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Orthopaedic Conditions > Knee conditions > Flashcards

Knee conditions Flashcards

1
Q

Acute swelling around the knee- traumatic synovitis

A

Any moderately severe injury (e.g., torn meniscus_ can precipitate reactive synovitis
Swelling appears after several hours

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2
Q

Acute swelling around the knee- Post traumatic hemarthrosis

A

Swelling immediate after injury, means blood in joint
Pain, warm, tense, tender, restriction
X-ray needed to eliminate fracture, if not suspect tear of ACL

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3
Q

Acute swelling around the knee- non-traumatic hemarthrosis

A

In Pt with clotting disorders, knee is common site for acute bleed
Variety of blood disorders are hereditary, e.g., haemophilia

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4
Q

Chronic joint swelling of entire joint- non-infective arthritis

A

Commonest cause of swelling is OA + RA
Other signs such as deformity, loss of movement or instability may be present
X-ray needed to show features

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5
Q

Swelling anteriorly- pre patellar bursitis

A

Fluctuant swelling confined to front of patella, joint itself is normal
Due to constant friction between skin + bone
Treatment= firm bandaging, and avoiding kneeling

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6
Q

Swelling anteriorly- infra patellar bursitis

A

Swelling below patella
Superficial to patella ligament
Treatment same as prepatellar

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7
Q

Swelling posteriorly- semimembranosus bursa

A

Bursa between semimembranosus + medial head of gastrocnemius may become enlarged
Presents as painful lump behind knee, slightly medial
Most conspicuous when knee is straight
Knee joint is normal
Usually takes a while to heal

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8
Q

Swelling posteriorly- popliteal cyst

A

Bulging of posterior capsule + synovial herniation may produce swelling in popliteal fossa
Usually caused by RA or OA
Occasionally ‘cyst’ ruptures + synovial contents spill into muscle planes causing pain + swelling in calf- can be mistaken for deep vein thrombosis
Reoccurrence is common if underlying condition isn’t treated

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9
Q

Swelling posteriorly- popliteal aneurysm

A

Need to be cautious that popliteal swelling isn’t an aneurysm

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10
Q

Swelling laterally- meniscal cyst

A

Small, tense swelling, usually on lateral side/just below joint line
Can be mistaken for bony lump
Usually tender to pressure

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11
Q

Swelling laterally- calcification of collateral ligament

A

Acute painful swelling may suddenly appear
Usually medial side of joint line
Rubbery and tender

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12
Q

When are bow legs common

A

In babies- considered normal development

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13
Q

When are knock knees common

A

4 year olds- considered normal development

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14
Q

How to measure bilateral bow-legs

A

Measure distance between knees with child standing + heels touching- should be less than 6cm

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15
Q

How to measure knock knees

A

Estimated by measuring distance between medial malleoli when knees are touching with patella facing forward- usually less than 8cm

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16
Q

What to do if deformity is still occurring at age 10

A

Surgery

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17
Q

Pathological bow-legs and knock-knees in children

A

Unilateral deformity likely to be pathological as is severe bilateral deformity

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18
Q

Likely cause of unilateral deformity

A

Eccentric growth from physics of distal femur or proximal tibia
Usually progressive

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19
Q

When should operative treatment be offered for deformity

A

Near end of pubertal growth
By age 10 deformity is often grown out of

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20
Q

Pathological bow-legs and knock knees in adults

A

Angular deformities common in adults
Usually bow-legs in men and knock knees in women

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21
Q

Osteochondritis dissecans

A

Bone underneath cartilage dies due to lack of blood flow
Sometimes separates from femoral condyle and appears as loose body in joint

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22
Q

Epidemiology of Osteochondritis dissecans

A

Trauma, either single impact with edge of patella or repeated contact with adjacent tibial ridge

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23
Q

Age groups affected by Osteochondritis dissecans

A

Adolescents involved in competitive sport and children
Usually male aged 15-20

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24
Q

Clinical presentation of Osteochondritis dissecans

A

Intermittent ache or swelling
Attacks of giving way, knee feels unreliable, may lock
Quadricep muscle wasting
Usually small effusion
Tenderness localised to one femoral condyle
+ve Wilsons test

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25
Q

Prognosis of Osteochondritis dissecans

A

Early stages with cartilage still intact= no treatment needed but activities reduced for 6-12 months
Small lesions often heal spontaneously

