Knee OA Flashcards
Hx
62 yr old F, R ant knee pain, 18 months, cant walk over 300m without pain, hard to descend OA, paracetamol/NSAIDs dont work, keeps her awake at night. No hx of trauma/ other knee problems
look
antalgic gait
fixed flexion deformity R knee
Quads atrophy R knee vastus medialis
valgus/ varus alignment
feel
joint line tenderness
effusion
crepitus
patellar tap test for effusion
active movement
painful and decreased ROM of knee +/- flexion deformit
passive movement
painful and decreased ROM of knee +/- flexion deformit
Crepitus
cruciate ligament test
ant drawers test neg
lachmans test neg
medial and lateral collateral ligament
valgus and varus stress test neg
meniscus exam
McMurray test neg
other
examine hip and ankle
check BMI
Distal neurovascular exam
special tests
cruciate ligament test
medial and lateral collateral ligament
meniscus exam
DDx
Knee OA
Knee pain secondary to hip pathology
Medial meniscus tear
Inflammatory arthritis
why is knee OA likely?
decreased active and passive ROM of knee joint with crepitus, 10 degrees fixed flexion deformity present, joint-line tenderness
why is hip pathology unlikely?
normal hip exam, no stiffness on passive medial rotation R hip
why is medial meniscal tear unlikely?
no hx of trauma, gradual increase in severity of symptoms, reduced ROM, ant knee pain = OA in patellar-femoral joint
why is inflammatory arthritis unlikely?
no early morning stiffness
no bilateral symmetrical polyarticular inflammation of joints
no FHx
do bloods ESR/ CRP/ RF/ anti-CCP/ ANCA
