Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Managing Clinical Cases MSK > Lecture 2 - The Knee > Flashcards

Lecture 2 - The Knee Flashcards

1
Q

What are the two articulations in the knee joint?

A

Patello-femoral joint - articulation between the posterior surface of the patella (sesamoid bone) and the trochlear surface of the femur

Tibiofemoral joint - articulation between the condyles of the femur and the tibial plateau forming a modified synovial hinge joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the intra-articular components of the knee (excluding bones) and identify which are extra-synovial

A

PCL
ACL - extra-synovial
Menisci
Fat pads - extra-synovial
Suprapatellar bursa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Identify 5 reasons why glutes are important to knee pathology

A
  • Reduce iliotibial band loading and irritation which causes lateral knee pain
  • Reduces force on knee joint
  • Stabilises pelvis to maintain proper leg and knee alignment
  • Stability in the hip preventing lateral tracking of kneecap
  • Prevents knee from entering too much of a valgus position when squatting, running or landing from a jump
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the three muscles that insert into the pes anserine?

A

Gracilis
Semitendinosus
Sartorious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the general properties of a synovial effusion in the knee

A

Onsets over 3-6 hours
Slight to moderate tension
Smaller volume therefore often missed
Occurs in slight to moderate injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the general properties for a haemarthrosis

A

Onset is immediate
High tension
Large in volume and obvious
Occurs in significant and severe injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the milk test and explain as you go along?

A

Milk test - finger and thumb on distal hand come up onto joint line and gently milk the suprapatella bursa

The suprapatella bursa is intra-capsular and therefore swelling in the knee joint moves into the bursa

If the finger and thumb separate on the distal hand this indicates an effusion as the swelling separates your fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the patella tap test

A

Pressure on proximal side of the knee squeezes fluid under the patella

Tap patella down, if it drops and clicks onto the femur this is positive as it indicates that the patella is moving through the fluid to hit the femur, if it doesn’t move that’s because the patellar was already on the femur and therefore swelling isn’t indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can you treat a knee effusion

A

Medication (refer to GP)
Gentle closed chain exercises that mobilise the knee i.e. cycling
RICE
Potential aspiration if severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you clear the hip and why should you do so (name specific conditions)

A

You should clear the hip to eliminate hip conditions that refer pain to the knee. This includes conditions such as osteoarthritis, ITB syndrome, nerve compression, tight hip muscles and tendonitis

  • AROM at the hip - Hip pathology indicated depends on results i.e. tight hip flexors can impact knee
  • PROM at the hip - look for capsular pattern, if articular capsule of hip is indicated there will be limited internal rotation, flexion and abduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why do tight hip flexors cause knee pains?

A

Tight hip flexors pull the pelvic bone into anterior tilt reducing movement of the femur

The reduced movement of the femur leads to internal rotation at the knees, this causes tendons, ligaments and muscles to tighten to protect the knee leading to pain and increase likelihood of injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What specific movement indicates an arthritic knee?

A

Lack of passive hyper extension following passive flexion and extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the first thing you would do if you suspected an ACL or PCL injury and why?

A

These are intracapsular ligaments and therefore injury can cause an effusion so during assessment, effusion testing must be performed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What might you feel on palpation of someone with an affected ACL? Is it a relevant or effective palpation?

A

Tenderness, however it is not a consistent or effective marker for picking up ACL injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you perform the anterior draw test for an ACL injury and what should you do first?

A

First - test the integrity of the PCL using the posterior drawer test as laxity picked up in the ACL test could actually be due to initial sagging of the tibia due to an injured PCL

  • Flex patient’s knee to 90 degrees and sit on their foot
  • Place hands round the proximal portion of the leg with thumbs in the joint line
  • Draw the tibia forward

Positive = marked laxity and/or pain compared to the other side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is the anterior drawer test not effective in a lot of ACL tears?

A

The anterior drawer test only tests the antero-medial band of the ACL therefore only picking up 15-20% of all ACL tears as the majority of the ligament is made up of the postero-lateral band.

