Knee pathology Flashcards
Bone - Osgood slatters disease apophysitis
- Interview 4
+ Examination 2
- Age – Childhood
- Sporty children who complain of pain after sport.
- Develop a characteristic lump over tibial tuberosity
- Localised Pain and swelling
+ Observation and Palpation
+ Pain on isometric Quads
Osteoarthritis
- Interview 7
+ Examination 3
- Gradual onset (may have trauma)
- > 45-years or over
- Joint pain related to activity and weightbearing
- Mild swelling
- Crepitus
- Early morning stiffness (EMS) or morning stiffness that lasts no longer than 30-minutes
- Exclusion of other diagnosis
including gout, RA, septic arthritis and malignancy.
+ Passive motion – Non-contractile structures
+ Observation – mild effusion, joint deformity (later stages)
+ Active range.
Rheumatoid arthritis
- Interview 4
+ Examination 3
- Early morning stiffness (EMS) for longer than 30minutes.
- Swelling and heat
- General health: may have malaise (feeling unwell), fatigue and low grade fever as systemic.
- Extra-articular- rheumatoid nodules, vasculitis, pulmonary fibrosis, carditis, ocular disease
+ Palpation – swelling and temperature
+ Measure swelling
+ Passive range of motion – non-contractile structures.
Prepatella bursitis
- Interview 1
+ Examination 2
”Housemaids knee” carpet layers, gardeners, roofers and plumbers.
+ Palpation- local tenderness,
+ Bursae- swelling +/- heat.
Infrapatella bursitis
- Interview 1
+ Examination 3
- (superficial and deep) – “jumpers knee” repetitive strain and irritation to patella tendon often due to jumping activities.
+Isometric Quads – reproducing pain.
+ Palpation- local tenderness,
+ Bursae- swelling +/- heat.
Pes anserine bursitis
- Interview 1
+ Examination 4
- sports that require repetitive use of S, G and ST e.g. running, cycling, breaststroke swimming and sports that require change of direction.
+ Observation – wide Q angle, knee valgus
Functional task – single leg squat, step up noting excessive valgus strain
+ Pain on repetitive active knee flexion and extension
+ Palpation- local tenderness,
+ Bursae- swelling +/- heat.
Suprapatellar bursitis
- Interview 1
+ Examination 1
- Blunt trauma e.g. fall onto knee and repetitive overuse e.g. running.
+ Palpation- local tenderness,
+ Bursae- swelling +/- heat.
Plica Syndrome - Fold of synovial membrane: Plica (50% people) Irritation = Plica syndrome
- Interview 1
+ Examination 1
- blunt trauma or repetitive bending and straightening
+ Pain on repetitive active knee flexion and extension
Muscle injuries and tendonitis
- Interview 3
+ Examination 3
- Strains – Hamstring, Gastrocnemius, Quadriceps
- Tendonitis- Patella tendonitis
- Mechanism of injury – sudden (strain) versus gradual onset (tendonitis).
+ Muscle testing – contractile tissue
+ Palpation – show me where you pain is?
+ Pain on passive movement in opposite direction.
Ligament injuries
- Interview 7
+ Examination 11
Mechanism of injury
- Valgus – MCL
- Valgus – LCL
- Direct blow to anterior tibia – PCL
- ACL Majority non-contact- knee externally rotated (10-30 degrees) then goes into varus and internal rotation e.g. in side-stepping or cutting movements.
- Immediate swelling
- Reduced movement especially inability to fully extend
- Giving way on twisting movements
Can occur in combination with meniscal injuries
Special tests
+ Varus and Valgus strain (MCL/LCL)
+ Lachmans and anterior draw (ACL)
+ Posterior draw and Posterior sag sign (PCL).
Accessory movements
+ Anterior-posterior translation (AP/ PA)
+ Varus and Valgus
Palpation
meniscus acute and degenerative
- Interview 2, Acute-5, degen- 3
+ Examination 4
- Age
- Mechanism: Rotational Forces in a flexed knee
Acute tear
1) Non-contact: sudden twisting
2) Contact- Foot planted, Varus force on flexed knee with femur ext rotated- lat. Meniscus. Valgus force, femur int. rotated, medial meniscus
- Localised pain on joint line
- Localised swelling
- Locking
Degenerative Meniscus- gradual onset
* Pain difficult to pin-point.
* Recurrent swelling
Special tests
+McMurry’s
+Apley’s
+Thessaly test
+Palpation- joint line
Active internal and external rotation
Blood supply
- Deep Vein Thrombosis - calf and popliteal vein
- Peripheral Artery Disease
- interview-3
+exam 4
- Swelling
- Past Medical History of smoking, diabetes, obesity, high blood pressure.
- Leg pain (cramping) when walking (claudication) relieved with rest.
+Observation- discolouration, swelling, shiny skin, sores that won’t heel.
+Palpation:
+Temperature difference
+Loss of pulses – Posterior Tibial (between medial malleolus and TA), Dorsalis Pedis (lat to EHL distal to navicular)
