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MSK2 > knee presentations > Flashcards

knee presentations Flashcards

1
Q

Patellar fx epidemiology

A

1% of all fxs
most common 20-50 yo
Males 2x>F
>50% non-displaced

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2
Q

Patellar fx hx

A

MOI: fall on A. knee
sudden quad activation

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3
Q

Patellar fx sxs

A

pain/inability to extend knee
A. knee pain

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4
Q

Patellar fx exam

A

-palpable gap at fx site (may or not)
-local tenderness
-painful RT> AROM for ext
-painful end range flex ROM
-antalgic gait

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5
Q

Pittsburgh knee decision rule

A
  1. hx blunt trauma/fall
  2. inability to WB x4 steps immediately and in ED
  3. age <12 y/o OR >50
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6
Q

Ottawa knee decision rule

A

TTP head of fibula
inability to WB x4 steps immediately or in ED
Age >/= 55
inability to flex knee 90
isolated TTP patella

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7
Q

Tendon rupture: patellar and quad epidemiology

A

patellar: <40 yo commonly
quad: >40 yo commonly
quad: M 4-8x>F

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8
Q

Patellar and quad tendon rupture rfs

A

-local steroid injection
-prolonged corticosteroid use
-RA
-lupus
-connective tissue diseases
-infectious diseases
-arteriosclerosis
-DM
-hyperthyroidism

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9
Q

Patellar and quad tendon rupture hx

A

-eccentric overload extensor mechanism/trauma
-sudden onset from fall, hemarthrosis common
—-quad: related to regaining balance/rapid quad contraction
—-patellar: jump landing common
-hx degen. tendinopathy
-hx TKA
-ACL reconstruction (patellar tendon graft)

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10
Q

Patellar and quad tendon rupture sxs

A

anterior knee pain

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11
Q

Tendon rupture exam

A

-absent active knee ext OR painful active knee ext (complete/ partial)
-painful knee flexion ROM
-palpable defect
-antalgic gait OR unable to ambulate

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12
Q

Osgood Schlatter disease

A

apophysitis of tibial tubercle
M>F
ages: M: 10-15, F: 8-13
repetitive loading of knee into flexion
radiology: calcification of tibial tubercle

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13
Q

Osgood Schlatter hx

A

adolescent athlete
common bilaterally

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14
Q

Osgood Schlatter sxs

A

anterior knee pain
aggravated w/ activity/ resisted knee ext

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15
Q

Osgood Schlatter exam

A

-local TTP
-prominent tibial tubercle observed visually
-pain end-range knee flex ROM
-painful RT w/ knee ext>AROM
-possibly pain w/ tuning fork

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16
Q

Articular cartilage deficits

A

lesion prevalence: 60-70%
32-58% non-contact trauma MOI

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17
Q

Articular cartilage healing

A

Loss of proteoglycans: matrix reaches loss that is irreversible (matrix cannot replenish)
Mechanical: blunt trauma, penetrating injury, friction abrasion, sharp concentration of joint forces
-Healing depends on extent: chondral, chondral/subchondral, subchondral, cystic

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18
Q

Articular cartilage healing: Chondral vs subchondral

A

Chondral: limited response bc no inflammatory response
Subchondral: extends to blood supply, fills in w/ fibrocartilage, fibrin clot at 48hrs, 2 months kinda looks like normal cartilage, erosive changes at 6 months

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19
Q

Osteochondritis Dissecans

A

-articular cartilage defect
-separation of cartilage from subchondral bone
-juveniles

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20
Q

Osteochondritis dissecans rfs

A

lateral aspect of medial condyle most common
-M>W
greatest 10-20 yo
active individuals
commonly bilat

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21
Q

Osteochondritis dissecans hx

A

-traumatic MOI vs insidious
-hemarthrosis w/in 2 hrs

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22
Q

Osteochondritis dissecans sxs

A

non-specific knee pain
aggravated w/ activity, improves w/ rest
stiff/swell with activities
grinding, locking, catching

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23
Q

Osteochondritis dissecans exam

A

TTP femoral condyle/ medial or lateral joint lines
antalgic gait
knee effusion
limited/ painful knee ROM

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24
Q

Articular cartilage defects -surgery interventions

A

-arthroscopic lavage and debride
-microfracture
-autologous osteochondral mosaicplasty grafting
-ACI (implant)
-OAT procedure (autograft transfer)
-Allograft transplantation
-post op mx

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25
Q

Meniscus lesion epidemiology

A

-incidence
-concomitant ACL injury common

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26
Q

Meniscus lesion hx

A

-contact vs noncontact injury vs degenerative
-audible pop in directional change
-delayed effusion (6-24 hrs following injury)

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27
Q

meniscus lesion sx

A

catching/ locking/ giving way
local knee pain

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28
Q

meniscus lesion exam

A

-pain at end range knee EXT
-pain/limited flex ROM
-pain/weak flex and ext RT
-joint line tenderness
+McMurray’s, Thessaly, Appley’s, dynamic test (lateral meniscus)
Varus or valgus test (not for meniscus but may be +)