So a complete tear will be picked up but incomplete tears will not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How would you perform a modified anterior drawer test to test for an MCL rupture alongside an ACL rupture?

A
  • Externally rotate the knee to tighten the medial ligament
  • If the anterior drawer was previously lax, this should be eradicated when the test is repeated in this position
  • If it is not eradicated, this could indicate an issue with the MCL no longer acting as a secondary restraint
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you perform the Lachmann’s test and what do you have to do first?

A

Test the PCL first - posterior sagging of the tibia can lead to a false positive in ACL tests

  • Have the patient in supine and have your knee or a towel under the patient’s knee to bring it to 20-30 degrees flexion
  • Place your proximal hand on the distal femur and your distal hand behind the proximal tibia with fingers in the joint line
  • Have your thumb on the tibial tuberosity and then perform an anterior draw
  • A positive is if there is a squishy end feel and/or laxity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you perform the pivot shift test and what does it do?

A

Patient in supine

Bring knee into full extension, apply internal rotation at the foot and apply a valgus force at the knee (if ACL is torn the tibia will sublux forward on the femur)

Gently flex to around 30 degrees

Positive = hearing or feeling a clunk which is the lateral tibial plateau reducing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How would you treat an ACL tear in the acute phase?

A

Treat effusion and/or haemarthrosis if relevant
NSAIDs and painkillers
RICE
Refer for an MRI which is the gold standard imaging for a suspected ACL tear
Refer for an x-ray to eliminate a fracture
Arthroscopy is an alternative to an MRI but is more invasive and expensive (however arthroscopy can be used for treatment as well and sometimes MRIs don’t pick up on partial or chronic tears)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does the ACL do?

A

Prevents anterior tibial translation on the femur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the common movement causes of an ACL tear?

A

Pivoting with your foot firmly planted
Experiencing a strong valgus force i.e. during a football tackle from the lateral side
Overextension of the knee due to a sudden directional or speed change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What symptoms will patients with an ACL tear likely report

A

Experiencing a sudden and severely painful ‘pop’ in the knee during injury

Giving way during twisting or rising

Persistent deep aching pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some methods of treatment for non-acute ACL injuries

A

Surgery followed by post-surgical rehab
Non-surgical rehab
Local measures to decrease inflammation i.e. NSAIDs
Splinting/taping - minimal evidence to indicate it’s effectiveness in improving long term patient outcomes but can reduce rate of subsequent re-injury due to sensory feedback from the splinting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are key aims during the 1st week of post-surgery for an ACL tear?

A

Reduce swelling
Walk without crutches
Prevent deep vein thrombosis through foot and ankle exercises
Mobilise kneecap
Isometric contraction of quads and hamstrings with knee bent over a pillow/towel (no open chain quad movements)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are key aims during weeks 2-6 of post-surgery for an ACL tear?

A

Increasing knee flexion range to 130
Mobilising scar by mobilising the kneecap
Proprioception work
Strengthening of quads and hamstrings (no open chain quad movements, don’t do resisted hamstring work if a hamstring graft has been used)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are key aims during weeks 6-12 of post-surgery for an ACL tear?

A

Achieve full range of movement in the knee
Progress strengthening quads and hamstrings (no open chain quad movements)
Avoid varus and valgus strains
Propioception work
General fitness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are key aims during week 12 - 5 months of post-surgery for an ACL tear?

A

Introduce open-chain quad exercises
Work on strength and confidence by incorporating non-contact sport specific exercises
Increased proprioception and balance exercises

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are key aims from 5 months onward of post-surgery for an ACL tear and what are the conditions for returning to sport

A

Perform sport-specific exercises

Begin a return to sport after the following conditions are met:
Laxity in ligaments
Fully cardiovascularly fit
No swelling
Full strength in quads, hamstrings and calves Equal balance between the two legs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What occurs between 0-2 weeks on a non-surgical rehab pathway for an acl tear?

