Knee conditions Flashcards
Chondromalacia Patella
Anterior knee pain due to softening and degeneration of the articular cartilage of the patella.
cause:
- abnormal patella position can increase the likelihood of chondromalacia patella
- It is thought to occur when the undersurface of the kneecap comes into contact with the thigh bone causing swelling and pain. This abnormal rubbing can lead to softening and degeneration of the cartilage leading to chondromalacia patella
Age group:
-young active patients
- common problem in young women
clinical presentation:
- anterior knee pain
- deep knee flexion aggravates pain, prolonged sitting and stairs ascent and descent
- patella alta may be seen
- small knee effusion, tenderness, patella crepitus
- hyperextension of patella
prognosis:
- most patients will respond favorably to nonoperative treatment
tests:
- ballottment and clarks
Prepatellar bursitis
Inflammation of prepatellar bursitis
causes:
- frequent kneeling
- acute trauma to the front of the knee
- infection, pyogenic prepatellar bursitis common in children
risk factors:
- occupation- someone who kneels a lot during their job
clinical presentation:
- pain unusual unless affected
- painful when leaning directly on it
- swelling on anterior surface of the knee
- redness suggests pyogenic bursitis
- more diffuse, swelling and pain than normal may be an intrinsic injury with the knee
prognosis:
- aseptic bursitis, can evolve into pyogenic bursitis, the synovial fluid is an excellent medium for bacterial growth
- aseptic bursitis, occasionally resolves with rest, NSAID’s, compression wraps and avoidance of kneeling
Overuse syndromes
MSK pain or dysfunction, can result from overuse (physical activity that exceeds strength of MSK tissues).
This can cause microtrauma to these structures
causes:
- overstretching tissues past their physiological barrier
- vigorous physical activity
- overuse can also cause tendinitis, capsulitis, bursitis or stress fractures
age group:
- young active people
risk factors:
- athletes that compete in a lot of sports
clinical presentation:
- achy pain, 1-2 days after physical activity
- structures that have suffered microtrauma will often be tender
- tissue pain and dysfunction may be severe
prognosis:
- most will heal with elimination of offending activity and rest
- time frame can be variable, but is often complete within 8 weeks
Medial/Lateral Collateral Ligament Strain
Pt with MCL strain may have a history of medial knee pain after trauma to lateral knee or lower leg.
causes:
- can occur with impact to the outside or inside of the knee
- may be due to history of twisting injury causing a snap or a pop
clinical presentation:
-CL pain seperated into 3 grades of seriousness:
grade 1
- mild medial pain
- medial edema
- possibility of swelling and limping
- tenderness
grade 2
- moderate knee pain
- swelling and limping
- instability
grade 3
- severe knee pain
- swelling
- knee gives way into valgus
prognosis:
- patients with grade 1 and 2 should have resolution of tenderness to palpation within 6 weeks
- grade 3 strain may require surgical intervention
Torn Meniscus
Can be acute or chronic degenerative tears
causes:
- Acute tears: any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it
- chronic tears: degenerative changes in older patients can cause tears. known as ‘wear and tear’.
age group affected:
- acute tears- 20-40
- chronic tears- older patients 40+
risk factors:
- sports like football that require twisting of the knee quickly to change direction
clinical presentation:
- insidious onset of knee pain and effusion
- effusion can occur and vary in size depending on patients recent activity level
- patients with chronic tears may show less positive findings in orthopedic tests
prognosis:
- dependent on the size of the tear and the severity of the symptoms
-small meniscal tears that produce little-no pain can be treated with RICE
- large tears may need surgical intervention
Degenerative Joint Disease (OA)
Most affected joint in the body from OA.
Degeneration of cartilage within the knee.
causes:
- degeneration of cartilage, causes knee to be rougher and so knee doesnt move as smoothly as it should, this means the knee might be painful and stiff
age group affected:
- most common cause of knee pain in the elderly
- between 50-80
risk factors:
- more common in elderly women over 50
- injuries can increase likelihood of OA occuring
- genes we inherit can play a part
- being overweight
clinical presentation:
- insidious knee pain, swelling and stiffness gradually can become more severe
- pain worse on cold days
- pain exacerbated by activity relived by rest
- night pain, however unrelenting night pain should be considered as something else like- gout, malignancy, or infection.
- morning stiffness (less than 30 mins)
- antalgic gait
- some degree of quad atrophy
prognosis:
- OA will get worse and more severe over time
treatment to help:
- weight loss
- high-impact activities should be avoided
- non-impact activities (swimming) are good
Miscellaneous Problems: Pes Anserine Bursitis, Knee Effusion, Baker’s Cyst
Pes Ansurine Bursitis- inflammation of the bursa located on the medial side of the knee at the proximal tibia where the pes ansurine complex of the medial tendons (sartorius, gracilis, and semitendinosus) insert. Pes ansurine bursa provides cushioning to these tendons during activity.
causes:
- overuse injuries that affect the medial knee
risk factors:
- active people, who play sports like football where kicking the ball can affect the medial knee
clinical presentation:
- medial sided knee pain
- pain often insidious onset, often no history of trauma. (so can tell the difference between MCL strain and this as MCL strain will have history of trauma to the medial knee).
