Knee Pain Complaint Flashcards
The greater the tearing of the ligament in a sprain the greater the what?
Blood loss and subsequent bruising
What are sx of inflammation?
Pain and stiffness
What are signs of inflammation?
Warmth, redness, swelling, pain to touch and pain with motion
When taking the history on knee pain what should you look for when asking about what may have caused the pain?
Activity out of the ordinary like painting, cleaning or rearranging, traveling, playing with grandchildren, climbing ladders
Trauma such as falls, exercise/sports or MVAs
Injury related knee pain
Definitive onset
Generally mono-articular and unilateral
Non-injury related knee pain
Insidious or gradual
May be associated with constitutional sx, mono-articular or poly-articular, may be migratory
May change with activity and may have extra Articular signs
What to ask for mechanism of injury?
What was the direction of the force? What did your joint do? What did it feel like at the time?
Was there any immediate swelling? Bruising?
Could you still use the joint?
How does it feel now?
Describe what can be seen in a ligamentous disruption or fracture
Swelling is immediate or <2 hours
Unable to walk or bear weight
Describe what is seen during a sprain or meniscus injury
Swelling appears >2 hours
Able to stand, walk, bear weight within a few minutes
What is the sequence of assessing joint pain?
Gather history Point to the pain Mechanism of injury PE bilaterally (observation, palpation, ROM, extremity examination, special tests)
What should you asses when evaluating ROM?
Passive and active ROM
Watch the pt for signs of pain (grimaces or hesitancy to move the joint)
Watch the joint for signs of asymmetric movement
Document the directions tested and how they were tested
Describe internal/external rotation of the tibia
Knee flexed 90 degrees
Thumbs on each side of the tibial tuberosity grasping the calf
Induce internal/external rotation of the tibia on the femur
10 degrees in each direction
Compare bilaterally
Fibular head motion is not a true what?
AP motion
It is slightly anterior-lateral and posterior-medial
~30 degrees
What is unique about the fibula?
Unique motions
Only ligamentous attachments
The fibular head glides anteriorly with what?
Foot pronation and posteriorly with supination
What is crepitus?
A palpatory sensation of grinding during ROM
How do you assess neurologic function?
Muscle strength, DTR and dermatomes bilaterally
How do you assess for vascular function?
Pulse, capillary refill and edema bilaterally
What is Osgood-Schlatter syndrome?
Traumatically induced apophyseal injury to the tibial tubercle in adolescents
Most common between ages 8-15
Bilateral in 30% of cases
Typically during a growth spurt
Osgood-Schlatter syndrome commonly occurs with what?
Increase activities such as sports which causes micro trauma to the patellar ligament insertion onto the tibial tuberosity
Report of pain with climbing stairs or squatting
How is osgood-schlatter diagnosed?
Point tenderness over the tibial tubercle
All other ligaments and structural testing is negative
Radiography unnecessary
What are typical findings in OA pts?
Boney enlargement or deformity at the joint margins, genu varum deformity and stiffness lasting <30 mins
Crepitus is common
What are the risk factors for OA?
Increasing age
Trauma, obesity, anatomic factors (varus and valgus deformities)
What is OA?
Chronic inflammatory disease
Loss of articular cartilage
Osteophytes often appear at insertion site of tendons or ligaments
Soft tissue components react including thickening of joint capsule
What is knee bursitis (housemaid’s knee)?
Chronic micro trauma from repetitive activity or pressure
Presents with local swelling, tenderness, erythema and warmth
Pain with AROM or compression (pre-patellar bursa)
Must eliminate infectious etiology (systemic disease processes)
What can be seen on PE for knee bursitis?
Redness (erythema) and swelling at site of bursa
Tenderness and warmth
Remaining exam: ligaments intact
How can pre-patellar bursitis be evaluated?
Aspiration of the bursa for cell count, C&2 and assess for crystals
What is patellofemoral pain syndrome (chondromalacia patella)?
Diffuse, aching, anterior knee pain
Can be unilateral or bilateral
Aggravated by climbing stairs, ascending hills, squatting or sitting for prolonged period of time (theater sign)
What is seen on the PE for patellofemoral pain syndrome?
Joint symmetry, rarely with effusion
Address patella position within femoral groove as well as tracking with active ROM
Crepitus under the patella with AROM and PROM
+Patellar grind test
Quadriceps weakness may be identified
What is IT band syndrome?
Pain over the lateral aspect of the knee (above the joint line)
May occur with increase in activity
What is seen on the PE for IT band syndrome?
Appear symmetric No warmth or erythema Pain with palpation over the lateral femoral condyle Normal ligamentous testing Positive OBER’s test on effected side Assess fibular head for dysfunction
What is patellar subluxation?
Dislocation which is a complete lack of contact between two articular surfaces
How is the ACL injured?
By sudden rotation or hyperextension injury or direct hit
Positive anterior drawer and Lachman
What is the etiology of ACL injury?
Contact injury: fixed lower leg with direct blow causing hyperextension or valgus deformation (less common)
Non-contact injury: sudden deceleration with change in direction (more common)
What is the classic presentation of ACL injury?
Sudden onset severe knee pain with large effusion developing within 2 hours typically from hemarthrosis
Pt can report popping sensation or knee instability
Can have associated injuries to other parts of the knee
What is the etiology of meniscal injuries?
Acute meniscal tear: results from sudden change of direction in which the knee is twisted or rotated while the corresponding foot is planted
Chronic: often from degenerative changes seen in older pts with minimal twisting injury history
What is the classical presentation for meniscal injuries?
Slow onset knee pain with swelling or effusion developing over the next 24 hours
Pts with untreated tears for weeks can report locking or catching of knee during extension
What is the unhappy triad?
Injury of the ACL, MCL and medial meniscus
Foot planted, valgus deformity, rapid deceleration injury and rotation
How are meniscal injuries diagnosed?
Often can be made clinically based on history and exam
Medial or lateral joint line tenderness
Positive McMurray’s test
Knee MRI can confirm diagnosis
Acute vs chronic meniscal injury
Generally hear a pop or snap at the time of the injury (acute»_space; chronic)
Deep knee bending is painful or squatting
Joint may pop or lock
Often a loss of full extension
Joint line tenderness on affected side
Joint effusion present with acute > chronic
Positive tests of meniscal injuries
Abnormal gait with decreased stance phase and knee extension on the symptomatic side Bounce home Joint line tenderness on affected side McMurray test Apley Grind
