MSK - knee

Question 1

What are the 2 most likely hypotheses for the medial side injury?

Answer 1

1. MCL injury (myogenic)

2. Meniscus injury (arthrogenic)

Question 2

What special questions should be asked for the knee in a subjective examination?

Answer 2

• any locking or giving way (with or without pain)
• any persistent loss of ROM
• any unexplained swelling or warmth
• any pain in hip or groin

Question 3

What should be asked for past medical history in a subjective examination?

Answer 3

THREADS:
Thyroid
Rheumatoid (or other) Arthritis
Epilepsy
Asthma
Diabetes
Surgery

Question 4

What red flags could be brought up?

Answer 4

• previous history of cancer
• unexplained weight loss (first noticeable symptom of cancers of the esophagus, pancreas and stomach as a tumor can press on the stomach and can make you feel full faster)
• night pains and sweats
• recently unwell (fever/infection)

Question 5

What would you palpate during the objective assessment?

Answer 5

• joint lines of the knee
• patellofemoral
• soft tissue tendon insertions
• mid muscle
• posteriorly

Question 6

Name some functional tests that could be carried out for the knee objective assessment.
What should be considered when performing these?

Answer 6

Squat
Sit to stand
Single leg balance
Step up
Gait analysis
Consider:
 - power
 - ROM
 - pain response
 - proprioception
 - balance

Question 7

Name and describe the test for an MCL tear and what a positive result would look like.

Answer 7

Valgus stress test

• begin in a supine position
• hold the lower leg, just above the ankle (medial side)
• other hand stabilises the lateral side of the femur
• externally rotate tibia
• slight passive abduction
• causes stress on MCL
• looking for pain produced and excessive gapping on the medial side

Question 8

Name and describe the test for an LCL tear and what a positive result would look like.

Answer 8

Varus stress test

• begin in a supine position
• hold the lower leg, just above the ankle (lateral side)
• other hand stabilises the medial side of the femur
• laterally rotate the tibia
• slight passive adduction of the ankle
• looking for pain produced and excessive gapping on the lateral side

Question 9

Name and describe 3 tests for meniscal damage and what a positive result would look like.

Answer 9

1. Thessaly test
   - always compare with good leg
   - single-leg stand on injured leg, flex to 20degrees
   - hold plinth for support if necessary
   - rotate 3 times
   - positive result = pain in the joint line
2. Duck walk
   - only for those with a small meniscal tear and reasonable ROM as it is an extreme position
   - squat all the way down, onto toes
   - walk forward and backward
   - positive result = pain
3. McMurrays test
   - begin in supine position
   - fully flex knee
   - rotate tibia medially and extend knee (lateral meniscus)
   - rotate tibia laterally and extend knee (medial meniscus)
   - repeat 3 times
   - positive result = clicking, locking or pain

Question 10

Describe how ligament injuries can be classified

Answer 10

Grade I
 - low force trauma
 - ligament stretch
 - pain 
 - minimal instability
Grade II
 - higher force trauma
 - more pain
 - increasing instability
 - partial tear
Grade III
 - high force trauma
 - pain and functional loss
 - marked instability
 - severe or complete tear