A
  • Aiming to restore full extension and re-gain quad control gradually working on flexion
  • Knee should be kept straight and elevated when sitting or laying and locked into extension in a brace when standing and walking (crutches should be used)
  • Brace is unlocked and removed at advice of the doctor and occurs 6 weeks or later when adequate quad control is achieved
  • Pain or activities that result in locking or giving way should be avoided
  • RICE, ankle pumps and patellar mobilisations
  • Seated assisted knee flexions
  • Gastroc and soleus stretches, hamstring stretches in supine
  • Calf and quad strengthening (gentle, no open chain, no pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What occurs between 2-6 weeks on a non-surgical rehab pathway for an acl tear?

A
  • Improve ROM for flexion
  • Stretch muscle groups
  • Strengthen of muscle groups
  • Proprioception
  • Restoring normal gait
  • Eliminating instability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What occurs between 6-8 weeks on a non-surgical rehab pathway for an acl tear?

A
  • Progressive strengthening
  • Maintain ROM
  • Advanced proprioceptive exercise
  • Running
  • Lateral shuffle and cone drills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What occurs between 8 - 12 weeks and onward on a non-surgical rehab pathway for an acl tear?

A
  • Progressive strengthening
  • Safe return to work or sports
  • Quadriceps and hamstring strength should be nearly equal
  • Patient education re sports bracing, healthy BMI and activity modification
  • Stretch regularly
  • Control pain and swelling
  • Equal balance and single leg hop tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What symptoms do people with a PCL tear complain of and why do they get pain in any mentioned positions?

A

Instability
Pain going downstairs
Pain crouching down and removing shoes
Pain = due to tibia posteriorly translating in these positions and therefore being afforded more rotation causing pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Why does quad weakness increase risk of a PCL injury:

A

Quads are the first resistance to anterior translation of the femur i.e. when walking down a hill
If quads are weak, more strain is put on the PCL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What movements cause PCL injuries?

A

When you are going forward and then your foot isn’t:
- Going down a hill and your foot gets stuck
- Direct force to tibia in opposite direction to your forward motion i.e. low rugby tackle

37
Q

How would you treat a PCL injury in the acute stage?

A
  • RICE
  • NSAIDs/pain relief
  • Reduce/treat effusion and/or haemarthrosis if applicable
  • Surgery for severe tears (arthroscopy)
  • Braces and crutches to assist with stability until quadricep strength is regained
  • Gold standard imaging = MRI
38
Q

What occurs in phase 1 (0-4 weeks) of rehab for a PCL injury

A
  • PWB and WBAT on crutches
  • Brace overnight fixed in extension to protect the ligament
  • Quadricep activation
  • Gastroc and hamstring stretching
  • Aim to restore some ROM
  • Patellar mobilisation
  • Hamstring contraction avoided to avoid posterior tibial translation
  • Can have NMES if unable to achieve quadricep stimulation
39
Q

What occurs in phase 2 (4-8 weeks) of rehab for a PCL injury

A
  • Achieve full ROM
  • Glutes activated
  • Weaned off crutches
  • Proprioception and balance progression
  • Patellar mobilisations
  • Still avoid hamstring contractions
40
Q

What occurs in phase 3 (8-12 weeks) of rehab for a PCL injury

A
  • Maintain range
  • Advanced proprioception and balance
  • Strengthening and emphasise use of glutes for hip and pelvis stability
  • Progress to a functional return to work/activity
  • At end of phase remove brace and begin hamstring contractions between 0-55 degrees progressing from there
41
Q

How do you perform a posterior drawer test for a PCL tear?

A
  • Patient in supine
  • Flex knee to 90 degrees and sit on foot to stabilise femur
  • Hold the tibia with thumbs in joint line
  • Translate tibia backward
  • Positive = marked laxity/lack of end feel
42
Q

How do you perform reverse lachmann’s test to test for PCL tear

A
  • Patient in supine
  • Flex knee 20-30 degrees over your knee or a towel
  • Proximal hand stabilises femur, distal hand round back of tibia in joint line
  • Thumb on tibial tuberosity
  • Draw tibia backward
  • Springy end feel/laxity = positive
43
Q

Why would you palpate from femur onto tibia, what should you feel and what do differing results indicate?