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29
Q

Tissue healing: Ligament

A

1st degree: minor tear of fibers
2nd: partial tear of structure
3rd: complete rupture

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30
Q

Ligament heal P1

A

acute inflammation and reaction (3 days) hematoma formation

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31
Q

Ligament P2

A

repair and regeneration (2-3 days post injury to ~6 wks)
fibroblasts produce collagen
matrix disorganized

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32
Q

Ligament P3

A

remodeling and maturation (>=12mnths post injury)
collagen fibers more parallel
increase tissue concentration and tensile strength

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33
Q

Ligament healing requirements

A

-disrupted tissue must remain in continuity
-controlled forces necessary to facilitate collagen synthesis
-protection from harmful stresses on tissues

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34
Q

ACL lesion epidemiology

A

VERY common
knee OA incidence high following ACL injury
increase risk for injury to other stabilizers of knee

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35
Q

ACL lesion correlations

A

-Females 2-9x>M
(jump landing mechanics, Q angle, narrower intercondylar notch, hormones and laxity)
-decreased hamstring or core strength
-duration of activity/fatigue
-dry/artificial turf
-high BMI

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36
Q

ACL lesion hx

A

-non contact injury (more likely)
pivoting w. planted foot and ext knee
deceleration and direction change/ cutting
jump landing in full knee ext
hyperext or hyperflex of knee
-contact injury
varus or valgus force to knee that imposes shear force on joint

36
Q

ACL lesion sxs

A

-feeling of instability in knee
-c/o severe pain at time of injury
-audible pop w/ injury
-report of immediate swelling immediately (effusion)

37
Q

ACL lesion exam

A

-weigh shifted posture when standing
-knee joint effusion
-antalgic gait
-AROM and PROM painful/limited all planes
-boggy/guarded end feel
-resisted testing weak and painful all planes
-excessive laxity w/ KT-1000 test
+pivot shift. anterior drawer, Lachman’s

38
Q

PCL sprain epidemiology and hx

A

3-20% of knee injuries (not as common)

-audible pop
-MOI: posterior force at prox anterior tib
violent hyperext
fall on flexed knee w/ PF

39
Q

PCL sprain sxs

A

local posterior knee pain aggravated w/ deceleration and kneeling
feelings of LE giving way/ instability

40
Q

PCL sprain exam

A

gait: limited knee ext in stance
effusion
+posterior drawer
limited/painful knee ext and flex ROM
pain w/ RT of ext >90

41
Q

MCL sprain epi

A

pretty common
correlation w/ soccer, football, hockey

high grade injuries may lead to chronic knee instability
common concomitant knee injuries

42
Q

MCL sparin hx

A

MOI: valgus force, rotary trauma, younger>older, M 2x>F

43
Q

MCL sprain sxs

A

medial knee pain
aggravated w/ activity, change in direction w/ ambulation, valgus force ay knee

44
Q

MCL sprain exam

A

swell/bruise
antalgic gait
potential limited/painful knee ROM
local TTP
+valgus stress test

45
Q

LCL sprain hx

A

MOI: varus trauma at knee

46
Q

LCL sprain sxs

A

lateral knee pain
aggravated w. directional change in ambulation

47
Q

LCL sprain exam

A

local lateral knee effusion
TTP LCL
+varus stress test ay 0 and 30 knee flex
guarded/boggy end feel w/ end range ROM flex and ext

48
Q

Patellofemoral Instability predisposition

A

-structural: smaller patella, shallow groove (lateral tilt and lateral displacement toward ext (30)
-patella alta/baja
-quad muscle imbalance proposed (VMO/VL)
-generalized ligamentous laxity

49
Q

Patellofemoral instability concerns

A

concern w/ tracking patella and distribution of loading
subsequent dislocations common
concomitant osteochondral lesion common

50
Q

Patellofemoral instability hx

A

sublux/ dislocation of PTF joint

51
Q

PTTF instability sxs

A

giving way of LE
peri-patellar pain

52
Q

PTF instability exam

A

peripatellar tenderness
hypermobility
apprehension sign
ecchymosis/swelling/effusion in acute stage

recurrent instability= sx mx

53
Q

PFPS correlations

A

-common w/ active individuals and adolescents
-altered patellar tracking contributes to aberrant loading patterns of joint

-quad weak/ muscle imbalance
-lateral retinaculum tightness
-increased Q-angle
-hip weakness (ABD, ER)
-altered foot/ankle kinematics
-increased femoral angle of inclination
-increased femoral anteversion
-limited hip extensor endurance
-VMO weakness
-Hip ER and ABD weak
-subtalar pronation (IR tibia)

54
Q

PFPS hx

A

athletes
females
insidious

55
Q

Osteoarthropathy

A

Knee is most common
Commonly symptomatic, hx of knee injury, obese people
Radiography: joint space loss, osteophytes, sclerosis
-symp vs asymp: joint pain and func limitation

56
Q

PFPS sxs

A

-anterior/peri patellar knee pain
-aggravated w/ prolonged sitting, stairs, inclined walking, squatting
-knee crepitus
-catching at knee

