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MSK 1 > Knee/Leg > Flashcards

Knee/Leg Flashcards

1
Q

Degenerative Joint Dz AKA

A

Arthritis of knee

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2
Q

DJD patho

A

progressive (irreversible) degeneration of articular cartilage of femoral condyles and tibial plateau surfaces

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3
Q

DJD is associated with

A

aging
obesity
repetitive wear and tear
previous trauma

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4
Q

types of knee arthritis

A

Osteoarthritis (MC)
rheumatoid
psoriatic

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5
Q

pain in DJD

A

pain and stiffness (worse when getting out of bed in AM)

progressively worse over months to years

relieved with rest

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6
Q

endstage DJD pain

A

pain at all times (worse with weight bearing)
instability
loss of AROM, PROM

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7
Q

PE of knee arthritis

A

tenderness of joint line
decreased AROM/PROM

valgus or varus deformity (late stage)

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8
Q

dx studies in DJD

A

AP an Lateral XRAY

loss of joint space, sclerosis, subchondral cyst, osteophytes @ joint

if hip is affected = AP pelvis

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9
Q

non rx tx of knee arthritis

A

non weight bearing exercise

weight loss
maintain AROM

refer when pt unable to cope or advanced deformity

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10
Q

rx tx of OA knee

A

NSAID
steroid injection
Hyaluronic acid

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11
Q

bursa

A

fluid filled sac lying between bony prominence and tendon, ligaments, skin or muscles

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12
Q

three major bursa of knee

A

pre patellar
infrapatellar
pes anserine

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13
Q

bursitis knee

A

bursa become inflamed and irritated due to chronic pressure or friction = thickening and swelling

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14
Q

pre patellar bursa

A

anterior aspect of knee

superficial, lies between knee and skin

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15
Q

infra patellar bursa

A

anteroinferior knee and lies between patellar tendon and tibia epiphysis

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16
Q

pes anserine bursa

A

MEDIAL knee

under SGT

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17
Q

bursitis of knee history

A

insidious onset

pain present with activity or direct pressure and worse after resting then resuming activity

+/- swelling

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18
Q

pre patellar bursitis history

A

bursa swell to size of tennis ball

common in carpet layers or wrestlers

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19
Q

pes anserine history

A

over use or improper warm up

MC in obese patients, early warning of medial joint DJD

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20
Q

PE of bursitis of knee

A

swelling and redness then palpate for tenderness, ROM

infected - red ness and tenderness more marked and AROM more painful

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21
Q

diagnostic tests of bursitis

A

AP and Lateral Xray to r/p tumor

characterized by nighttime pain

infection = aspiration and culture of synovial fluid

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22
Q

non rx tx of bursitis

A

ice, decreased activity

PT, u/s. phonphoresis

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23
Q

rx tx of bursitis

A

NSAIDs, steroid injection

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24
Q

Plica

A

fold of joint lining that is remnant of tissue from embryologic development

NML fold

infrequently causes symptoms

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25
Q

plica syndrome

A

inflammation and thickening of the bands that cause various symptoms in a subset of the population

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26
Q

history of plica syndrome

A

activity related aching in anterior or anteromedial aspect of knee

“snapping or popping” or buckling sensation (NOT actually buckling)

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27
Q

PE of Plica

A

tenderness to palpation MC mediosuperiro knee next to patella and medial femoral condyle

feel a pop at 60 degrees while extending

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28
Q

diagnosis of plica (images)

A

radiographs of patella to r.o. pathology

MRI to definitively diagnose

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29
Q

ddx of Plica

A

meniscal tears

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30
Q

non rx tx of Plica

A

physical therapy for modality and stretching rehab

MAY do arthroscopic resection

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31
Q

rx tx of Plica

A

NSAID

steroid injection

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32
Q

patellofemoral pain etiologies

A

maltracking (grind along surface causing destruction of patella and cartilage) MC

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33
Q

patho of patellofemoral pain

A

patella articulates with femoral trochlea between condyles

34
Q

history of patellofemoral pain

A

insidious onset

diffuse anterior knee pain worse with prolonged sitting, climbing stairs, jumping, squatting

instability or catching sensation

35
Q

PE of patellofemoral pain

A

women = increased Q angle

maltrackingn of patella

36
Q

diagnostic tests of patellofemoral pain

A

AP, lateral X ray

37
Q

non rx tx of patellofemoral pain

A

quad strengthening

referral for failure of conservative tx

38
Q

menisci of the knee

A

cartilaginous tissue that serve to fusion joint and provide additional stability

39
Q

which menisci is fixed? mobile?