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26
Q

Loose bodies epidemiology

A

Injury- child to bone or cartilage
Osteochondritis dissecans
OA
Charcots disease
Synovial chondromatosis

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27
Q

Clinical presentation of loose bodies

A

May be symptomless or complain of sudden locking
Joint gets stuck in position
Pt can usually wriggle knee to unlock
May be aware of something ‘popping in and out’
May swell

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28
Q

Prognosis of loose bodies

A

If loose body causing symptom removed, treatment is successful

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29
Q

Tuberculosis epidemiology

A

Coughing
Sneezing

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30
Q

Age groups affected by TB

A

Any age but mainly children

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31
Q

Clinical presentation of TB

A

Pain + limp are early symptoms
Swollen knee or low-grade fever
Thigh muscle wastage
Knee feels warm
Restriction

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32
Q

Prognosis of TB

A

Active synovitis- knee is rested in bed-splint, exercise intermittently for short spells
Healing stage- wear weight relieving calliper
Aftermath- if joint is painful, arthrodesis recommended

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33
Q

RA epidemiology

A

May start as synovitis in knee

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34
Q

Age groups affected by RA

A

40-60
Bit older for men

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35
Q

RA risk factors

A

Genetics
Obesity
Sex- women

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36
Q

Clinical presentation of RA

A

Valgus- knees in
Early stage- pain + swelling, may be large effusion + wasting of thigh muscle, restricted ROM
Advancing- joint becomes unstable, muscle wasting and restriction increases, x-ray shows loss of joint space, complete absence of osteophytes
Later stage- joint becomes increasingly deformed

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37
Q

Prognosis of RA

A

Anti-inflammatory drugs
Once bone destruction is present, joint is unstable and total joint replacement advised

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38
Q

OA epidemiology

A

Knees most common site
Injury to articular surface, torn meniscus, instability/pre-existing deformity
In many cases no obvious cause can be found
Tend to be overweight + have long standing bow legged deformity

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39
Q

Age groups affected by OA

A

Usually over 50

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40
Q

Clinical presentation of OA

A

Pain, worse after activity
After rest joint feels stiff and hurts to ‘get going’
Swelling, giving way, locking
Quadricep wastage

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41
Q

Prognosis of OA

A

If not severe, treatment is conservative
Analgesics can be prescribed for the pain
Quadricep exercises + heat
Joint loading lessened (walking stick)
If unresponsive to conservative treatment, operative options may be necessary

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42
Q

Recurrent dislocation of patella epidemiology

A

Stretching of ligaments which normally stabilise
Initial episode thought to have occurred spontaneously

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43
Q

Risk factors of recurrent patella dislocation

A

Generalised ligament laxity
Under-development of lateral femoral coddle + flattening of intercondylar groove
Maldevelopment of patella
Valgus deformity of knee

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44
Q

Clinical presentation of recurrent patella dislocation

A

Girls affected more commonly
Condition often bilateral
Knee suddenly gives way + Pt falls
Patella always dislocates laterally
Tenderness on medial side
Swelling

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45
Q

Prognosis of patella dislocation

A

Quadricep strengthening exercises, in particular vests medialis

46
Q

Tibial tubercle apophysitis

A

An inflammation or stress injury to the areas on or around growth plates in children and adolescent

47
Q

Tibial tubercle apophysitis epidemiology

A

Traction injury

48
Q

Age groups affected by tibial tubercle apophysitis

A

Fairly common in adolescents, particularly those engaged in sports

49
Q

Risk factors of Tibial tubercle ‘apophysitis’

A

Sport

50
Q

Clinical presentation of Tibial tubercle ‘apophysitis’

A

Pain
Swelling of tibial tubercle
Extension against resistance is often painful

51
Q

Prognosis of Tibial tubercle ‘apophysitis’

A

Spontaneous recovery is usual, but it takes time
RICE

52
Q

Chronic ligamentous instability epidemiology

A

Sports injury

53
Q

Chronic ligamentous instability clinical presentation

A

Giving way during weight bearing activities, sometimes accompanied by pain
Joint looks normal apart from slight wasting, rarely tenderness
Observe gait and knee posture in standing