A
  • To test for PCL tear (causing posterior laxity)
  • Tibia should be anterior
  • If the tibia is anterior but other tests indicate PCL test, indicates grade 1
  • If the tibia and femur are in line then this indicates a grade 2 tear
  • If you drop backward onto the tibia it indicates a significant tear at grade 3
44
Q

How do you perform a sag sign test?

A
  • Patient in supine
  • Knee in 90 flexion
  • Hip in 45 flexion
  • Sit on patient’s foot
  • Tibia should be 10mm anterior to femur in this position, if it sags backward, this is a positive sag sign and indicates PCL damage
45
Q

How is a dial test performed and what do the results indicate?

A

Test:
- Patient in prone
- Bend knee to 30 degrees and externally rotate foot and measure angle
- Repeat at 90 degrees

Results:
- If 10 degrees more external rotation on injured side compared to uninjured side at 30 but not 90, indicates posterolateral complex instability
- If 10 degrees more external rotation on injured side compared to uninjured side at 90 and not 30, a PCL instability is indicated
- If at 90 and 30, PCL injury and PLC instability indicated

46
Q

What is the posterolateral complex composed of?

A

LCL
Popliteus tendon
Popliteofibular ligament

47
Q

What is the clinical presentation of an LCL injury

A
  • Varus force
  • Nearly always traumatic and often alongside ACL or PCL injury
  • Pain, swelling and tenderness on outside of knee
  • Feels like it may give way
48
Q

What test do you perform to assess for an LCL injury?

A

Varus stress test:
- Patient in supine
- Knee flexed to 20 degrees over towel or over your knee
- Proximal hand on distal femur with thumb in lateral joint line
- Distal hand holds heel with forearm along medial border of foot and internally rotate tibia
- Apply a varus strain
- Feel for gapping under your thumb, laxity and pain

49
Q

How would you treat an acute LCL injury?

A

NSAIDs and pain relief
Refer for an MRI which is the gold-standard for ligament injuries and for an x-ray to rule out fractures
Modify activities that cause pain
If severe, surgery, but uncommon

50
Q

How do you treat LCL injury in the non-acute stage?

A
  • If activities are causing pain this is a clear indicator that they are stressing the ligament and therefore should be modified during the recovery period
  • Restore strength in the quadriceps, glutes, hamstrings (immobilise hamstrings if surgery to protect the reconstruction) and calves, you can utilise isometrics for strengthening
  • Maximise ROM with pain-free passive exercises
51
Q

What is the clinical presentation of an MCL injury?

A
  • Can be traumatic due to valgus force
  • Can be caused by repetitive valgus strain (skiing, regularly crouching down, breaststroke)
  • Tenderness on medial border of knee
  • Swelling
  • Instability
  • Bruising
  • Co-occurs commonly with other injuries such as ACL tears and medial meniscal tears
52
Q

Why does the ACL being injured lead to strain being put on the MCL

A

MCL is secondary resistance to anterior translation (ACL is primary) so ACL issues can lead to increased strain on the MCL

53
Q

How do you test for an MCL injury?

A

Valgus stress test:
- Patient in supine
- Leg flexed to 20 degrees over a towel or your knee
- Proximal hand on distal femur with thumb in medial joint line
- Distal hand under heel with the border of patient’s foot along your forearm and apply external rotation
- Apply a valgus force
- Positive if laxity, pain or gapping under thumb on medial side at joint line

54
Q

How do you treat an MCL injury?

A
  • NSAIDs and pain relief
  • Refer for MRI (gold-standard for ligaments) and for x-ray to check for fractures
  • May need crutches and brace as per doctor advice
  • Restore ROM
  • Strengthening (only to be progressed when current movements are pain free)
  • Severe injuries alongside other ligamentous injuries may require surgery
55
Q

Where are the menisci situated and what is their purpose?