A

lateral is mobile

medial is fixed = more likely to be torn

40
Q

hx of meniscus tear

A

injury pain, that subsided, 2 days later - effusion

pain is worse with forced flexion (I.e. squatting)
buckling or catching sensation

41
Q

traumatic meniscus tear

A

occurs when knee is subjected to a twisting type motion

42
Q

bucket handle tear

A

buckling or catching sensation that causes tear to flip over and block knee from full extension

immediate ortho referral

43
Q

PE of meniscus tear

A

inspect/palpate for effusion and joint line tenderness

McMurry test +

44
Q

Dx studies meniscus tear

A

lateral and merchant view plain films (r/o fracture)

MRI is sensitive for tear

45
Q

non rx tx of meniscus tear

A

rest, ice, compression, PT, elevation

refer for sx if conservative tx fails

46
Q

meniscus tear sx and physical therapy

A

PT prior to sx will allow surrounding muscles to be strengthened therefore improving results post op

47
Q

ACL fxn

A

major stabilizer of the knee

limits ration and anterior translation of tibia on femur

able allow for sudden change in direction (I.e. in sports)

48
Q

hx of ACL tear

A

sudden pain giving way of knee from twisting on a bent, hyperextended knee

“pop” followed by effusion immediately (vascular tear as well)

49
Q

PE of ACL tear

A

inspection and palpate

LACHMAN TEST, anterior drier

50
Q

diagnostic tests ACL tear

A

Xray (AP, lateral, tunnel view)

MRI (not necessary in complete tear)

51
Q

Rx tx of ACL tear

A

NSAID of choice

opioids are not preferred due to long term pain control needed

52
Q

non rx tx ACL tear

A

rest, ice, crutches

PT with ROM strengthening and bracing

surgery (referral for suspected ACL tear, following MRI)

joint aspiration of blood effusion for pain relief

53
Q

MCL and LCL tear fxn

A

give stability to knee against valgus and varus stress

54
Q

MCL protects against (valgus/varus) stress

A

VALGUS

55
Q

LCL protects against (valgus/varus) stress

A

VARUS

56
Q

MCL and LCL tear hx

A

direct force applied to lateral or medial side causes sprain or tear of ligament

pain, swelling, stiffness

may have localize ecchymosis and swelling 2nd day

57
Q

PE MCL and LCL tear

A

look for edema and ecchymosis

Tenderness on bone - avulsion of ligament from bone

special test: valgus and varus

58
Q

diagnostic tests MCL and LCL tear

A

XR to r/o fracture then MRI

59
Q

tx of MCL and LCL tear

A

PT, bracing, ice

joint effusion, complete tear of LCL - orate referral

NSAID

60
Q

patellar/quad tendon

A

connects the quad femoris muscle group to tibial tubercle on anterior proximal tibia

61
Q

two spots for patellar/quad tendon tear

A

< 55 = distal to patella

>55 = proximal to patella

62
Q

patellar/quad tendon tear hx

A

fall on partially flexed knee

63
Q

patellar/quad tendon tear PE

A

palpable defect superior or inferior to patella

Inability to fully extend against gravity

64
Q

patellar/quad tendon tear dx tests

A

r/o fracture AP/Lateral XR

MRI (not needed)

65
Q

patella alta XRAY

A

indicative of patella tendon rupture

66
Q

patella baja

A

indicative of quad tendon rupture

67
Q

patellar/quad tendon tear tx

A

surgical repair early
partial tear = immobility, ALL REFERRED to ortho

long leg locked hinge brace post op

68
Q

patellar/quad tendon tear and NSAIDS

A

AVOID NSAIDS due to decreased tissue healing

69
Q

tibial plateau consist of

A

articular surface
epiphysis
metaphysis of proximal tibia

70
Q

tibial plateau fracture common from

A

jumping from a hight landing on knocked nee

severe forceful valgus or varus stress on stationary thigh

71
Q

hx tibial plateau fracture

A

MCV hit from side can result in medial fracture

direct blow to distal lateral high with planted foot

72
Q

tibial plateau fracture PE

A

palpation - tender tibial rim

asses NV distally

73
Q

radiographs of tibial plateau fracture

A

AP and lateral

CT recon for surgical planning

74
Q

tibial plateau fracture tx

A

ORIF for displaced and intra-articular fracture

referral for all patients

MC will also have meniscal or ligament injury as well

increased likelihood of developing OA

75
Q

patella fxn

A

seasomoid bone embedded within quad tendon

serves as fulcrum on femur to improve effectiveness of vector force on quad contraction during extension of knee

76
Q

patella fracture hx

A

direct blow by fall or object

pain, swelling, inability to extend the knee

77
Q

patella fracture PE

A

AROM (decreased or absent to to pain or lack of extension mechanism intact)

XR Ap and Lateral

78
Q

patella fracture tx

A

long leg cylinder cast or long leg hinged brace

complete and or extensor mechanism not intact, surgical fixation req

79
Q

Osgood Schlatter Dz

A

overuse injury of growing child that results from repetitive stress when too tight quad drops pulls on apophysis of tibial tuberosity (11-13 y/o)

80
Q

Osgood Schlatter Dz when pain Is b/l

A

no need for XRAY

if unilateral, need one to r/o tumor

81
Q

when do you need sx for Osgood Schlatter Dz

A

avulsion of ossification center

82
Q

Sinding larsen Johansson syndrome

A

similar to osgood except occurs at junction of PATELLAR TENDON and DISTAL POLE of patella

(pain at inferior pole of patella)

MSK 1 (9 decks)

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