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J MSK > Knee conditions > Flashcards

Knee conditions Flashcards

1
Q

general treatment for someone with knee pain that presents to their GP

A

physio

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2
Q

which knee ligament strain is most common

A

MCL

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3
Q

inflammation of patellar ligament at tibial tuberosity

A

Osgood schlatters disease

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4
Q

crack in articular cartilage and underlying subchondral bone in teenages bc of shear stress on joint

A

osteochondritis dissecans (OCD)

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5
Q

teenager with joint ‘catching and locking’

A

osteochondritis dissecans (OCD)

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6
Q

in osteochondirits dissecans (OCD) if an area of the knee surface looses its blood supply what can happen

A

a bit of bone can break off

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7
Q

if someone gets osteoarthritis in the medial part of their knee, what kind of stance did they have (valgum or varum)

A

varum

opposite to what youd think

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8
Q

if someone gets osteoarthritis in the lateral part of their knee, what kind of stance did they have (valgum or varum)

A

valgum

opposite to what youd think

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9
Q

aetiology of osteoarthritis in the knee

A

any previous trauma, infection, injury etc etc

malalignment (varus or valgum)

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10
Q

first line treatment for knee osteoarthritis (3)

A

weight loss
increase activity
mobility aids

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11
Q

second line treatment for knee osteoarthritis (after weight loss, increase activity etc)

A

surgery - total knee replacement, partial knee replacement

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12
Q

who gets total knee replacements for knee osteoarthritis

A

end stage disease in elderly patients

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13
Q

who gets partial knee replacement for knee osteoarthritis

A

young patients

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14
Q

how long does a total knee replacement last

A

15-20 years

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15
Q

investigation for soft tissue knee injuries (2)

A

MRI - to see ligaments

xray - to exclude fracture

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16
Q

first line treatment for anyone with a ?soft tissue knee injury

A

pain relief = 1-10mg morphine sulphate

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17
Q

MCL rupture presentation (incl alignment) (2)

A

valgus instability (knock kneed) - think about if you removed MCL how there would be nothing to stop knee from going inwards

pain for several months (reassure patient this is normal)

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18
Q

treatment of MCL

A

probs nothing, heals well on its own

encourage early movement to prevent stiffness

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19
Q

aetiology of LCL

A

football tackles (remember bc their usually on the lateral side of leg)

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20
Q

presentation of LCL rupture (incl alignment) (2)

A

varum (bow legged)

hyperextension of knee

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21
Q

in a MCL rupture what else may also be damaged

A

ACL

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22
Q

in a LCL rupture what else may also be damaged

A

PCL

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23
Q

treatment of LCL

A

surgery if full tear (tendon graft)

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24
Q

complications of LCL rupture

A

common fibular nerve injury

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25
Q

aetiology of ACL rupture

A

sports injury

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26
Q

presentation of ACL rupture (3)

A

haemarthrosis (swelling with blood)
pain for a few days
locking/catching/twisting/popping

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27
Q

what fraction of people are fine after an ACL rupture

A

1/3

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28
Q

what fraction of people need to avoid certain activities but are otherwise fine after an ACL rupture`

A

1/3

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29
Q

what fraction of people need surgery after ACL rupture

A

1/3

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30
Q

which tests are positive in ACL rupture (2)

A

anterior drawer test

lachmans test

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31
Q

what test is;

bend knee at 90 degrees, put you hand behind tibia and try to pull it forward to see if it moves

what is it testing

A

anterior drawer test

ACL rupture

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32
Q

what test is;

leg in air at a 30 degree angle, put hand above and below tibia and try to pull tibia forward

what is it testing

A

lachman test

ACL rupture

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33
Q

investigation for ACL rupture

A

MRI

xray to rule out fractures

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34
Q

if someone gets a ligament surgical repair, what are they actually getting done

A

ligament graft from somewhere else in the body

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35
Q

treatment of ACL rupture

A

physio

surgery (1/3)

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36
Q

what tendons can be used for tendon grafts in the knee

A

Achilles tendon
medial 1/3 of patellar tendon
hamstring tendon

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37
Q

requirements for tendon after a tendon graft

A

good blood supply

38
Q

are PCL ruptures common

A

no rare

39
Q

recurrent hyperextension
instability descending stairs
bruising in popliteal fossa
‘sagging tibia’

A

PCL rupture presentation

40
Q

positive examination for PCL rupture

A

posterior drawer test

41
Q

what test is;

bend both knees at 90, push tibia backwards to see if it moves

what is it testing

A

posterior drawer test

PCL rupture

42
Q

what happens if 3 or 4 ligaments rupture

A

dislocated knee

43
Q

treatment of multiligament injury

A

surgery

44
Q

unhappy triad of ruptures

A

medial collateral ligament
anterior cruciate ligament
medial meniscus ligament

(the medial/front ones!)

