Module 15 - Knee Injuries + LBP Flashcards
ACL*
acute:
- non contact deceleration/change in direction
- HYPEREXTENSION
- POPPING sensation
- swelling within the first 12 hours. If swelling occurs 12 to 24 hours after injury, a meniscal injury is more likely.
ACL Testing *
-Lachman Test
-Anterior Drawer Test
-Pivot Shift Test
-Posterior Sag Test
Drawer can sometimes be negative due to hamstring guarding
LACHMAN is more reliable than Drawer
PCL *
Dashboard and falls when knee is flexed
-falling on flexed knee
-usually trauma
-impact on anterior tibia with HYPEREXTENSION of knee
-knee pain
PCL Testing*
Drawer Test
injuries occur when force occurs on the anterior proximal tibia during knee flexion or with hyperextension and rotation.
Lachman Test*
ACL
The knee is placed in 15 degrees of flexion and external rotation of the hip
- Shows forward translation
-perform normal knee first
-supine with injured knee flex 30
-grasp calf and over anterior joint line
-pull tibia anteriorly in sudden firm motion
outcome:
- assess laxity (>6-8mm)
- compare to other knee
- lack of clear endpoint = +
- will have pliability
Drawer Test *
ACL and PCL
patient is supine, hips and knees flexed, and feet are flat on the table
ANTERIOR:
- supine, with injured knee flex 90
- fix foot at slight external rotation
- pull anteriorly and assess displacement of tibia
POSTERIOR:
- same thing but pull posteriorly (backwards)
Pivot Shift Test *
ACL
- supine
- affect knee extended and tibia is internally rotated
- apply valgus pressure to knee
- + if “clunk” is felt at 30 flexion
Lateral and Medical Collateral Ligament Injuries *
MCL: valgus injury
LCL: varus injury
- immediate onset of pain
- swelling at medial aspect of knee
- usually with trauma
Tests:
- Valgus (MCL)
- Varus (LCL)
- McMurry (MCL and LCL)
- Joint Line Tenderness
- Thessaly Test
Valgus and Varus Test*
McMurry Test*
McMurray test is performed to evaluate medial and lateral meniscal tears while rotating the lower leg internally and externally.
Diagnostic of injury
true positive McMurray test, the examiner feels a pop during the maneuver
Joint Line Tenderness*
Thessaly Test*
Meniscal Tear*
If swelling occurs 12 to 24 hours after injury, a meniscal injury is more likely.
- popping and clicking noises
Axial loading and rotation `
- Sudden twist injury while foot is planted
- OR prolonged degeneration
- Recurrent knee pain
- Episodes of catching or locking of knee
- esp. with squatting or twisting knee
- loose bodies in the knee from torn cartiledge
- With or without trauma
- OA patients get degenerative tears
XR is sufficient in these patients
Ottawa Knee Rules*
Knee XR is only required for knee injury patients with ANY of the following:
- 55yo and older
- Isolated tenderness of patella
- Tenderness of fibula head
- Inability to flex to 90 degrees
- inability to bear weight both immediately and in clinic for 4 steps (unable to transfer weight twice onto each limb regardless of limping)
PRICEM*
Protect
Rest
Ice
Compression
Elevate
Medicate
LBP Stork Test
Jerry, a 17-year-old obese male football lineman, presents to your outpatient clinic complaining of recurrent, dull, achy low back pain which is worse with activity. The primary care NP suspects spondylolysis. Which physical exam maneuver would be most useful to test for this condition?
Carpal Tunnel
Tapping the median nerve along the course on the volar aspect leads to paresthesias along the nerve distribution. It is the most sensitive test for carpal tunnel syndrome. However, most practitioners obtain nerve conduction studies to determine the degree of compression. Most cases of carpal tunnel syndrome can be treated conservatively.
Lumbar Spinal Stenosis Symptoms
walking makes pain worse
standing makes worse
sitting and lying down helps
4/5 strength of left leg from hip flexors
DTR diminished in LLE
Why is the medical meniscus more frequently torn that the lateral meniscus
medial meniscus is firmly affixed to the medial collateral ligament
Which of these conditions would an xray be more likely to provide a definitive diagnosis of the suspected condition than to rule out another condition
OA
Which of the following mechanisms of action is most commonly associated with meniscal tear?
axial load and rotation
Low Back Pain first line treatment
REMAIN ACTIVE
Ice/Heat
NSAIDs
Muscle Relaxers
Tramadol
Goals of Treatment for LBP
The goals of treatment for acute low backpain are to relieve pain, improve function, reduce time away from work, and develop coping strategies through education.
Chronic low back pain
REMAIN ACTIVE
1st line: NSAIDs
Second line: Antidepressants
Third line: muscle relaxers
