knee evaluation Flashcards
week 4
differential diagnoses:
lower leg
- meidal tibial stress syndrom (MTSS)
- periostits
- exertional compartment syndrome
- deep vein thrombosis (DVT)
- lateral tibial periostitis (shin splits)
medal tibial stress syndrom (shin splits)
objective tests:
some whys to consider:
objective tests:
- shin palpation test (SP 90%)
some whys to consider:
- increase in activity
- decreased tib ant, tib. post and soleus strength
- decreased ankle DF ROM
- decreased talocrural mobility
- decreased hip abduction/external rotaiton strength
- pes planus/pes cavus
- RED-S
bone stress injuries
chronci exertional compartment syndrom
5 P’s that resolve at rest
Differential diagnoses
anterior knee
- patellar or quadricep tendinopathy
- patellar or quadriceps tendon rupture
- PFPS
- chondromalacia
- patella sublux/dislocation
- fat pat syndrome
- pre-patellar bursitis
- plica syndrome
- osgood schlatter
- sinding-larsen-johansson (SLJ) syndrome
patella tendiopathy
risk factors
- male
- increased waist circumference
- increase in trianign vol and freq
- decreased muscle length of hamstrings, quaddriceps
- decreased foot arch height
- deceased ankle DF
- increased horizontal brakingforces during landings
tendinopathy
quadriceps tendinopathy
- less common than patellar tendinoapthy
- different tha npatellar tendinopahty: widdth, attachments
- may lead to rupture: older patients, underlying medical condtions (gout,RA, diabetes)
patellorfemoral pain syndrome (PFPS)
- retropatellar or peripatellar pain
- reproduction of pain with:
squatting, stair climbing, prolonged sitting, otehr functional task that loads the patellofemoral joint in a flexed position - exclusion of all other possible causes of pain
theses movemetns show increased contact and pressure between patella and femur
tests for patellofemoral pain syndrome
- patellar tilt test (SP: 92%)
- compression test (SN 68-83%, SP 18-54%)
- clarke sign ( SP 75%)
- resisted knee extension (SP 95%)
- pain with squatting (SN 91-94%)
- pain with stair climbing (SN 94%)
patellofemoral pain syndrome
test cluster:
- less than 40 years of age AND isolated anterior knee pain
OR medial patellar facet tenderness
SN: 64% SP: 93%
PFPS - ICF cassification system
overuse
movement coordination deficits
muscle performance deficits
mobility deficits
Articular cartialge
chondromalacia:
PFPS vs chondromalacia:
patellar sublux/dislocation
- often in lateral directin
- forceful quadriceps contraction from knee flexed position
- can generally relocae patella by extending knee
- positive patellar tilt test (SP92%)
getting up and twisting - direction change
pediatric conditions - apophysitis
siding larsen johansson (SLJ) syndrome:
osgood-schlatter disease:
apophysitis = inflammation and stress injury where a muscle and its tendon attaches to the area on a bone where growth occurs in a child or adolescent
- inferior pole of patella (fracture site)
- tibial tuberosity (fracture site)
fills in with calcium to create a bony enlargement of that area due to the fracture
fat pad syndrome
- pain with end range knee extension
plica syndrome
anteromedial pain exacerbated with squatting clicking and popping
clicking/popping (rubber band feeling) something is rolling over a structure - this is how it differs from just capitation of the joint or crepitus
just a thickening of the capsule
multiple different locations - 4 types
pre patellar bursitis
house maids knee - caused from direct contact of knee on ground.
anterior aspect of knee bursa inflammation
can happen acutely - like in football
or chronic
differential diagnoses:
posterior knee
- hamstring tendinopathy
- gastrocnemius tendinopathy
- popliteus strain
- bakers csyt
- PCL sprain
posterior knee:
tendinopathy and musle strains
- distal hamstrings
- proxima lgastrocnemius
- popliteus
bakers cyst
due to underlying meiscus or intra-articular dysfunction
- sign of another condition typically * you can drain them but they will come right back
differential diagnoses:
lateral knee
- lateral meniscus tear
- LCL sprain
- proximal tibiofibular joint dysfunction
- iliotibial band (ITB) syndrome
meniscus tears: what will affect the differnt tears and or regions
consider how glide of the femoral condyles during knee motioin will affect the different tears and or regions of the meniscus
- femur rubbing back and forth
meniscal pathology composite score
the combo of hisory of “catching” or “locking” pain wiht force hyper extension, pain with maximum passive knee flexion, and pain or audible click with mcmurry’s maneuver and joint line tenderness
meniscus tear
special tests:
mcmurray’s test
- lateral meniscus SP:94%
- medial meniscus SP: 77%
thessaly test (20° knee flexion)
- lateral : SP 95-96%
- medial: SP 83-97%
apleys compression test:
- SP/SN 53%
joint line tenderness
- SN 76% SP 77%
deep squat test:
- SN 75-77%
proximal tibiofibular joint dysfunction - thinking what?
