. crepitus
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5
Q

physical exam findings for knee osteoarthropathy

A
  1. antalgic gait
  2. swelling/warmth at knee
  3. TTP joint lines
  4. painful/limited knee ROM (flexion, extension)
  5. painful/limited MMT
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6
Q

what is arthrofibrosis?

A
  1. dense proliferative intra-articular and extra-articular scar tissue formation with related limitations in knee ROM
    • inflammation present
    • may lead to degenerative joint changes
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7
Q

Hx for arthrofibrosis

A
  1. traumatic injury/knee surgery
  2. progressive increase in pain and knee ROM limitations
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8
Q

symptomology for arthrofibrosis

A
  1. stiffness (worse in morning)
  2. knee swelling
  3. creptius
  4. diffuse knee pain
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9
Q

physical exam findings for arthrofibrosis

A
  1. limited knee ext in static stance or stance phases of gait
  2. limited/painful knee ROM
    • PROM with firm end-feel
  3. hypomobile patellofemoral glides (multi-directional)
  4. knee effusion/swelling
  5. inhibited/weak/painful knee ext
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10
Q

what is genu recurvatum?

A

hyperextension of the knees (>10º)

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11
Q

epidemiology of genu recurvatum

A
  1. females > males
  2. correlated with:
    • joint laxity
    • hx knee injury
    • poor muscular control (CVA)
  3. excessive stress on posterior knee structures
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12
Q

genu recurvatum may predispose someone to ______

A
  1. ACL injury
  2. compressive injury anteriomedial tibiofemoral joint
  3. tensile loading posteriolateral joint supporters
  4. posterior corner capsulo-ligamentous avulsion injuries
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13
Q

Hx for genu recurvatum

A
  1. forced knee extension injury
  2. jump landing in extension
  3. force to anteriomedial proximal tibia
  4. noncontact hyperextension with planted foot
  5. concomitant PCL injury
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14
Q

symptomology of genu recurvatum

A
  1. C/O knee instability
  2. anteriomedial knee pain vs posteriolateral knee pain
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15
Q

physical exam findings for genu recurvatum

A
  1. postural exam (visual inspection) → knee hyperextension
    • tibial ER
    • genu varum/valgum
    • tibial varum
    • excessive pronatio n
    • impaired propioception at knee
  2. edema, ecchymosis
  3. TTP locally
  4. Neurovascular screening, exam necessary
  5. antalgic gait
  6. hypermobility posterior glide with posteriolateral bias (with ER of tibia)
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16
Q

Patellar Tendinopathy general info

A
  1. aka Jumper’s knee
  2. caused by an eccentric overload
  3. microtrauma
    • failed healing response
  4. average 32 months pain/functional limitations
  5. 53% of affected athletes quit sport
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17
Q

Hx for patellar tendinopathy

A
  1. basketball and volleyball players
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18
Q

symptomology of patellar tendinopathy

A
  1. anterior knee pain
  2. aggravated with jumping/extensor mechanism
19
Q

physical exam findings for patellar tendinopathy

A
  1. TTP patellar tendon/inferior pole of patella
  2. painful squat
  3. pain end-range flexion ROM
  4. pain resisted > active knee extension
20
Q

what is ITB Friction syndrome?

A
  1. At the knee
    • increased compression on soft tissue structures between lateral femoral condyle and ITB
    • thickening of burase
21
Q

ITB friction syndrome correlates

A
  1. prominent femoral epicondyle
  2. leg length discrepancy
22
Q

ITB friction syndrome Hx

A
  1. long distance runners
  2. downhill skiers,
  3. Jumping sports
  4. weight lifters
  5. cycling
  6. Insidious/progressive onset
23
Q

Symptomology of ITB friction syndrome

A
  1. lateral knee pain
  2. aggravated with activity/repetitive knee flexion/extension and stairs
24
Q

physical exam findings for ITB friction syndrome

A
  1. local TTP
    • distal ITB
    • Gerdy’s tubercle
    • lateral femoral condyle
  2. (+) Ober test
  3. Potentially painful hip ABD MMT
25
Q

what is Hoffa’s syndrome?

A
  1. hypertrophy/inflammation of infrapatellar fat pad
  2. impingement between femoral condyles and tibial plateau (knee extension)
26
Q

Hx for Hoffa’s syndrome

A
  1. trauma vs repetitive extension microtrauma
27
Q

Hoffa’s syndrome symptomology

A
  1. anterior (infrapatellar) knee pain
  2. aggravated by activities that require (repetitive) knee extension
28
Q

physical exam findings for Hoffa’s syndrome

A
  1. pain knee extension ROM
  2. Local TTP
    • medial and lateral patellar tendon
29
Q

what is Plica Syndrome?

A
  1. irritated suprapatellar, mediopatellar infrapatellar and lateral patellar plicae
  2. 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
30
Q

suggested clinical diagnosis for plica syndrome

A
  1. Supportive hx
  2. failure with conservative management
  3. arthroscopic observation of fibrotic plica with impingement in patellofemoral joint during knee flexion
  4. no other likely diagnostic hypothesis (Dx of exclusion)
31
Q

epidemiology of Plica Syndrome

A
  1. symptomatic → from very common to non-existent (controversial)
32
Q

Hx for plica syndrome

A
  1. microtrauma
  2. any age
    • greatest risk at adolescence
  3. intial knee injury with secondary inflammation to plicae
33
Q

symptomology of plica syndrome

A
  1. anterior knee pain
  2. clicking/catching/locking/giving way
  3. aggravated with
    • activity
    • prolonged standing and sitting
    • squatting
34
Q

physical exam findings for plica syndrome

A
  1. hypertrophied plica without effusion
  2. TTP (local)
  3. painful knee flexion ROM
    • less pain with active extension
  4. painless extension PROM (likely)
35
Q

what is a Baker’s cyst?

A

swelling at posterior knee

painful with synovial effusion

may rupture

36
Q

Hx for Baker’s cyst

A
  1. intra-articular effusion
37
Q

Symptomology of Baker’s cyst

A
  1. posterior knee pain
38
Q

physical exam findings for Baker’s cyst

A
  1. local swelling proximal to popliteal fossa
  2. pain knee flexion/extension ROM
  3. prominence of cyst increases with resisted knee flexion
39
Q

List the types of bursitis possible at the knee

A
  1. superficial and deep infrapatellar (nun’s knee)
    • direct mechanical irritation
  2. prepatellar
    • recurrent anterior knee trauma
  3. superficial pes anserine
    • structures between MCL/pes anserine
    • swimmers/distance runners
40
Q

physical exam findings for bursitis at the knee

A

local TTP

local swelling

41
Q

potential area for entrapment of the superficial fibular nerve

A
  1. trauma posteriolateral knee (fibrosis)
  2. compartment syndrome
42
Q

motor distribution of the superficial fibular nerve

A
  1. fibularis longus and brevis
43
Q

sensory distribution of the superificial fibular nerve

A
  1. distal 2/3 lateral leg/ankle/dorsal foot
44
Q

other clinical indicators for the superficial fibular nerve

A
  1. hx direct trauma/iatrogenic
  2. neurodynamic tension test, sensitized with supination

MSK 2 (20 decks)

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