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Differential Diagnosis Test 1 > Lower Extremity > Flashcards

Lower Extremity Flashcards

1
Q

athlete with anterior knee pain

A

patellofemoral arthralgia

patellar tracking disorder

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2
Q

elderly patient with knee pain

A

osteoarthritis

usually affects the medial portion of the joint (weight bearing)

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3
Q

young athlete with tibial tuberosity pain

A

osgood schaltet disease

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4
Q

complaint of instability

A

chronic ACL damage

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5
Q

complaint of painful locking

A

meniscus tear

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6
Q

hyperextension

A

ACL tear

patellar dislocation

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7
Q

hyperflexion

A

PCL tear and/or associated ACL tear

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8
Q

sudden deceleration

A

ACL tear

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9
Q

valgus force

A

medial collateral ligament tear

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10
Q

valgus force with rotation

A

ACL
MCL
Menisci

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11
Q

blow to flexed knee

A

contusion
patellar fracture
PCL tear

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12
Q

ACL Testing

A

challenging posterior to anterior stability of the knee
lachman’s test
anterior drawer test
pivot shift test

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13
Q

Meniscus Testing

A

compressive challenge
McMurrays test
Apley’s Compression and Distraction

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14
Q

Collateral Ligament Testing

A

Varus Stress Test

Valgus Stress Test

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15
Q

Patellofemoral Disorders

A

Compression
Stability
Tracking

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16
Q

Ottawa Knee Rules for Acute Trauma

A

patient over 55 years old
isolated tenderness at the patella
isolated tenderness of the fibula head
patient is unable to flex knee to 90 degrees
patient is unable to bear weight immediately after the injury or take four steps

17
Q

Classic presentation of ACL tear

A

acute or chronic onset

18
Q

Acute onset ACL tear

A

• sudden onset of pain following hyperextension maneuver,
sudden stopping or cutting, or contact injury with the knee being hit from the side
• may hear pop
• joint swelling appears quickly
• patient is unable to bear weight

19
Q

Chronic presentation of ACL tear

A

Patient will have a past history of the acute onset type with a gradual resolution of joint swelling and pain, with the complaint usually being instability

20
Q

O’Donaghue’s Triad

A

aka unhappy triad
ACL
Medial Meniscus
MCL

21
Q

What type of fracture is associated with ACL tear?

A

Segond’s Fx or potential tibial spine fracture, or head of fibula

22
Q

Segond’s Fx

A

type of avulsion fracture (soft tissue structures tearing off bits of their bony attachment) of the lateral tibial condyle of the knee, immediately beyond the surface which articulates with the femur

Mechanism of injury: internal rotation and varus stress which causes abnormal tension on the central portion of the lateral capsular ligament

ACL is most common injury with Segond’s Fx, other injury includes Medial Meniscus or Lateral Meniscus

First image with a knee injury is plain film, if Segond’s is found then do an MRI

23
Q

Complete ACL Tear

A

focal discrete complete disruption of all visible fibers

24
Q

Partial / Intrasubstance Tear

A

abnormal signal intensity within substance of ligament with some intact and some discontinuous fibers

25
Q

What color should ligaments/tendons be on MRI

A 
low signal (black)
if damaged it will be a higher signal (gray)
26
Q

Where does the ACL lie

A

The ACL lies in a plane 10-15 degrees externally rotated to the sagittal plan

27
Q

Posterior Cruciate Injury

A
  • knee pain following a blow to the front of his tibia with the knee in a flexed position or by forced hyper flexion
  • less common than an ACL tear
  • posterior drawer sign
  • SAG sign
  • X-ray reveals increased signal and thickening
28
Q

Where does the PCL attach

A

attaches proximally on the internal aspect of the medial femoral condyle and runs distally to where it attaches to the posterior eminence of the tibia

29
Q

Where does the ACL attach

A

It attaches proximally at the internal aspect of the lateral femoral condyle and runs distally to its broad attachment to the anterior tibia and the anterior aspect of the tibial spine

30
Q

Where does the PCL lie

A

It lies in the sagittal place and can usually be seen in its entirety on a single sagittal MR slice

31
Q

Where do avulsion fx mostly occur

A

they occur at the insertion of the ACL (most common) and PCL. Most commonly seen in adolescents.

Differential Diagnosis Test 1 (2 decks)

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