Knee Problems Flashcards
What is patellofemoral pain syndrome associated with?
Overuse- it is therefore common in young athletes
Also associated with malalignment, muscle imbalance and patella tracking abnormalities
Where is pain felt in patellofemoral pain syndrome?
Anteriorly in the knee
Tenderness on compression of the patella
What is important to ask about in the history for any knee problems?
Recent trauma
Previous trauma or dislocations
What are some signs of patellofemoral pain syndrome?
Pain on compression of the patella
Tenderness around the patella
What does a positive Clarke’s test show? How is it done?
Positive result is pain on compression on the patella with a tensed quadriceps
Sign of patellofemoral pain syndrome
What is the management for patellofemoral pain syndrome?
Rest
NSAIDs for pain relief
Quadriceps and hip strengthening exercises
What is a bipartite patella?
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
What is the lay name for patella tendinopathy?
Jumper’s knee
What might you find on examination if a patient has patella tendinopathy?
Tenderness around the insertion point of the quadriceps
What is the management for patellar tendinopathy?
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
Where is hoffa’s fat pad?
This is the infrapatellar fat pad
What is the symptom of hoffa’s fat pad syndrome?
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.
What is osgood schlatter disease?
Repeated traction causes inflammation and avulsion of the secondary ossification centre at the tibial tuberosity
What are the symptoms of osgood schlatter disease?
Tenderness and pain at the tibial tuberosity
Pain on strenuous activity and quadriceps contraction
Enlarged and prominent tibial tuberosity
What is the management for Osgood Schlatter disease?
Limit strenuous activity
Majority of cases are self limiting
Physiotherapy
NSAIDs and ice compression
Rarely surgical excision if failure to resolve
What age group is commonly affected by Osgood-schlatter disease?
10-15 year olds
Due to traction and avulsion of the secondary ossification centre of the tibial tuberosity
What is bursitis?
Inflammation of the bursa- these are synovial fluid filled sacs around joints which provide cushioning and limit friction
What is a Baker’s cyst?
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
What is clergyman’s knee?
This is inflammation of the infrapatellar bursa which causes pain, tenderness and erythema beneath the patella
What bursa is affected in housemaids knee?
The pre-patella bursa
What are the symptoms of prepatellar bursitis? What must you rule out given the symptoms?
Pain and tenderness anterior to the knee
Swelling
Erythema
(anterior knee pain)
ALWAYS ASK COULD THIS BE A SEPTIC JOINT
What is thought to cause prepatellar bursitis?
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.
What are some risk factors for osteoarthritis developing in the knees?
Increased BMI Female gender Repeated trauma Increasing age Occupation Genetic factors
What is meant by primary or secondary bursitis?
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