45
Q

aetiology of meniscal tears

A

sporting injury/twisting injury

46
Q

which meniscus is more likely to tear

why

A

medial

under more stressed

47
Q

what is the largest type of meniscal tear

A

bucket handle tear

48
Q 
joint line tenderness
sharp sudden localised pain 
effusion the next day 
'catching and locking'
springy block test 
positive steinmans test
A

meniscal tear

49
Q

what test is this;

put fingers on joint line of knee
bend knee to 90 degrees
medially and laterally rotate knee, feeling for any joint line tenderness

what is it testing for

A

steinmans test

meniscal tear

50
Q

treatment of meniscal tear if young and acute tear

A

surgery

51
Q

treatment of acute meniscal tear if old/previous surgeries failed

A

partial meniscectomy

52
Q

complication of all knee ligament tears

A

osteoarthritis

53
Q

what is the blood supply to the meniscus

why is this significant in the healing process

A

peripheral 1/3 has blood supply

poor healing

54
Q

definition of knee dislocation

A

3 or 4 of ligaments have ruptured

55
Q

which nerve is commonly affected in knee dislocations

how does this present

A

common fibular

foot drop

56
Q

who do PCL ruptures present in

A

rugby players

anterior tibial injury (eg in car crash)

57
Q

treatment of knee dislocation

A

emergency surgery

58
Q

treatment of knee dislocation if the patient has arthritis too

A

knee replacement

59
Q

complications of knee dislocation (3)

A

popliteal artery injury
common fibular and tibial nerve injury
compartment syndrome

60
Q

why are females more likely to get a patellar dislocation

A

more lax in ligaments

61
Q

which group (age and sex) of people are most likely to get patellar dislocations

A

female teenagers

62
Q

investigation of patellar dislocation

A

xray to look for fractures

63
Q

in which direction does the patella (knee cap) usually dislocate (move) to

A

laterally

64
Q

treatment of patellar dislocation

A

splint for 3 weeks, physio

65
Q

which is more severe, patellar dislocation or knee dislocation

A

knee dislocation

66
Q

which is more common patellar dislocation or knee dislocation

A

patellar dislocation

67
Q

are recurrent patellar dislocations common

A

yes - 1 in 5

68
Q

what condition typically occurs when you fall onto your knee when your quads are contracted

A

extensor mechanism rupture

69
Q

what are the 5 components of the extensor mechanism

A 
quads
quads tendon 
patella 
patellar retinaculum 
patellar ligament
70
Q

in a <40 year old, what component of the extensor mechanism is most likely to rupture

A

patellar tendon

71
Q

in a >40 year old, what component of the extensor mechanism is most likely to rupture

A

quads tendon

72
Q

how many components of the extensor mechanism do you need to rupture before you get an extensor mechanism rupture

A

one

73
Q

which knee condition are chronic steroid users (body builders) most likely to get

A

extensor mechanism rupture

74
Q

what is Osgood schlatters disease

A

apophysitis at tibial tubercle (insertion of the patellar tendon)

75
Q

who does osgood schlatters disease typically occur in

A

adolescent boys

76
Q

presentation of Osgood schlatters disease

A

bony lump at tibial tubercle

pain worse after exercise

77
Q

examination test for extensor mechanism rupture

A

straight leg raise

78
Q

treatment of extensor mechanism rupture (2 + 1 not + 1 stop)

A

surgery and physio

NOT INJECTION, STOP STEOIDS

79
Q

anterior knee pain worse going downhill, clicking

A

patellofemoral dysfunction

80
Q

valgus

A

MCL

81
Q

varus

A

LCL

82
Q

twisting/popping

A

ACL or meniscal tear

83
Q

dashboard/hyperextension

A

PCL

84
Q

getting up from squatting

A

meniscal tear

85
Q

haemarthrosis

A

ACL

86
Q

swelling (effusion) next day

A

meniscal tear

87
Q

pain in joint line

A

meniscal tear

88
Q

swelling in popliteal fossa

A

bakers cyst

89
Q

what type of cyst is a bakers cyst and example of

A

ganglion cyst

90
Q

what is a bakers cyst filled with

A

mucous/synovial fluid

91
Q

treatment of bakers cyst

A

nothing, leave alone

92
Q

why does mucous/synovial fluid build up in the popliteal fossa in a bakers cyst

A

weakness in synovial tendon sheath

J MSK (30 decks)

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