A

Menisci sit on the tibial plateau supporting and cushioning the condyles of the femur to enable smooth movement of femoral condyles over the tibial plateau

56
Q

What is true and pseudo locking and true and pseudo giving way?

A

True locking = knee has to be rotated to unlock

Pseudo-locking = Feeling a hard end feel when ‘lock’ing into extension/hyper-extension

True giving way = falling to the ground

Pseudo giving way = lightly flexing

57
Q

Identify 6 different types of meniscal tears

A

Bucket handles
Longitudinal tears
Flap tear
Horizontal tears
Transverse/radial tears
Oblique tears

58
Q

What is the role of a physio regarding a meniscal tear?

A

Diagnose, refer and treat symptoms

59
Q

What is the difference between red and white areas of the menisci regarding healing?

A

Red areas may heal or can be repaired by surgery (on the outside of the menisci)
White areas won’t heal and either need to be surgically removed or patient has to tolerate problem

60
Q

What would you expect from palpation for the 2 different sides of meniscal injury

A

Lateral - tenderness 2cm posteriorly from mid line

Medial - tenderness over mid joint line and 1cm either side

61
Q

What are the two special tests for the menisci

A

Thessaly’s - The patient stands on injured leg leaning on shoulder of the practitioner, practitioner stabilises the patient’s hips and then the patient rotates to the left and right. If pain is caused on rotation to the ipsilateral side to the injury, lateral meniscus is indicated and if contralateral side then medial meniscus indicated

Mcmurray’s medial - patient lies in supine, hip and knee flexed to 90, tibia externally rotated, valgus strain applied, knee brought into extension, clunking or symptoms reproduced is positive

Mcmurray’s lateral - patient lies in supine, hip and knee flexed to 90, tibia internally rotated, varus strain applied, knee brought into extension, clunking or symptoms reproduced = positive

62
Q

How would you treat a meniscal tear excluding rehab

A
  • Refer on for further investigation, they need to have an MRI to see if the tear is in the white or red zone and therefore whether surgery may be indicated and to determine rest of management
  • NSAIDs and RICE for acute injury
63
Q

How would you rehab a torn meniscus?

A

Weight loss - reduces load going through knee and femur to reduce the rate of erosion of menisci and reduce inflammatory chemicals in the body that can quicken cartilage and meniscal breakdown

Exercises and strengthening - needs to follow orthopaedic decisions made following meniscal rehab surgery

Strengthening: Quads, hamstrings, soleus/gastroc, hip ab and adductors, hip flexors etc to reduce amount of energy/force passed to the meniscus

Flexibility and ROM - Reduces degeneration, keeps joints healthy and creates more movement putting less strain on the knee during twisting and stopping movements

64
Q

Discuss some of the thoughts and literature around degenerative mensical tears

A
  • No benefit of surgery + physio over just physio in non-arthritic, non-traumatic tears
  • General lack of consensus on signs or symptoms of degenerative meniscal tear
  • Surgery should only be considered if significant risk to articular processes i.e. repeated effusion, persistent pain and true locking otherwise should always be first attempt/consideration
65
Q

How would you treat degenerative meniscal tears

A

Injections

Selective activity

Rehab and conservative management in line with a traumatic meniscal tear

66
Q

What age are degenerative meniscal tears most common?

A

Over 45

67
Q

What is housemaid’s knee and what causes it?

A

Prepatellar bursitis

Positional overuse trauma from being on all fours

68
Q

Where is the prepatella bursa?

A

Sits between the skin and the patella bone

69
Q

Where is suprapatellar bursa and what does bursitis of this bursa also usually indicate in the knee?

A

Between the quadriceps and the distal femur, communicates with joint so is usually indicative of swelling in the knee

70
Q

What is vicar’s knee and what is it caused by?