57
Q

PFPS exam

A

-patella alta/baja
-abnorm Q-angle
-pain squat
-possible peri-patellar swelling
-antalgic gait
-pain/limited knee flex/ext AROM
-pain/limit knee flex PROM
-pain/weak knee ext
-hip ER and ABD weakness
-pain/ hyper vs hypomobility PF joint
-+clarke’s

58
Q

OA hx

A

-insidious
-hx trauma, sx
-family hx
-obesity
-knee hypermobility
-joint shape abnorm
-extreme physcial activity levels
->50 yo
-F>M

59
Q

OA sxs

A

retropatellar pain
aggravated w/b activities, squat, stairs, prolonged sitting
crepitus

60
Q

OA exam

A

-antalgic
-swelling/warm at knee
-TTP joint lines
-pain/limit knee ROM
-pain/limit knee RT
-maybe + Appley compression test

61
Q

Arthrofibrosis
what is it?

A

-dense proliferative intra and extra-articular scar tissue formation w/ limitations in knee ROM
-inflammation present
-can lead to degenerative joint changes

62
Q

Arthrofibrosis hx

A

traumatic injury/ sx
progressive increase in pain and knee ROM limits

63
Q

Arthrofibrosis sxs

A

stiffness (worse in morning)
knee swelling
crepitus
diffuse knee pain

64
Q

Arthrofibrosis exam

A

-limited knee ext in static stance or stance gait
-limit/pain knee ROM (PROM=firm end feel)
-hypomobile patellofemoral
-knee effusion/swelling
-inhibited/weak/pain knee ext

65
Q

Genu recurvatum
what is it?
epidemiology

A

hyperext of knee >10 degrees

F>M
correlated w/ joint laxity, hx knee injury, poor muscular control (CVA)
excess stress on posterior knee structures

66
Q

GR may predispose to

A

-ACL injury
-compressive injury anteriomedial tibiofemoral joint
-tensile loading posteriolateral joint supporters
-posterior corner capsulo-ligametous avulsion injuries

67
Q

GR hx

A

-forced knee ext injury
-jump landing in ext
-force to anteriomedial prox tibia
-noncontact hyperext w/ planted foot
-concomitant PCL injury

68
Q

GR sxs

A

c/o knee instability
anteriomedial knee pain or posteriolateral knee pain

69
Q

GR exam

A

-postural exam- visually see hyperext (tibial ER, genu varum/valgum, tibial varum, excess pronation) (impaired proprio)
-edema, ecchymosis
-TTP locally
-NV screen necessary
-antalgic
-hypermobility P. glide w/ posteriolateral bias

70
Q

Patellar Tendinopathy

A

Jumper’s knee
eccentric overload
microtrauma (failed healing response)
avg. 32 mnths pain/limitations
lot’s of athletes quit

71
Q

PT hx

A

BB and volleyball players

72
Q

PT sxs

A

anterior knee pain
aggravated w/ jumping/ extensor mechanism

73
Q

PT exam

A

TTP patellar tendon/ inferior pole of patella
pain squat
pain end range flex ROM
pain RT>AROM knee ext

74
Q

ITB friction syndrome

A

Knee: increased compression on soft tissues between lateral femoral condyle and ITB (~30 knee flex)

thickening of bursa
correlations: prominent femoral epicondyle, LLD

75
Q

ITB FS hx

A

long distance runners
downhill skiers, jumping sports, weight lifters, cycling
insidious/progressive

76
Q

ITBFS sxs

A

lateral knee pain
aggravated w/ activity/ repetitive knee flex/ ext and stairs

77
Q

ITBFS exam

A

local TTP (distal ITB, gerdy’s, lateral femoral condyle)
+Ober
Hip ROM painful end range ADD
Potentially painful hip ABD RT

78
Q

Baker’s Cyst

A

swelling at P. knee’
painful w/ synovial effusion
may rupture

79
Q

Baker’s cyst hx

A

Intra-articular effusion

80
Q

Baker’s cyst sxs

A

posterior knee pain

81
Q

Baker’s cyst exam

A

-local swelling prox to popliteal fossa
-pain knee flex/ext ROM
-prominence of cyst increases w/ resisted knee flex

82
Q

Bursitis: Knee

A

-superficial and deep infrapatellar (nun’s knee) (direct mechanical irritation)
-prepatellar (recurrent A. knee trauma)
-superficial Pes anserine (structures between MCL/pes)(swimmers/distance runners)

83
Q

Bursitis knee exam

A

Local TTP
local swelling

84
Q

Superficial Fibular Nerve (SFN) potential areas of compression

A

Trauma posteriolateral knee, compartment syndrome

85
Q

SFN motor distr

A

fibularis longus and brevis

86
Q

SFN sensory distr

A

distal 2/3 lateral leg/ankle/dorsal foot

87
Q

SFN clin indics

A

-hx direct trauma/ iatrogenic
-neurodynamic tension test, sensitized w/ supination

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