knee disorders Flashcards by Halimo Ali Hashi

quadriceps tendon rupture etiology

traumatic disruption of the quadriceps tendon
mechanism: deceleration injury

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quadriceps tendon rupture history

audible pop followed by pain

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quadriceps tendon rupture PE: (I,P,ROM,Special)

I: +/- deformity with a depression above the patella
P: palpable step off or soft spot above the patella
ROM: cannot straight leg raise
Special: straight leg raise

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quadriceps tendon rupture xray

can be normal - no pull on patella

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quadriceps tendon rupture treatment

surgery

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prepatellar bursistis (housemaid’s knee) etiology

inflammation of the bursa over the patella
kneeling excessively

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prepatellar bursistis PE (I, P, ROM)

I: superficial swelling over patella
P: boggy - can push fluid around
ROM: typically normal, if severe flexion may be limited

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prepatellar bursitis treatment dont’s

never stick a needle, never drain, get infected really easily

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prepatellar bursistis treatment

conservative - RICE, activity mod
if gram stain + - surgical bursectomy
aggressive - sterile aspiration

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patella dislocation etiology

dislocation of the patella laterally
pivoting injury/valgus injury on extended knee

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patella dislocation PE (I, P, ROM, Special)

I: visible swelling, relocation, or dislocation
P: tenderness medial side of patella
ROM: can’t assess if dislocated
Special: apprehension test

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patella dislocation treatment

reduce
keep knee straight/extended
knee immobilizer with patellar cutout for 7-10 days, slow PT weeks 2-3, brace week 4-6

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patellofemoral pain syndrome etiology

pain from the patellofemoral joint
often young kids, associate with distance runners
insidious onset

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patellofemoral pain syndrome PE (I,P,ROM,Special)

I: normal
P: normal or diffuse tenderness around patella
ROM: normal, maybe pain with knee flexion
Special: patellar apprehension test

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another name for patellofemoral pain syndrome

chondromalacia of the patella

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patellofemoral pain syndrome treatment

conservative - RICE, anti-inflammatories, PT, activity modification, bracing

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patellar fracture etiology

fracture of the patella
blunt trauma/falling directly on patella
unable to ambulate

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patellar fracture PE (I,P,ROM,Special)

I: swelling, possible abrasion + depression at mid patella
P: anterior tenderness over the patella
ROM: do not assess
Special: can’t straight leg raise

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patellar fracture treatment

no displacement - knee immobilizier
displaced - surgery (tension band wire)

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patellar tendon tear etiology

disruption of the patellar tendon
deceleration injury
jumping down from a height of 3 ft or more, abrupt stopping

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patellar tendon tear PE (I,P, Special)

I: swelling, deformity with patella “high riding patella”
P: tenderness, step off inferior to patella
Special: can’t straight leg raise

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patellar tendon treatment

surgery

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osgood schlatter’s disease etiology

pain at insertion of the patellar tendon on the tibial tubercle

osgood schlatter’s disease history

complaints of chronic focal pain at the tibial tubercle
starting, stopping, jumping sports
often one sided

osgood schlatter's disease PE (I,P,Special)

I: normal P: tenderness at tibial tubercle Special: focal pain at tibial tubercle with resisted straight leg raise

osgood schlatter's disease treatment

conservative - RICE, cho pat straps

medial and lateral collateral ligament tear etiology

Blow to lateral aspect of knee with foot planted

MCL and LCL tear PE (I,P,Special)

I: mild to moderate swelling P: tenderness over MCL or LCL Special: valgus and varus stress test, lachman test, anterior/posterior drawer test

pes anserine bursitis etiology

inflammation at 3 hamstring insertion site

pes anserine bursitis history

insidious onset of medial joint pain often will point exactly to medial aspect of knee below the joint line common in long distance runners

pes anserine bursitis PE (I, P, Special)

I: may see swelling P: tenderness at medial aspect of knee BELOW joint line Special: resisted flexion may reproduce pain

three tendons that insert at pes anserine bursa

sartorius, gracilis, semitendonosis

pes anserine bursitis treatment

RICE, activity modification, NSAIDs, sports holiday bracing

IT band syndrome etiology

inflammation of the insertion of the ITB

IT band syndrome PE (I, P)

I: normal P: tenderness lateral to knee at the ITB insertion at the superior fibular head and superior

femoral condyle fracture etiology

fracture of one or both femoral condyles

femoral condyle fracture history

high energy injury, MVA, fall from height

femoral condyle fracture PE (I,P, ROM, NV)

I: look for break in skin, swelling P: severe tenderness at distal femur ROM: do not assess to avoid displacement NV: reasonable risk

femoral condyle fracture treatment

surgical risk for osteoarthritis non weight bearing

tibial plateau fracture etiology

fracture of the proximal tibia - intraarticular

tibial plateau fracture history

high energy - MV accident

tibial plateau fracture PE (I,P,ROM,NV)

I: look for break in skin P: tenderness around proximal tibia ROM: do not assess to avoid displacement NV: common fibular nerve (peroneal nerve)

tibial plateau fracture treatment

surgery - ORIF

tibio-femoral dislocation etiology

dislocation of the knee tibia posterior high risk for popliteal artery disruption high risk for peroneal n. or tibial n. disruption

tibio-femoral dislocation history

may complain of cool foot or inability to move foot orthopedic emergency!

tibio-femoral dislocation PE (I, P, ROM, NV)

I: significant deformity P: tenderness ROM: do not assess NV: high association of peroneal n. or tibial nerve

meniscal tear etiology

tear in medial or lateral meniscus

meniscal tear history

can be traumatic or atraumatic (degenerative) repetitive squatting, twisting or compression

meniscal tear PE (I,P, Special)

I: normal P: focal medial or lateral joint line tenderness Special: Mcmurrays, appley's, flick, spring

meniscal tear treatment

do not heal on own, athroscopy

ACL tear etiology

tear of the anterior cruciate ligament

ACL tear history

deceleration injury can be contact or non contact giving out episode very painful + non ambulatory or mild pain and ambulatory

ACL tear PE (I,P, Special)

I: may see large effusion or no effusion P: non tender Special: Lachman's, anterior/posterior drawer test

ACL tear treatment

surgery higher risk of osteoarthritis

baker's cyst etiology

not a cyst effusion of joint fluid in the knee

baker's cyst treatment

of the intra-articular pathology