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Anatomy Y2 > MSK CAS > Flashcards

MSK CAS Flashcards

1
Q

When performing an intermediate knee exam what position does the patient lie in?

A

On the couch with their knee, quadriceps and calf muscles visible

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2
Q

What should you inspect for in an intermediate knee exam?

A

Scars
Muscle wastage
Knee deformities

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3
Q

What can scars indicate in a knee exam?

A

Previous injury and trauma

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4
Q

What can muscle wastage indicate in a knee exam?

A

Disease eg arthritis

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5
Q

When should a neuro exam be done in relation to a knee exam?

A

If muscle wastage is suspected to be due to LMN

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6
Q

What are the 2 knee deformities?

A

Varus and valgus

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7
Q

What is varus?

A

Bow legged

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8
Q

What is valgus?

A

Knock knees

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9
Q

What do we palpate for in a knee exam?

A

Temperature
Patella
Medial and lateral joint lines
Effusion

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10
Q

Where do you palpate for temperature in a knee exam?

A

Above patella, above and below the joint and always compare left to right

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11
Q

Why may temp be raised in a knee exam?

A

Due to inflammatory disease like osteoarthritis and septic arthritis

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12
Q

When must you look at the patient’s face and why?

A

During palpation to look for signs of pain, can indicate meniscal damage

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13
Q

Where might meniscal damage at the knee occur ?

A

Tibial tuberosity
Head of fibula
Popliteal fossa

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14
Q

What is a sign of Baker’s cyst?

A

Swelling at the popliteal fossa

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15
Q

What is effusion?

A

Excess synovial fluid?

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16
Q

What are the 2 methods to feel for effusion at the knee? When is each used?

A

Tap method- use for large effusions

Sweep method- use for small effusions

17
Q

Describe the tap method for assessing effusions at the knee

A

Make sure patient’s knee is extended
Slide your non-dominant hand down the thigh to empty suprapatellar pouch
Press firmly over patella with dominant hand and you’ll feel a tap as the patella hits the femur

18
Q

Describe the sweep method for assessing effusions at the knee

A

Make sure patient’s knee is extended
With the back of your non-dominant hand sweep upward on the medial side of the knee to empty the medial compartment
Keeping your non-dominant hand in place, sweep downward on the lateral side of the knee to empty the lateral compartment with the back of your dominant hand
If there is a small effusion you will see a ripple or bulge of fluid appears on the medial side of the knee from the lateral compartment

19
Q

What muscles handle flexion of the knee?

A

Biceps femoris Semitendinosus
Semimembranosus
and (gracilis)

20
Q

What muscles handle extension of the knee?

A

Quadriceps muscles Quadriceps tendon
Patella
Patellar tendon
Tibial tuberosity

21
Q

What will damage to the knee extensors cause?

A

Inability to straight leg raise

22
Q

What are the 2 ways movement at the knee is assessed?

A

Active and passive

23
Q

How is active movement at the knee assessed?

A

Ask the patient to flex and extend each knee as much as possible in turn
Whilst the patient is doing this, look for pain on movement and note the Range of Motion (ROM) of each joint.

24
Q

What can reduced ROM during active movement at the knee indicate?

A

Arthritis

25
Q

How is passive movement at the knee assessed?

A

Ask the patient to relax their legs
Flex and extend each patient’s legs to the maximum extent
Test the extensor compartment by lifting the patient’s foot with the patient’s leg relaxed
Look for hyperextension by comparing the angle between the thigh and lower leg.

26
Q

What angle of hyperextension is normal?

A

Up to 10 degrees of hyperextension is normal provided it is the same on the other side.

27
Q

How should ROM differ in passive movement compared to active?

A

ROM should be more than compared to active movement

28
Q

What are the 2 special tests in a knee exam?

A

Anterior draw for ACL and posterior sag for PCL

Medial and collateral ligaments

29
Q

How is the anterior draw for ACL and posterior sag for PCL done?

A

Flex the patient’s knee to 90 degrees and maintain this position
Check that the hamstring muscles are relaxed and look for posterior sag (posterior subluxation of the tibia on the femur).
With your hands behind the upper tibia and both thumbs over the tibial tuberosity, pull the tibia anteriorly

30
Q

What does posterior sag cause?

A

This causes a false-positive anterior drawer sign that should not be interpreted as ACL laxity

31
Q

How is anterior draw positive?

A

Significant movement (compared with the opposite knee) indicates that the ACL is lax. Movement of > 1.5 cm suggests ACL rupture

32
Q

How is the test for the medial knee ligaments done?

A

Ask the patient to flex their legs to 30 degrees
Place one hand on lateral aspect of the lower thigh
Place your other hand on the medial aspect upper calf with the fingers over the medial joint line
Provide a valgus stress with your hand over the thigh whilst feeling for the joint
opening in the medial joint line

33
Q

How is the test for the collateral knee ligament done?

A

Ask the patient to flex their legs to 30 degrees
Place one hand on medial aspect of the lower thigh
Place your other hand on the lateral aspect upper calf with the fingers over the lateral joint line
Provide a varus stress with your hand over the thigh whilst feeling for the joint opening in the lateral joint line

34
Q

What is the order for an intermediate knee exam?

A
  1. Positioning and Exposure
  2. Look: Looking for scars, knee deformity, muscle wasting
  3. Feel: temperature
  4. Around the patellar
  5. Medial and lateral joint lines
  6. The tibial tuberosity and head of the fibula
  7. Popliteal fossa
  8. Move: Active: Flexion and Extension
  9. Passive: Flexion and Extension
  10. Passive: Hyperextension
  11. Special Tests
  12. Anterior Draw and Posterior Sag
  13. Medial and Lateral Collateral ligaments

Anatomy Y2 (11 decks)

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