Knee: Other Dx Flashcards
Repetitive extension irritates the knee, most common in gymnasts. Pain behind the patellar tendon and to deep palpation at the joint line behind patellar tendon. Pain with forced knee extension. What’s dx
Infrapatellar fat pad irritation or Hoffa’s fat pad
This is common in runners usually due to hilly terrain or increase load. Can also come with biking at 20-40* of knee flexion. Pain at lateral epicondyle and positive noble compression test.
IT band friction syndrome
What muscles attach to the pes Anserine?
Satorious, semitendinosus, gracilis
This dx comes with repetitive activities, sporting activities and is very common with knee OA
Pes Anserine bursitis
This presents with swelling above the knee cap. This looks like quad tendinopathy but will have swelling and bogginess
Suprapatellar bursitis
This presents with swelling on top of the patella between bone and skin.
Prepatellar bursitis (housemaid or carpenters knee)
Pain close to the distal attachment of the patellar tendon. Due to kneeling but sitting back on your feet.
Infrapatellar bursitis or clergyman’s knee
This is a traction apophysitis of the growth plate located at the tibial tubercle
Osgood schlatter disease
What age for boys and what age for girls for osgood schlatter and Sinding Larsen Johansson?
Girls: 8-13
Boys: 10-15
This is a traction apophysitis that occurs at the patellar growth plate. Pain at the inferior pole of the patella
Sinding Larson Johansson
What are tx for SLJ and OSD
More frequent with sport specialization, warm up phenomenon. In the acute phase; rest and off loading. Then address motor control, strength, flexibility deficits
What test helps dx patellar instability?
Patellar apprehension test: patella pushed laterally, looking for apprehension, quad contraction, pain, normal glide is 25-50% of the patella
What is the tx for patellar instability?
Bracing and PT unless loose body or trochlea dysplasia
This is dx with pain at the inferior pole of the patella or along the length of the patellar tendon that is provoked with activities that activate the extensor mechanism.
Patella tendinopathy or jumpers knee
What are three differences between patellar tendinitis and PFP
- Location
- Pain at rest? None with Patellar tendinitis
- Gender: males more common with patellar tendinitis
What are the four tx stages to patella tendinopathy?
- Analgesic techniques
- Pain monitoring
- Progressive tendon loading
- The rest of the tx
How is isometric loading prescribed for patellar tendinopathy?
Midrange hold 5x45 seconds
Pain is allowed to reach _/10 but should not _ from week to week
5
Increase
How do you progress patellar tendinopathy patient?
Start with isometrics, then do isometrics on first day then isotonics every 2nd day starting with 4x15 then increasing weight to 4x6, then progress to every third day adding polymeric then progressing to sport specific training with isometrics on off days
What should you do differently with quad tendinopathy tx?
Avoid loading in deep squat at first then load in deep squat and varying degrees of hip extension
What is the ACR criteria for knee OA?
Pain in the knee then 3 of the following
1. Age over 50
2. Less than 30 min of morning stiffness
3. Crepitus on AROM
4. Bony tenderness
5. Bony enlargement
6. No palpable warmth of the synovium
What are the 5 kellgren Lawrence classifications?
Grade 0 no changes on x ray
Grade 1: little joint space change osteophytic lipping
Grade 2: definite osteocytes possible joint space narrowing
Grade 3: multiple osteophytes definite joint space narrowing, possible sclerosis
Grade IV: large osteophytes, marked joint space narrowing, severe sclerosis and bone deformity
Yes/no lateral heel wedge for knee OA
No
Y/N: Valgus brace for medial joint OA
Yes
