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SPC- MSK > Knee Problems > Flashcards

Knee Problems Flashcards

1
Q

What is patellofemoral pain syndrome associated with?

A

Overuse- it is therefore common in young athletes

Also associated with malalignment, muscle imbalance and patella tracking abnormalities

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2
Q

Where is pain felt in patellofemoral pain syndrome?

A

Anteriorly in the knee

Tenderness on compression of the patella

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3
Q

What is important to ask about in the history for any knee problems?

A

Recent trauma

Previous trauma or dislocations

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4
Q

What are some signs of patellofemoral pain syndrome?

A

Pain on compression of the patella

Tenderness around the patella

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5
Q

What does a positive Clarke’s test show? How is it done?

A

Positive result is pain on compression on the patella with a tensed quadriceps

Sign of patellofemoral pain syndrome

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6
Q

What is the management for patellofemoral pain syndrome?

A

Rest
NSAIDs for pain relief
Quadriceps and hip strengthening exercises

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7
Q

What is a bipartite patella?

A

This is a congenital abnormality where the patella has two parts

Often asymptomatic but can cause pain and discomfort if there are any tracking abnormalities

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8
Q

What is the lay name for patella tendinopathy?

A

Jumper’s knee

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9
Q

What might you find on examination if a patient has patella tendinopathy?

A

Tenderness around the insertion point of the quadriceps

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10
Q

What is the management for patellar tendinopathy?

A

Rest
NSAIDs
Steroid injections may help- this is into the space around the tendon not into the tendon itself- injecting steroids into a tendon causes it to become floppy and unstable

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11
Q

Where is hoffa’s fat pad?

A

This is the infrapatellar fat pad

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12
Q

What is the symptom of hoffa’s fat pad syndrome?

A

Pain on extension of the knee
Worse if pressure is put on the patella tendon margins

Hoffa’s fat pad is the infrapatellar fat pad that tracks underneath the patella and becomes impinged when the knee is fully extended

Note- symptoms could suggest a ligament or meniscus injury but the MRI shows no abnormalities of the ligaments or menisci. May show hypertrophic fat pad.

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13
Q

What is osgood schlatter disease?

A

Repeated traction causes inflammation and avulsion of the secondary ossification centre at the tibial tuberosity

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14
Q

What are the symptoms of osgood schlatter disease?

A

Tenderness and pain at the tibial tuberosity
Pain on strenuous activity and quadriceps contraction
Enlarged and prominent tibial tuberosity

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15
Q

What is the management for Osgood Schlatter disease?

A

Limit strenuous activity
Majority of cases are self limiting
Physiotherapy
NSAIDs and ice compression

Rarely surgical excision if failure to resolve

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16
Q

What age group is commonly affected by Osgood-schlatter disease?

A

10-15 year olds

Due to traction and avulsion of the secondary ossification centre of the tibial tuberosity

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17
Q

What is bursitis?

A

Inflammation of the bursa- these are synovial fluid filled sacs around joints which provide cushioning and limit friction

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18
Q

What is a Baker’s cyst?

A

This is also called a popliteal cyst

It is a herniation of the bursa out of the joint into the popliteal space which causes discomfort

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19
Q

What is clergyman’s knee?

A

This is inflammation of the infrapatellar bursa which causes pain, tenderness and erythema beneath the patella

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20
Q

What bursa is affected in housemaids knee?

A

The pre-patella bursa

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21
Q

What are the symptoms of prepatellar bursitis? What must you rule out given the symptoms?

A

Pain and tenderness anterior to the knee
Swelling
Erythema

(anterior knee pain)

ALWAYS ASK COULD THIS BE A SEPTIC JOINT

22
Q

What is thought to cause prepatellar bursitis?

A

Inflammation of the bursa often secondary to trauma or overuse with prolonged pressure on the knee caps- this is why it is called housemaids knee.

23
Q

What are some risk factors for osteoarthritis developing in the knees?

A 
Increased BMI
Female gender
Repeated trauma
Increasing age
Occupation 
Genetic factors
24
Q

What is meant by primary or secondary bursitis?

A

Primary is degeneration that is not secondary to something else.

Secondary- secondary to another cause such as trauma, operation, post infective, malalignment or mechanical instability

25
Q

Why might you want to aspirate an inflamed bursa?