54
Q

Prognosis of Chronic ligamentous instability

A

Most cases operation is not required
Some Pt will accept the use of knee brace

55
Q

Patella tendinopathy

A

Patella ligament strain or partial rupture may lead to traction tendonitis

56
Q

Epidemiology of patellar tendinopathy

A

Repeated stress on patella tendon
Obesity
Sudden increase in body weight

57
Q

Age groups affected by patella tendinopathy

A

Adolescents- particularly athletes

58
Q

Risk factors of patella tendinopathy

A

Sport
Tight leg muscles
Muscular imbalance

59
Q

Clinical presentation of patella tendinopathy

A

Repeated episodes of pain and local tenderness

60
Q

Prognosis of patella tendinopathy

A

If persistent, may lead to calcification within ligament
Usually resolves spontaneously

61
Q

Chondromalacia Patella

A

Softening and degeneration of articular cartilage of patella

62
Q

Chondromalacia Patella epidemiology

A

Post-traumatic injury
Microtrauma- wear + tear

63
Q

Age groups affected by Chondromalacia Patella

A

Young females

64
Q

Risk factors of Chondromalacia Patella

A

Patella Alta (high rising)
High Q angle that may lead to malt racking

65
Q

Clinical presentation of Chondromalacia Patella

A

Tenderness of inferior angle of patella
Crepitation
Anterior pain following flexion and prolonged pain
Increased Q angle
Potential hyper mobility of patella
Pt should be able to extend knee

66
Q

Prognosis of Chondromalacia Patella

A

Once it starts its irreversible
Involves breakdown of surface layer of cartilage surface, which is progressive
Can be treated with isometric exercises and activity modification
Patella taping may be useful

67
Q

Prepatella bursitis

A

Inflammation, swelling and enlargement of prepatellar bursitis

68
Q

Prepatellar bursitis epidemiology

A

As a result of frequent kneeling
Acute trauma to anterior knee

69
Q

Risk factors of prepatellar bursitis

A

Occupation- e.g., carpet laying

70
Q

Clinical presentation of pre patella bursitis

A

Pain when directly kneeling on it
Swelling, tenderness, and redness of tissues overlying patella

71
Q

Prognosis of pre patella bursitis

A

Infectious (pyogenic) bursitis may develop
Occasionally resolves with rest, icing, NSAIDs, compression wraps, and avoidance of kneeling
Very rarely is surgery necessary
Pyogenic bursitis may require drainage

72
Q

Overuse syndromes

A

Refers to musculoskeletal pain or dysfunction following physical activity that exceeds strength of musculoskeletal tissues such as bones, tendons, ligaments, joints and bursa

73
Q

Epidemiology of overuse syndrome

A

Vigorous physical activity with no distinct history of trauma
Exercise may cause microtrauma to structures

74
Q

Clinical presentation of overuse syndrome

A

Symptoms are variable
Pain often achy and most pronounced 1-2 days after intense physical activity, especially when Pt has not warmed up/stretched
Pain may be vague and poorly localised
Structures that have suffered microtrauma will be tender and inflamed
Stretching will elicit pain

75
Q

Prognosis of overuse syndrome

A

Can cause tendonitis
Should heal with elimination of offending activity
Time frame resolution is variable, often within 8 weeks
If symptoms last longer than this, reconsider diagnosis

76
Q

DDX of overuse syndrome

A

Patella tendon rupture
Tibial stress fracture
Patella fracture
ACL rupture
Meniscal tear

77
Q

Medial/lateral collateral ligament strain epidemiology

A

Following trauma
Report of history of twisting injury with ‘pop’ or ‘snap’

78
Q

M/LCL strain age groups

A

20-34 and 55-65

79
Q

Risk factors of M/LCL strain

A

Contact sports

80
Q

Clinical presentation of M/LCL strain

A

Pain may be worsened with weight bearing
Tenderness of medial/lateral side of knee
Compare to symptomatic

81
Q

Grade 1 M/LCL strain symptoms

A

Tenderness, minimal swelling, and ecchymosis

82
Q

Grade 2 M/LCL strain symptoms

A

More pain and tenderness that can be localised to tibia or femoral insertion of MCL

83
Q

Grade 3 M/LCL strain symptoms

A

Complete rupture of MCL, knee joint swelling and effusion will be minimal as much of haemorrhage diffuses into surrounding soft tissue

84
Q

Prognosis of M/LCL strain

A

Grade 1- no specific treatment
2+3 should be protected for 6 weeks
3 or severe instability should be evaluated for reconstruction pf possible associated ligament injury

85
Q

Importance of meniscus

A

Improve articular cartilage congruency + stability
Control complex rolling + gliding actions of the joint
Distributing load during weight bearing

