Module 15 - Knee Injuries + LBP

Question 1

ACL*

Answer 1

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.

Question 2

ACL Testing *

Answer 2

-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

Question 3

PCL *

Answer 3

Dashboard and falls when knee is flexed

-falling on flexed knee
-usually trauma
-impact on anterior tibia with HYPEREXTENSION of knee
-knee pain

Question 4

PCL Testing*

Answer 4

Drawer Test
injuries occur when force occurs on the anterior proximal tibia during knee flexion or with hyperextension and rotation.

Question 5

Lachman Test*

Answer 5

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

Question 6

Drawer Test *

Answer 6

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)

Question 7

Pivot Shift Test *

Answer 7

ACL
- supine
- affect knee extended and tibia is internally rotated
- apply valgus pressure to knee
- + if “clunk” is felt at 30 flexion

Question 8

Lateral and Medical Collateral Ligament Injuries *

Answer 8

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

Question 9

Valgus and Varus Test*

Question 10

McMurry Test*

Answer 10

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

Question 11

Joint Line Tenderness*

Question 12

Thessaly Test*

Question 13

Meniscal Tear*

Answer 13

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

Question 14

Ottawa Knee Rules*

Answer 14

Knee XR is only required for knee injury patients with ANY of the following:

1. 55yo and older
2. Isolated tenderness of patella
3. Tenderness of fibula head
4. Inability to flex to 90 degrees
5. inability to bear weight both immediately and in clinic for 4 steps (unable to transfer weight twice onto each limb regardless of limping)

Question 15

PRICEM*

Answer 15

Protect
Rest
Ice
Compression
Elevate
Medicate

Question 16

LBP Stork Test

Answer 16

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?

Question 17

Carpal Tunnel

Answer 17

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.

Question 18

Lumbar Spinal Stenosis Symptoms

Answer 18

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

Question 19

Why is the medical meniscus more frequently torn that the lateral meniscus

Answer 19

medial meniscus is firmly affixed to the medial collateral ligament

Question 20

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

Answer 20

OA

Question 21

Which of the following mechanisms of action is most commonly associated with meniscal tear?

Answer 21

axial load and rotation

Question 22

Low Back Pain first line treatment

Answer 22

REMAIN ACTIVE
Ice/Heat

NSAIDs
Muscle Relaxers
Tramadol

Question 23

Goals of Treatment for LBP

Answer 23

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.

Question 24

Chronic low back pain

Answer 24

REMAIN ACTIVE
1st line: NSAIDs
Second line: Antidepressants
Third line: muscle relaxers