hypermobiity
hypomobility
iliotibialband (ITB) syndrome indicated what is weak/compensated
- decreased gluteal strength
- dynamic knee valgus
what is current best evidence to treat a person with ITB syndrome?
differential diagnoses:
medial knee
- medial meniscus tear
- MCL tear
- pes anserine bursitis/tendinopathy
pes anserine tendinopathy/bursitis
medial knee pain after recent increase in activity
- often seen in patients who are recovering from lower extremity surgical intervention
differential diagnoses:
other diagnoses for knee not yet talked about
- osteoarthrtis
- osteochondritis dessicans
- ostechondral defect
- ACL sprain
- multi ligament instability (knee dislocation)
- fractures
- referred pain
what is the greatest conceren with knee osteoarthrtis
loss of mobility
what are some function activites ROMs needed with assessing for knee osteoarthrits
riding a bike: 110° flexion
gait
- knee extension: 0°-5° hyperextension
- knee flexion: 60° flexion
stairs:
- ascending: 80° flexion
- descending 117° flexion
rising from a chair: 85° flexion
donning socks: 120° flexion
knee osteoarthritis test cluser
- age > 50 yrs
- knee crepitus
- palpable bony enlargement
- bondy tenderness to palpation
- morning stiffness that improves in less than 30 minutes
- no palpable warmth of the synovium
if less than 3: SN 95% if more than 3: SP 69%
articular cartilage lesions test cluster
- acute trauma with hemarthrosis
- insidious onsest aggravated by repetitive impact
- intermittent pain and swelling
- history of catching or locking
- joint line tendernesss
hemarthrosis: a condition of articular bleeding, that is into the joint cavity. This can occur after an injury. Patients will typically present with pain, swelling and a decreased range of motion of the involved joint
anterior cruciate ligament sprain
MOI:
clincial findings:
MOI: deceleration or acceleration motion with non-contact valgus load at or near full extension
- hearing or feeling ‘pop’
- hemarthrosis within 0-12 hrs of injury
- history of givignway
- positive lachman test
- positive pivot shift test
posteriro cruciate ligaments
MOI
Clinical findings
- posterior directed force on proximal tibia, fall ont oflexed knee, orsudden/violent hyperextension injury
- localized posterior knee pain wiht kneeling or decelerating
- posterior sag sign of proximal tibia
- positive posterior drawer test at 90° knee flexion
medial collateral ligament sprain
clinical findings
- rotaitonal trauma
- TTP ove MCl
- trauma by force applied to lateral aspect of lower extremity
- medial knee pain with valgus stress test (30° knee flexion)
- laxity with valgus stress test (30° knee flexion)
lateral collateral ligament sprain
clinical findings
- varus trauma
- localized swelling over LCL
- TTP over LCL
- lateral knee pain with varus stress test (0° and 30° knee flexion)
- laxity with varus stress test ( 0° and 30° knee flexion)
multi-ligament injuries
- posterior rotatory instabililty
- anterior rotaory instability
- knee dislocation
what test is performed for posterior rotatory instability
posterolateral corner (PLC) injuries
-extenral rotation recurvatum test
fractures commonly seen at knee
- tibial plateau
- segond
- tibialspine avulsion
screening for radiographs
- pittsburgh knee rules
- ottawa knee rules
pittsburgh knee rules
- acute fall or blunt trauma
- inability to ambulate
- age <12 years or > 50 years
SN: 86%
SP: 51%
lower SN and SP than ottawa knee rules
ottawa knee rules
- age 55 years and older
- TTP at fibular head
- isolated TTP of patella
- inability to flex to 90°
- inability to weight bear both immediately and idn the ED
SN: 100%
SP 52%
referred pain
hip conditions taht refer to the knee
- slipped capital femora lepiphysis (SCFE)
- avascualr necrosis (AVN)
- hip osteoarthritis
a segond fracture (avulsion) can tell you what about the knee?
you can almost 100% be certain an ACL issue is going on
