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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
plica syndrome
inflammation and thickening of the bands that cause various symptoms in a subset of the population
26
history of plica syndrome
activity related aching in anterior or anteromedial aspect of knee "snapping or popping" or buckling sensation (NOT actually buckling)
27
PE of Plica
tenderness to palpation MC mediosuperiro knee next to patella and medial femoral condyle feel a pop at 60 degrees while extending
28
diagnosis of plica (images)
radiographs of patella to r.o. pathology MRI to definitively diagnose
29
ddx of Plica
meniscal tears
30
non rx tx of Plica
physical therapy for modality and stretching rehab MAY do arthroscopic resection
31
rx tx of Plica
NSAID | steroid injection
32
patellofemoral pain etiologies
maltracking (grind along surface causing destruction of patella and cartilage) MC
33
patho of patellofemoral pain
patella articulates with femoral trochlea between condyles
34
history of patellofemoral pain
insidious onset diffuse anterior knee pain worse with prolonged sitting, climbing stairs, jumping, squatting instability or catching sensation
35
PE of patellofemoral pain
women = increased Q angle | maltrackingn of patella
36
diagnostic tests of patellofemoral pain
AP, lateral X ray
37
non rx tx of patellofemoral pain
quad strengthening | referral for failure of conservative tx
38
menisci of the knee
cartilaginous tissue that serve to fusion joint and provide additional stability
39
which menisci is fixed? mobile?
lateral is mobile | medial is fixed = more likely to be torn
40
hx of meniscus tear
injury pain, that subsided, 2 days later - effusion pain is worse with forced flexion (I.e. squatting) buckling or catching sensation
41
traumatic meniscus tear
occurs when knee is subjected to a twisting type motion
42
bucket handle tear
buckling or catching sensation that causes tear to flip over and block knee from full extension immediate ortho referral
43
PE of meniscus tear
inspect/palpate for effusion and joint line tenderness McMurry test +
44
Dx studies meniscus tear
lateral and merchant view plain films (r/o fracture) MRI is sensitive for tear
45
non rx tx of meniscus tear
rest, ice, compression, PT, elevation refer for sx if conservative tx fails
46
meniscus tear sx and physical therapy
PT prior to sx will allow surrounding muscles to be strengthened therefore improving results post op
47
ACL fxn
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
hx of ACL tear
sudden pain giving way of knee from twisting on a bent, hyperextended knee "pop" followed by effusion immediately (vascular tear as well)
49
PE of ACL tear
inspection and palpate LACHMAN TEST, anterior drier
50
diagnostic tests ACL tear
Xray (AP, lateral, tunnel view) MRI (not necessary in complete tear)
51
Rx tx of ACL tear
NSAID of choice opioids are not preferred due to long term pain control needed
52
non rx tx ACL tear
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
MCL and LCL tear fxn
give stability to knee against valgus and varus stress
54
MCL protects against (valgus/varus) stress
VALGUS
55
LCL protects against (valgus/varus) stress
VARUS
56
MCL and LCL tear hx
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
PE MCL and LCL tear
look for edema and ecchymosis Tenderness on bone - avulsion of ligament from bone special test: valgus and varus
58
diagnostic tests MCL and LCL tear
XR to r/o fracture then MRI
59
tx of MCL and LCL tear
PT, bracing, ice joint effusion, complete tear of LCL - orate referral NSAID
60
patellar/quad tendon
connects the quad femoris muscle group to tibial tubercle on anterior proximal tibia
61
two spots for patellar/quad tendon tear
< 55 = distal to patella | >55 = proximal to patella
62
patellar/quad tendon tear hx
fall on partially flexed knee
63
patellar/quad tendon tear PE
palpable defect superior or inferior to patella | Inability to fully extend against gravity
64
patellar/quad tendon tear dx tests
r/o fracture AP/Lateral XR MRI (not needed)
65
patella alta XRAY
indicative of patella tendon rupture
66
patella baja
indicative of quad tendon rupture
67
patellar/quad tendon tear tx
surgical repair early partial tear = immobility, ALL REFERRED to ortho long leg locked hinge brace post op
68
patellar/quad tendon tear and NSAIDS
AVOID NSAIDS due to decreased tissue healing
69
tibial plateau consist of
articular surface epiphysis metaphysis of proximal tibia
70
tibial plateau fracture common from
jumping from a hight landing on knocked nee severe forceful valgus or varus stress on stationary thigh
71
hx tibial plateau fracture
MCV hit from side can result in medial fracture | direct blow to distal lateral high with planted foot
72
tibial plateau fracture PE
palpation - tender tibial rim | asses NV distally
73
radiographs of tibial plateau fracture
AP and lateral | CT recon for surgical planning
74
tibial plateau fracture tx
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
patella fxn
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
patella fracture hx
direct blow by fall or object pain, swelling, inability to extend the knee
77
patella fracture PE
AROM (decreased or absent to to pain or lack of extension mechanism intact) XR Ap and Lateral
78
patella fracture tx
long leg cylinder cast or long leg hinged brace complete and or extensor mechanism not intact, surgical fixation req
79
Osgood Schlatter Dz
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
Osgood Schlatter Dz when pain Is b/l
no need for XRAY if unilateral, need one to r/o tumor
81
when do you need sx for Osgood Schlatter Dz
avulsion of ossification center
82
Sinding larsen Johansson syndrome
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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