A

Rule out infective causes- send for MC and S

Gout and Pseudogout- Polar light microscopy

26
Q

What are some symptoms of OA in the knee?

A

Stiffness that usually resolves within 30 minutes
Decreased range of movement
Joint pain and tenderness
Crepitations

27
Q

What changes are seen in OA of the hand?

A

Heberden’s Nodes- DIP

Bouchard’s Nodes- PIP

28
Q

What X-ray changes are seen in OA?

A

Loss of joint space
Osteophyte formation
Subarticular sclerosis
Subchondral cysts

29
Q

Give a management plan for a patient with OA of the knee?

A

Conservative- Weight loss, keep the joint moving, exercise, swimming is a good option, muscle strengthening, physio can help with muscle strengthening and instability

Medical-
1st Paracetamol +/- Topical NSAID (only for knee and hand)
2nd Oral NSAID (+PPI) / Weak opioids/ Steroid injections

Failure of conservative methods- severe prolonged pain with significant impacts on QoL then consider joint replacement.

30
Q

What is the most common cause of a swelling in the popliteal fossa?

A

Baker’s cyst

This is a herniation of the synovial membrane which lines the knee joint

31
Q

What symptoms might a Baker’s cyst cause?

A

Can be asymptomatic
May cause pain, swelling
If it ruptures can cause pain and swelling around the calf

32
Q

How can you differentiate between a baker’s cyst and a popliteal aneurysm?

A

One will be pulsatile

33
Q

If someone has a Baker’s cysts what is it important to rule out? How might this be done?

A

DVT

USS Doppler- If not possible within four hours and DVT suspected give LMWH

(A knee MRI would also show the outpouchings)

34
Q

How might you manage a baker’s cyst?

A

Nothing if asymptomatic

Symptomatic
Analgesia- WHO Pain ladder start with paracetamol and NSAIDs
Aspirate

35
Q

What investigation must be done to investigate for fracture?

A

Plain radiograph

36
Q

What features are seen with a meniscal injury?

A

Joint line tenderness

Locking of the knee

37
Q

What is the investigation for a suspected meniscal injury?

A

Knee MRI

Arthroscopy may be considered

38
Q

What is the management for a meniscal injury?

A

Conservative if small tears- Analgesia according to WHO

If persistent or locked then surgery

39
Q

Why is an acutely locked knee in need of urgent orthopaedic referral?

A

An acutely locked knee leads to compression of the cartilage which rapidly causes ischaemia and irreversible damage to the cartilage

A knee that occasionally locks is not prone to the same issues and flow can return when locking relieves.

40
Q

When does a locked knee require urgent referral?

A

When it is acutely locked and is not unlocking- due to ischaemia to the cartilage as the cartilage is compressed in a locked joint.

41
Q

What are the signs of an ACL tear?

A

Hemarthrosis
Effusion within hours
+Ve Draw test and Lachman’s

42
Q

What typically causes an ACL injury?

A

Twisted on the knee with a fixed foot

43
Q

Which of the cruciate ligaments is most commonly injured?

A

ACL

PCL is much stronger

44
Q

When doe PCL injuries often happen?

A

Car crashes as the knee strikes the dashboard

45
Q

What are the signs of a collateral ligament injury?

A

Tenderness over the relevant collateral
Pain on valgus and varus stress testing
Pain on extension of the knee as this engages the collaterals

46
Q

Why is pain felt on extension of the knee when there is a collateral ligament injury?

A

Extension of the knee engages the collaterals resulting in the pain

47
Q

What movements cause pain in the knee when there is a collateral ligament injury?

A

Valgus and varus stress tests

Extension of the knee- engages the collateral ligaments

48
Q

What is the management for a ligament injury of the knee?

A

Rest and usually heals within 6-8 weeks

Injury to the lateral collateral ligament is often more extensive and more likely to require surgery

49
Q

How long do ligaments typically take to heal?

A

6-8 weeks

50
Q

Which of the collateral ligaments is most often injured?

A

The medial collateral ligament

51
Q

What should always be done before relocating a dislocated joint?

A

Plain radiograph to rule out fracture

And this covers against litigation

SPC- MSK (18 decks)

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