- history of overuse
- tenderness to palpation at the proximal medial tibia, at the attachment of the pes anserine tendons
prognosis:
- often have resolution of sympoms
- can become chronic sometimes
Lesions of menisci
There are meniscal tears and meniscal cysts
Meniscus have 3 important roles:
- improving articular congruency and stability
- controlling the complex rolling and gliding actions of the joint
- distributing load during weightbearing
These functions are compromised if the menisci are torn or removed.
Medial meniscus is less mobile than the lateral and, consequently more liable to tearing when subjected to abnormal stress.
Osteochondritis dissecans
Condition where bone underneath cartilage dies due to lack of blood flow.
The bone and cartilage can then break loose, causing pain and possibly hindering joint motion.
causes:
- trauma, either single impact with the edge of the patella or repeated contact with an adjacent tibial ridge.
AG:
- occurs mostly often in children and adolescents
- males aged 15-20
CP:
- pain
- decreased range of motion
- intermittent aching or swelling
- credits due to loose bodies
- knee can feel unreliable, attacks of giving way. Knee may lock
- quadriceps muscle is wasted, and the joint may be slightly swollen; usually a small effusion
Diagnostic features:
- tenderness localised to one femoral condyle
- mcmurrays sign
Prognosis:
- can increase risk of OA developing in the knee
Loose bodies
Small fragments of articular cartilage or bone that break off and sit free in knee joint. As a result of degeneration or osteochondritis dissecans.
causes:
- caused by injury (chip in bone)
- osteochondritis dissecans
- OA (pieces of cartilage or osteophytes)
- Charcot’s disease (large osteocartilaginous bodies, separated by repeated trauma in a joint that has lost protective sensation)
- synovial chondromatosis (cartilage metaplasia in the synovium, sometimes producing hundreds of loose bodies)
CP:
- can be symptomless, may complain of sudden locking without injury
- pt may be aware of something ‘popping in and out the joint’
- sometimes knee swells up after 1st locking attack due to synovitis
- may cause crepitus
prognosis:
- loose body causing symptoms should be removed, unless joint is severely osteoarthritic
- can be done via arthroscopy
Tuberculosis
Blood-borne bacterial infection.
Can cause destructive changes.
Travels to the joint via the blood stream
causes:
- can be caught through droplets off other people who have contracted TB
AG:
- can appear at any age, more common in children than adults
CP:
- pain and limb are early symptoms
- swollen joint and a low-grade fever
- thigh muscles are wasted, thus accumulating the joint swelling
- knee feels warm and there is synovial thickening
- movements restricted and painful
Rheumatoid Arthritis
RA autoimmune disorder. Immune system mistakenly attacks own tissues.
RA starts in the knee as a chronic monoarticular synovitis. Sooner or later, however other joints become involved.
causes:
- Autoimmune condition, immune system attacking healthy body tissue.
- With RA, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.
CP:
- Early stage- pain and chronic swelling
- may be large effusion of thigh muscles.
- with articular erosion, joint becomes unstable, muscle wasting increases, and there is some restriction of motion
- RA will affect both knees
- morning stiffness lasting longer than 30 minutes
4 stages:
- preclinical- raised ESR
- synovitis- inflamed synovial membrane
- destruction- inflammation causes destruction to tissues in the joint
- deformity- destruction has caused deformity within the joint
prognosis:
- treatment with anti-inflammatory
- if joint becomes deformed, an osteotomy may improve joint function
Osteoarthritis
Knee one of the most common sites for OA.
Degenerative disorder, where cartilage within the joint degenerates and wears down over time.
causes:
- no obvious cause found
- wear and tear over time
- excessive loading can cause cartilage breakdown
- injuries to the knee can increase the likelihood of OA occurring
AG:
- older pt 40+
RF:
- pt overweight
- excess loading
- repetitive motion
CP:
- pain is leading symptom, worse after use or on stairs
- after rest, joints can be stiff and can hurt to ‘get going’
- morning stiffness lasting less than 30 minutes
- may be obvious deformity
- osteophyte formation may occur
- swelling is common, giving way or locking may occur
prognosis:
- if symptoms are not severe, treatment is conservative.
- OA will get worse over time, and cannot be cured
Patellofemoral disorders
Recurrent dislocation of the patella:
- due to knee being slightly valgus, there is a natural tendency for the patella to pull towards lateral side when the quadriceps muscle contracts.
- traumatic dislocation due to sudden, severe contraction of the quadriceps muscle while the knee is stretched in valgus and external rotation
condition is often bilateral.
Main complaint- from time to time, knee suddenly gives way and the patient falls, may be accompanied by pain and sometimes the knee gets stuck in flexion.
Chondromalacia of patella
Tibial tubercle ‘apophysitis’ (Osgood-Shlatter’s disease)
Swelling and pain of the tibial tuberosity
causes:
- occurs during growth spurts during puberty
- the bones, muscle, and tendons grow at different rates. In OSD, the tendon that connects the shinbone to the kneecap pulls on the growth plate at the top of the shinbone.
AG:
- fairly common complaint among adolescents, particularly those engaged in strenuous sports.
CP:
- pain and swelling
- tibial tuberosity usually prominent and tender. Sometimes active extension of the knee against resistance is painful.
Prognosis:
- Spontaneous recovery is usual
- activities like football and cycling should be limited