86
Q

Then meniscus epidemiology
Acute + chronic

A

Acute- rotational or twisting injury to flexed knee resulting in audible pop with concurrent localised sharp pain
Chronic- degenerative changes to menisci, often no discrete history of trauma

87
Q

Age groups affected by torn menisci

A

Acute 20-40
Chronic older
Usually younger person who sustains twisting injury

88
Q

Risk factors of menisci tear

A

Pivoting sports

89
Q

Clinical presentation of torn menisci

A

Acute- effusion, moderate pain, may describe mechanical symptoms (catching, locking) resulting in difficulty with flex/ext
Large tears- knee can become locked in flexion, severe pain caused from squatting/pivoting
Chronic- symptoms exacrberated by activity and improved with rest
Effusion may be relevant to recent activity
Tenderness with palpation along joint line

90
Q

Prognosis of meniscal tears

A

McMurray test will identify tear
Treatment based on side of tear, as well as Pt age and activity level
Small tears- RICE, NSAIDs, activity modification, stretching + strengthening

91
Q

Degenerative joint disease

A

Most common cause of knee pain in elderly Pt
Knee most commonly affected by OA

92
Q

Epidemiology of DJD

A

Rarely evidence of history or trauma
May present after aggravating knee with minimal twist or contusion
Younger Pt with previous knee trauma at increased risk at an early age due to post traumatic arthritis
May be in occurrence with chronic metabolic conditions (gout) and obesity

93
Q

Age groups affected by DJD

A

50-80

94
Q

Clinical presentation of DJD

A

Pain, swelling and stiffness that gradually becomes worse
Pain may be worse on cold days
Often exacerbated by activity and relieved with rest
Common to have night pain after day of activity, severe shoulder wise alternate diagnosis
Observe gait (antalgic gait)
Bowed legs (genus vacuum), or knocked knees (genus valium)
Tenderness to palpation is unlikely
Crepitus with flex/ext

95
Q

Prognosis of DJD

A

Initial treatment involves weight loss, activity modification, and NSAIDs
High impact activities such as running should be avoided
Swimming is beneficial
End-stage OA requires total knee replacement

96
Q

Pes anserine bursitis

A

Pes anserine bursa located on medial side of knee at proximal tibia
Provides cushioning to tendons during activity

97
Q

Epidemiology of pes anserine bursitis

A

Pain often insidious on onset, no history of trauma (unlike MCL sprain)
Report of history of overuse, commonly in sports such as breastroke- repetitive strain on tendons –>bursitis

98
Q

Risk factors of pes anserine bursitis

A

Sports involving reparative strain on medial tendons

99
Q

Clinical presentation of pes anserine bursitis

A

Medial knee pain
Tenderness to palpation of proximal medial tibia at attachment of pes anserine tendon

100
Q

Prognosis of pes anserine bursitis

A

RICE and NSAIDs initially
Identify stress aetiology
Often resolution of symptoms, however occasionally becomes chronic
Refer after 6 weeks of rest, NSAIDs and activity modification

101
Q

ACL tear Hx

A

Direct trauma with valgus hyperextension
Audible pop
Playing sport with quick stops or sharp cutting on non slip surafces

102
Q

ACL tear SSx

A

Severe Jt effusion
+ve ant drawer
Feeling of instability

103
Q

PCL tear Hx

A

Direct trauma with posterior to anterior stress
Audible pop

104
Q

PCL SSx

A

Effusion in popliteal fossa
Reduced ROM
Instability/feeling of giving way

105
Q

Chrondromalacia patella

A

Prior trauma
Retropatellar P
Worse with prolonged walking
Going down stairs

106
Q

Chrondro SSx

A

Knee tenderness
Worse after prolonged sitting
P going upstairs

107
Q

Meniscus tear

A

Painful clicking or snapping
Deep Jt line P
Jt locking
Local tenderness to palpation

108
Q

Osgood Schlatters

A

Active preteen/teem
Insidious onset or after intense activity
Local tenderness
Swelling
Red
P with PROM
P brought on by activity

109
Q

Osgood DDX

A

Osteochondroma- an overgrowth of cartilage and bone that happens at the end of the bone near the growth plate

110
Q

ITB friction rub

A

Recent inc inc running distance, intensity, frequency
Lateral knee P

Local tenderness, +ve Nobles

111
Q

Plica syndrome

A

P over lateral or medial condyle
Snapping sensation

Tender band or cord from patella to condyle

Orthopaedic Conditions (11 decks)

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