A

Superficial infrapatellar bursitis
Kneeling on just your knees rather than all fours

71
Q

Where is the superficial infrapatella bursa?

A

Between the patella tendon and skin

72
Q

Where is the deep infrapatellar bursa and what condition is commonly confused with bursitis of this bursa (and how can you distinguish them)?

A

Between patella tendon and tibia
Mistaken for patellar tendinopathy
Patellar tendinopathy is felt in the proximal or mid part of patellar tendon
Deep infrapatellar bursa is situated a little lower

73
Q

Where is the pes anserine bursa?

A

Deep to the anserine tendons (semitendinosus, gracilis and sartorius)

74
Q

What is a baker’s cyst?

A

A defect at the back of the knee capsule
When there is swelling at the knee joint it seeps into a little sac at the back of the joint
Occasionally there is a valve mechanism where it flows into the posterior sac but can’t come out

75
Q

What is a haem bursitis?

A

Bleeding into the superficial bursa caused traumatically

76
Q

What type of bursae (deep or superficial) have greater incidences of infection

A

Superficial

77
Q

What is the clinical presentation of most knee bursitis’s

A

Exquisite tenderness when poked

Gradual, nagging, annoying type of ache

Patient points too a specific area to describe the pain

78
Q

What objective test would you do if you suspect bursitis?

A

Diagnosis of bursitis is massively geographic so palpate and feel for exquisite tenderness in a particular place

79
Q

How do you treat a bursitis/

A

Ensure no signs of infection

Remove/adjust causative factor

Aspirate if large and uncomfortable

RICE - Particularly for superficial

Rehab - usually not that relevant as not due

80
Q

What positions might put you at more risk of fat pad syndrome

A
  • Standing on one leg i.e. with teenagers, mothers who stand on one side holding their child etc, leaning on one leg forces it into hyper extension
  • Genu valgum
  • Deep flexion positions i.e. working with plants and children
81
Q

When might people with fat pad syndrome’s pain be worse and why?

A

Fat pads are pinched in end range extension so pain is worse going up stairs, standing on one leg or for long periods, cycling with the saddle high so putting the leg forcibly into extension when pushing down on pedal

Fat pads are also pinched in deep flexion so pain is worse in deep squats i.e. when working with children or with plants

82
Q

What position do people with fat pad syndrome usually rest in?

A

50 degrees knee flexion as this is the most comfortable position for the fat pads

83
Q

Where are the infrapatellar fat pads situated?

A

Below the knee joint, posterior to the patellar tendon

84
Q

Why do the infrapatellar fat pads have a high potential for pain?

A

They are very rich in nociceptive nerve endings

85
Q

Why can infrapatellar fat pad syndrome interfere with mechanics of the joint?

A

Villi from the fat pad extend into the joint and can interfere with mechanics of the knee joint

86
Q

What is a potential surgery related cause of infrapatellar fat pad syndrome?

A

When patients have arthroscopies, the fat pads are the entry site so if people have knee pain post surgery that differs from their original knee pain it is likely because the fat pads have been irritated/injured

87
Q

What would you expect to see in an objective assessment of someone with fat pad syndrome?

A

Observation - enlarged fat pads, person stands with hyper-extended knees or one leg

Palpation - enlarged and tender fat pads

Weak eccentric hamstrings: Patient lies in prone and bends to around 10 degrees flexion and then perform resisted extension

Hoffa’s sign: Thumbs on fat pads, 90 degrees hip and knee flexion, hold hands underneath to support the knee, passively bring into full extension, positive sign is pain over the last 20 degrees which is then removed bringing back into flexion

Gentle overpressure into extension causes pain

88
Q

How would you treat infrapatellar fat pad syndrome?

A
  • Remove/adjust activities that cause the issue
  • Strengthen eccentric hamstrings to temper uncontrolled knee extension
  • Podiatry referral may be appropriate if there is a biomechanical cause
  • Surgery should be an absolute last resort and is often highly unnecessary
89
Q
A

Managing Clinical Cases MSK (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions