Lower Extremity Disorders Flashcards
ACL Tear
normal ACL function
Etiology & types
normally: ACL is responsible for preventing torsion (twisitng) of the knee and anterior translation of the tibia
Etiology
- a tear of the ACL: common (50% of knee injuries)
- Non-contact tear: quick deceleration & pivot
- contact tear: direct blow to the lateral knee
- think skiing, soccer, basektball, football
ACL Tear
Symptoms
Diagnosis
Treatmetn
Symptoms
- pop sound hear after a cut movement
- immediate discomfort
- swelling, instability (cant turn)
Signs
- tense effucion + limited ROM
- + lachmans test
- + anterior draw
- + pivot
Diagnosis
- MRI: gold standard: sagittal view see discontinuity & Kissal sign: two areas of white where the bones collided & see assocaited meniscus tears
- X-ray: can see overall assessment of knee and fracture: Segond fracture: lateral tibial plateau
Treatment
- nonoperative: those who are low-activity and 40+
- operatvive: reconstruction is gold standard with autograft (patella) or allograft
- PT
PCL Tear
Etiology
Etiology
- rarely isolated: accompanied with other tears
- high energy: MVA dashboard injury
- low-energy: fall onto flexed knee, direct anterior force
Symptoms
- trauma, instability to knee, buckling of knee
- subtle symptoms compared to ACL
- limb and stiff
Sign s
- swelling
- decreased terminal knee flexion
- + posterior drawer sign
- + posterior sag sign
PCL tear
Diagnosis
treatment
Diagnosis
- MRI: see sagittal view of discontinued ligament & other soft tissue injuries
- X-ray: see boney avulsion where PCL inserts on tibia
Treatment
- immediate: protect, ICE, rest, compression, elevation NSIADS)
- can be surgical
LCL (lateralcollateral) tear
Etiology
Risk Factors
Symptoms
Etiology
- raely isloated: usually medial blow to the knee
Risk Factors
- female,
- contact/pivot
- jump and landing
Symptoms
- swelling, instability of joint when chanign direction
- buckling and catching
- brusing
Signs
- + varus stress test: pushing from medial to elict pressure laterally
- decreased ROM
LCL tear
Diagnosis
Treatment
Diagnosis
- MRI: coronal view discontinued ligament
- X-ray: Arcuate sign: proximal fibula fracture where LCL attaches
- US can be used too
Treatment : based on grade of tear
Grade 1: sprain of ligament: crutches and hinged brace 4wks.
Grade 2: partial tear: crutches; immobilized knee brace 1-3 weeks & then hinged
Grade 3: complete tear: immobilize, NWB & surgery
MCL Tear
Etiology
Risk Factors
Symptoms & Signs
Etiology
- tear of the medial ligmanet as a result of a lateral knee blow
- most common knee injury
- direct blow to lateral knee
- shoe catches on surface
Risk Factors
- high level of sports
- ski boot
- contact sports
Symptoms
swelling, buckling and catching when changing directions
Signs
- valgus stress test + : so when lateral force applied: pain medially
- decreased ROM
MCL Tears
Diagnosis Treatment
Diagnosis
MRI: coronoal view to see discontinuity
X-ray: moderate effusion : sunrise view (patella over top looking down)
US
Treatment
- Grade 1: crutches and hinged brace 4 weeks (sprain)
- Grade 2: crutches and nonhinged brace 1-3 weeks (partial)
- Grade 3: complete tear: immobilze; NWB : surgery
Medial & Lateral Menisi tears
Etiology (which is more common)
symptoms
Etiology
- medial menisus tear more common than lateral
- lateral: assocaited with ACL tears (lateral blow to knee)
- most common indication for surgery
- cutting, squatting or twisitng motion
Symptoms
- clicking, & locking at attempt to flex
- pain at the joint line
Signs
- tender to palpate joint line
- qua atrophy if chronic
- + locked knee
- + McMurry’s sign
- bulge or ballottement (effusion)
Menisci Tears
Diagnosis
Treatment
Diagnosis
MRI: sagittal view shows tear & effusion
X-ray: rule out cartialge flaoting or OA
US
Treatment
- Conservative: RICE, injection, PT
Surgical
- symptomatic & no arthritis: good
- mild/mod. arthritis: try concervative
- advncaed artritis: do not do surgery
Patellar Tendinitis
Etiology
Symptoms
Etiology
- think jumping athletes “jumpers knee”
- high training volume, decreased flexibility and increae BMI = higher risk
- tendinitis secondary to repetitive trauma and micotears = inflammation
Symptoms
- pain local to the inferior pole of the patella
- gradual pain without spikes and gets better with rest
Signs
- tender to palpate tendon
- pain on single leg decline squat
Patellar Tendinitis
Diagnosis
Treatment
Diagnosis
- clincally made
- MRI: sagittal view = edema
- US: abnormal patellar tendon
Treatment
conservative: PT, ice, rest, strap on knee below for support
surgical: rarely done
Reasons for Anterior Knee Pain
conditions
etiology
Symptoms
Patellofemoral pain syndrome: “Runners knee”
Chondromalacia Patella: softening of the posterior cartialge of the patella (behind patella)
Etiology
- all a result of focal trauma, overuse and abnormal patellar tracking can be a result of an increase Q angle > 20 degrees (20 is normal) Q angle: femur to hip
Symptoms
- anteroir knee pain
- graudaul that DOES NOT RADIATE
- unilateral
- worsens with stairs
Signs
- crepitus, swelling
- patellar grinding & apprehension
- J sign: patellar movement
Anterior Knee Pain
Diagnosis
Treatment
Diagnosis
- not needed for imaging unless unstable/trauma
- X-ray: weight bearing image: see lateral patella (side) or high riding (above)
- MRI: stress edema, OA chondral flaps
Treatment
acute phase: NSAIDS, sleeve to compress
Recovery Phase: PT, tappig with K tape & good inserts
Srugical: RARE: medial patellofemoral ligmanet reconstruction or chrondroplasty
Patellar Dislocation
etiology
symptoms
Diagnosis
Treatment
Etiology
- majority are lateral dislocations
- usually secondary to the tear in the medial patellofemoral ligament tears and then gets pulled laterally)
- can be due to a flexed knee twisted (baseball swing)
Symptoms
- pop!!!
- able to self reduce
- notable deformity of patella
- patellar grinding test
Diagnosis
- X-ray is gold standard : see the dislocated patella
- MRI: see MPFL and edema
Treatment
- immediate reduction
- aspirate to allieve dislocation
- immoblizble 2-3 weeks
- stablize with patellar brace
- 12 weeks until sports
