knee conditions Flashcards
what are s&s of pre-patellar bursitis?
swelling and bruising over the anterior knee
pain over the anterior patella
what are s&s of infrapatellar bursitis?
swelling and bruising just below the patella
pain over the anteroinferior patella
which muscles attach to the pes anserine?
sartorius
gracilis
semintendinosus
what are risk factors for developing pes anserine bursitis?
overweight
women
ankle hyperpronation
cyclist
what are s&s for pes anserine bursitis?
localised pain over the pes anserine
painful knee flexion
what is the management for pes anserine bursitis?
rest, avoid aggravating activities
trp of affected muscles
orthotics
what are s&s for semimebranous bursitis?
pain at tendon insertion or in bursa between the tendon & medial head of gastroc on the posterior knee
what are the s&s of biceps femoris bursitis?
pain and swelling at biceps femoris tenson at the head of the fibula (posterior)
(common in sprinters due to overuse)
what are the s&s for popliteus bursitis?
localised pain in the posterolateral knee
tendon can be palpated with knee at 90° under resisted medial rotation of tibia
what is a baker’s cyst?
fluid-filled sac in the medial popliteal fossa
most commonly originates from the medial hamstring tendon
what are s&s of a baker’s cyst?
pain, fullness, stiffness in the posterior knee
fluctuant swelling and tenderness of the posterior knee
decreased ROM if its a large cyst
aching in the popliteal fossa
when is the foucher’s sign positive?
if the baker’s cyst disappears when the knee is flexed
what is chondrocalcinosus?
calcification of the cartilage/meniscus
what are the risk factors for developing chondrocalcinosus?
dehydration
diuretics
what is gout?
build up of uric acid crystals (occurs from breakdown of purine: alcohol, game meats and fish)
what is the most common site for gout to occur?
1st metatarsal joint
what are s&s for gout?
red, hot and swollen joints (need to rule out septic arthritis)
what is the pharmaceutical treatment for gout?
allopurinol
what is the most common site for CPPD or pseudogout to occur?
knee
triangular fibrocartilage
what are risk factors for developing CPPD?
> 50-60 years
diabetes
hyperparathyroidism
gout
which meniscus is most commonly affected?
medial meniscus
what are s&s for a meniscal tear?
pain within the joint line
painful clicking, popping and locking
swelling
+ve McMurray’s test
reduced ROM
what is the imaging of choice for a meniscal tear?
MRI
what is a parrot break in the knee?
a visible lump with leg at 45° when lateral meniscus is torn
what is a cleavage tear in the knee?
posterior horn of the medial meniscus is torn
what is the Osgood-Schlatter disorder?
traction apophysitis (growth plate inflammation) of the tibial tuberosity due to repetitive stress by the patella tendon
who is most at risk for developping Osgood Schlatter disorder?
sporty boys (up to 16 yrs)
what are s&s for osgood Schlatter disorder?
prominent bulge over tibial tuberosity (anterior knee)
pain on kneeling down
pain on going up and down stairs
pain, swelling and tenderness over the tibial tuberosity
RROM extension
what is the imaging of choice for osgood schlatter disorder?
x-ray
what is the management for osgood schlatter syndrome?
self limiting 12-24 months
anti-inflammatory analgesic
stretching quads and hamstrings
graded return to sport
what is osteochondritis dissecans?
necrosis of segments of the femoral condyle which may form intra-articular loose bodies
what is the most common site for osteochondritis dissecans?
lateral aspect of the medial femoral condyle
who is most likely to develop osteochondritis dissecans?
boys between 5-15 years
what are s&s of osteochondritis dissecans?
poorly localised aching knee pain
swelling
worse with strenuous activity and twisting motions of knee (particularly internal rotation
patient may walk with externally rotated leg
knee locking (knee gives away when walking)
what are the s&s of osteonecrosis?
persistent pain, swelling and stiffness
pain often worse at night
what is the imaging of choice for osteonecrosis?
MRI (x-ray may only show after 3 months)
what is the management for osteonecrosis?
avoid sport or precipitating activities for 6-8 weeks
gentle physical therapy
analgesics
grade III and IV need surgery
which type of athletes are most at risk for developing patella tendinitis?
sports including repetitive jumping (basketball, volleyball, football, high jumps)
what are s&s of patella tendinitis?
gradual onset anterior knee pain (below the patella)
pain worse with activity and better with rest
localised swelling over patella tendon
what is the management for patella tendinitis?
avoid sport and precipitating activities
stretching of calves, hamstrings and quads
what is patellofemoral pain syndrome?
pain over the anterior knee due to overuse of the knee
(most common in young females 13-15 yrs due to greater hip adduction)
what are s&s of patellofemoral pain syndrome?
pain behind the patella and deep knee
crepitus within the patella
pain on compression and side-to-side movement of the patella
‘movie sign’: has to straighten out leg after prolonged sitting
pain is worse with loaded knee flexion activities (climbing stairs, walking down slopes, squatting and prolonged sitting)
what is the management for patellofemoral pain syndrome?
VMO and quad strengthening (eccentric > concentric)
hip abductor strengthening
foot orthotics for hyperpronation
patella taping
acupuncture
what is the most common cause of a quadriceps strain?
forceful contraction during forced muscle lengthening
what are s&s of quadriceps rupture?
sudden pain over quadriceps
pop or sensation like an elastic band snapping
palpable defect in quadriceps or infrapatellar tendon
what is the most common mechanism of injury for an anterior cruciate ligament (ACL) sprain?
twisting of knee
sudden change in direction
blow through foot with a flexed knee
what are the s&s for ACL sprain?
onset of severe pain after sports injury
swelling (within 30 min)
feeling as if knee gives away or is loose
inability to weight bear
painful ROM
which special tests would be positive in ACL sprain?
lachman’s test
anterior draw test
pivot shift test
which ligaments/structures are associated with the unhappy triad of the knee?
ACL
medial meniscus
MCL
what is the imaging of choice for an ACL sprain?
MRI
what is the mechanism of injury in a posterior cruciate ligament (PCL) sprain?
A-P blow to tibia in a flexed knee (with foot plantar flexed creating reduced tibial stabilisation)
what are the s&s for PCL sprain?
pain in posterior knee
pain radiating into calf
limited running/jumping
no moderate swelling
genu rectuvatum
which tests are positive in PCL strain?
posterior sag sign
+ve posterior draw
what is the management for grade 1-2 PCL sprain?
graded rehabilitation program
0-4 weeks: brace in slight flexion + RICE
2-6 weeks: dynamic ROM exercises, static cycling and quad strengthening
4-12 weeks: closed chain: half squats, leg presses, resistance cycling, light jogging
> 12 weeks: return to activity
return to sport if quad and hamstring strength are 90% of non-involved side (4-6 weeks)
what is the management for a grade 3 PCL sprain?
surgical referral
what is the synovial plica syndrome?
fold of synovium which gets caught between the patella and femur during walking
what are s&s of plica syndrome?
acute aching in the medial patellofemoral joint
mild effusion
what is the management for synovial plica syndrome?
generally resolves without treatment
US
cross-friction
electrical stimulation
what are s&s of popliteus tendonitis?
localised tenderness in posterior/posteriolateral knee
pain provoked by running and prolonged standing
TTP popliteus tendon (with knee at 90°)
pain in resisted tibial rotation
what are s&s of pes anserine tendonitis?
localised tenderness over pes anserine tubercle
what are s&s for semimembranosus tendonitis?
tenderness over insertion into the posteromedial tibia
what are s&s of biceps femoris tendonitis?
tenderness over the insertion into the posterolateral tibia
