knee ortho Flashcards
What are the tests for collateral and ACL instability?
(7)
- Varus/valgus stress test (0 & 30)
- Anterior and posterior drawer test
- Levers sign (Lelli’s test)
- Lachman test (ACL)
- Pivot shift test
- Apley’s distraction test
- Stroke test
What are the tests for PCL & posterolateral instability? (5)
- Posterior instability (sag sign) PSCL
- quadriceps active test (activate agst resistence)
- Posterolateral drawer test
- Reverse pivot shift test
- Dial test
Osteochondrosis dissecans: exam
- knee warmer than non injured knee
- intermittent palpable swelling
- quadriceps atrophy
- passive and active ext ltd
- tibial Ext rot during gait
- fluid effusion
- catching, locking of knee
- Wilson’s test
What is the Wilson’s test? What does it test for?
Knee held 90 - 30 deg from full extension.
while rotating tibia
+ve internal rotation painful at about 30 deg flex - in IR tibia abuts medial femoral condyle causing pain)
tests for osteochondritis dessecans of knee
What is osteochondrosis dessicans?
- joint condition where bone under cartilage of joint dies due to lack of blood flow
- bone and cartilage can break lose –> pain and affect joint motion
- typically children & ado
what are the symptoms of osteochondrosis?
- pain walking up stairs, climbing hill, playing sport)
- swelling & tenderness; vague pain & swelling- knee swells with onset of pain; entire knee irritated, responds by producing extra synovial fluid
- stiffness
- feeling of joint instability - giving way, clicking, locking, popping
- m/c knee, ankle, elbow. Most commonly femoral condyle of knee, especially medial
- typically one joint - bilateral extremely rare
- more common in males
what are the ddx for osteochondrosis dessicans?
- inflammatory arthrities
- oa
- bone / joint cyst
- septic arthritis - purulent invasion of knee.
What are the questions for knee asst?
- Age: oa; ra, activity level (athlete)
- occupation: standing, walking, footwear
- site of pain: local/general
- valgus / varus (wo rotation) = MCL, LCL, patella fx/dislocation
- valgus/ varus (w rotation) = MCL, LCL, ACL, PCL, patella, meniscus
- blunt force trauma: anterior PF, patellar articular injury, osteochondral fx
posterior: muscular, popliteus, gastroc, hamstring.
knee joint effusion - immediate 0 - 2 hr
ACL, rupture, patellar dislocation, mjr chondral lesion
knee joint effusion: delayed 6 - 24 hr
meniscus, smaller chondral lesion
knee joint effusion no swelling
MCL sprain (superficial)
What is hemarthroses of the knee?
bleeding into space around joints
can cause extreme swelling, pain, stiffness
Dx by joint aspiration
what does haemartroses indicate?
significant intra-articular pathology
usually ACL
possibly medial meniscus
acute - usually sudden, ocasionally takes hours
tense, inflamed knee
what does joint effusion indicate?
general reaction to stress on knee
common in chronic conditions - chronic meniscus or oa
usually slower / recurrent
Ottawa Knee rules
- > 55 yrs
- fibular head tenderness
- patellar tenderness
- knee flexion ltd to 90 deg
- inability to weight bear (4 steps)
Pittsburg criteria
6. < 12 yo
7. 50+ yrs
8. inability to weight bear (4 steps)
