Knee Lecture Flashcards
Where does stability of the knee primarily come from?
Soft tissue structures around and within the joint
- capsule
- ligaments
- muscles
What are the two joints the knee is composed of?
Tibia femoral joint and patella femoral joint
What are the primary movements of the knee?
Flexion, extension and rotation
-rotation only occurs when knee is flexed
What are the red flags for knee injuries?
- inability to bear weight
- history of cancer
- recent trauma
- erythema
- excessive tenderness
- infection
- decreased distal pulses (circulatory problem)
- change in skin color
- unusually cool or warm extremity
- calf pain or tenderness or both –> increases with walking, decreases with laying down
- unrelenting pain
Differential diagnosis of the knee
-DVT (warmth, redness, swelling in calf)
-cellulitis (inflammation of skin tissues, red, swollen)
-peripheral arterial occlusive disease (claudication, circulatory)
-compartment syndrome
-fracture
-septic arthritis (staph infection or streppe that attacks a joint in the body)
-tumor
-restless leg syndrome
-RA
-OA
-degenerative hip or knee issues
-peripheral neuropathy (pinched nerve)
- patellofemoral pain: often occurs with tibiofemoral injury)
-ligament: ACL, PCL, MCL, LCL
-meniscus
Chondromalacia patella: patellofemoral pain syndrome
-pediatric (may be underlying hip disorder; slipped capital femoral epiphysis)
-popliteal cyst: swelling in back of knee
-sogood schlatters disease: tibial tuberosity irritated and enlarged
-bursitis
What questions would you ask in the patient interview?
- history: family, medical history of knee problems
- MOI: traumatic event, overuse, degenerative
- clicking, catching
- swelling
- what causes pain: stairs, hills, running, jumping
- diagnostic imaging
- pain
- was there a pop?
- injury during acceleration of deceleration
- acceleration or twisting: meniscus
- deceleration: crucial ligament - where is the pain
- orthotics
- shoes
What is the Ottawa knee rule?
Used to minimize unnecessary knee radiographs, but ensure all fractures are found
- X-ray not required if none of the following findings present after an acute injury
- Age >55
- Isolated tenderness of the patella (no other bony tenderness)
- Tenderness at the fibular head (fracture)
- Inability to flex the knee to 90 degrees
- Inability to bear weight both immediately and in th ER (4 steps, limping is okay)
What is the Ottawa knee rule?
Used to minimize unnecessary knee radiographs, but ensure all fractures are found
- X-ray not required if none of the following findings present after an acute injury
- Age >55
- Isolated tenderness of the patella (no other bony tenderness)
- Tenderness at the fibular head (fracture)
- Inability to flex the knee to 90 degrees
- Inability to bear weight both immediately and in th ER (4 steps, limping is okay)
What do you look for while observing the patient?
- equal WB bilaterally
- genu Varum (bowleg)
- genu Varum (knock-kneed)
- popliteal crease position
- Q-angle
- gait pattern
- swelling
- look at the entire kinetic chain
What’s the normal end feel of knee flexion with hip flexed?
Soft (soft tissue approximation)
What is the normal end feel of the knee flexed with the hip extended?
Firm (muscular)
What is the normal end feel of knee extension with hip extended?
Firm (capsular/ligamentous)
What is the normal end feel of knee extension with the hip flexed?
Firm (muscular)
What does the Lachmans special test test for?
ACL
Best test for ACL injuries
(+) test= mushy or soft end feel when the tibia is moved forward on the femur (feels like it could just keep moving)
Where does the ACL originate and insert?
Originates: posteriomedial lateral femoral condyle
Inserts: anteromedial intercondylar eminence
