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Pance Re-Up > MSK Re-Up #6 (Knee & Ankle) > Flashcards

MSK Re-Up #6 (Knee & Ankle) Flashcards

1
Q

Patellofemoral Syndrome (Chondromalacia) is idiopathic softening or fissuring of patellar articular cartilage from overuse. Who is it MC seen in?

What are some symptoms?

A

-Runners or cyclists, women

-Anterior knee pain behind or around patella worsening with knee hyper flexion (sitting, standing, jumping)
-Compression of patella during knee extension will produce positive apprehension sign (anticipated pain)

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2
Q

Treatment for patellofemoral pain syndrome?

A

-NSAIDs, rest, rehab (strengthen vastus medalis obliquis and quadriceps)
-Elastic knee sleeve for stabilization

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3
Q

How do meniscal tears occur?

What are some symptoms?

What is the MC type?

A

-Axial loading and rotation (squatting, twisting)

-Popping, giving way during ambulation or using stairs, effusion after activities. Locking, inability to fully extend the knee

-Medial 3x more common than lateral

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4
Q

What test can be done to diagnose a meniscal tear in the office?

What is the best imaging study?

A

Positive McMurray Sign: pop or click when knee flexed and then ER and extended
-Apley Test, Joint line tenderness, joint effusion, swelling

MRI

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5
Q

Treatment for meniscal tear

A

-Conservative: ice, NSAIDs, ortho follow up
-Surgical: arthroscopic repair or partial meniscectomy

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6
Q

The Medial Collateral Ligament resists ____ force on the knee whereas the Lateral Collateral Ligament resists _____ force on the knee.

Symptoms of LCL and MCL injuries

A

-Medial: Valgus (lateral trauma)
-Lateral: Varus (medial trauma)

localized knee pain, swelling, stiffness, ecchymosis
LCL: pain with varus stress
MCL: pain with valgus stress

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7
Q

The MC ligamental knee injury

How does it occur?

What are some symptoms associated with it?

A

-ACL Tear

Noncontact pivoting injury, deceleration, changing direction, hyperextension, internal rotation

Pop and swelling followed by hemarthrosis
May develop knee buckling, inability to bear weight

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8
Q

What is the most sensitive test for an ACL injury?

What are other tests that can be done?

A

Lachman Test (Most sensitive): knee placed at 15’ in supine position. Pull tibia forward. Positive if > 2mm of forward anterior translational movement

-Pivot Shift Test: valgus force applied to knee while slowly flexed.
-Anterior Drawer Test: like Lachman, but at 90’

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9
Q

What is seen on radiographs for an ACL tear (specific name).

What is the best diagnostic?

A

-Segond Fracture: avulsion of lateral tibial condyle

MRI

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10
Q

What are the components of Unhappy (O’Donoghue’s) Triad?

A

-Medial Meniscus Tear + ACL + MCL

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11
Q

Treatment for ACL Injury

A

-Conservative: rest, NSAIDs, ice, compression, PT
-Surgical: if young, athletes, those with high demand jobs

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12
Q

PCL injuries are MC associated with __________ and some symptom associated with this condition are…

On physical exam the best test for this is..

A

Dashboard injuries (anterior force to proximal tibia with knee flexed)

-Posterior knee pain, anterior bruising, large effusion

-Posterior drawer test: translation movement of the tibia posteriorly

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13
Q

Patellar Fractures MC occur due to _________. What radiograph views allow for best visualization?

What should be done?

A

-Direct blow to the patella (fall on a flexed knee for example)

-Sunrise and cross table lateral views

-Knee immobilizer, leg cast if nondisplaced
-Surgery if displaced

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14
Q

What is Osgood-Schlatter Disease?

What are some risk factors for it?

Symptoms?

A

-Inflammation of the patellar tendon at the insertion of the tibial tubercle due to overuse from repetitive knee extension and quadriceps contraction

-Males, 10-15 years old, during growth spurts, athletes

-Anterior knee pain and swelling related to activity, relieved with rest.
-Swelling, tendernes to anterior tibial tubercle

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15
Q

Management for osgood-Schlatter Disease?

A

-Conservative! (RICE, NSAIDs, quad stretching, knee immobilization)

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16
Q

Patellar dislocations occur after valgus stress after twisting injury or direct blow. Lateral is the MC type and it MC occurs in females. What should be done for this condition?

A

Closed reduction: push anteromedially on the patella while gently extending the leg

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17
Q

A Baker (Popliteal) cyst is a cystic herniation of the posterior joint capsule. What is the cyst filled with?

Symptoms?
What imaging studies are ordered for this?

A

-Synovial fluid

-Fullness behind knee, mass, decreased ROM in flexion

US or MRI

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18
Q

A femoral condyle fracture MC occurs after a __________.

This requires immediate ortho consult with ORIF because there are two complications that can occur. Name them.

A

-Axial loading (fall from height) or direct blow to the knee

-Peroneal nerve injuries: foot drop
-Popliteal artery injury

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19
Q

Similarly, a tibial plateau fracture also includes a complication of perineal nerve injury (foot drop). This is MC due to children in MVA’s.

Treatment?

A

-Nonweightbearing initially with hinged-knee brace
-Surgical if displaced

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20
Q

Iliotibial Band Syndrome (ITB), occurs MC in what populations? What are some symptoms?

A

-Runners and cyclists

-Lateral knee pain (sharp, burning, and worse with changes in terrain such as stairs or downhill), relieved with rest.
-Tenderness over lateral condyle.
-Pain with single leg squat.

21
Q

What are two tests that can be done for ITB?

A

-Noble Compression Test: pain over distal ITB at 30’ of knee flexion
-Ober Test

22
Q

Treatment for ITB

A

-Conservative initially (TOC)
-Steroid injections
-Surgery if refractory

23
Q

With a knee (tibial-femoral) dislocation, this a severe limb-threatening emergency. Immediate ortho consult for prompt reduction is recommended. Why is it so dangerous?

A

-Popliteal artery injury in 1/3 of patients and must perform arteriography or arterial duplex if pulses are diminished or absent.

Also check for peroneal nerve injury!!!

24
Q

With patellar and quadriceps tendon ruptures, this occurs MC in who?

Symptoms of a quad tendon rupture vs a patellar tendon rupture?

A

MC in males > 40 years old, systemic disease (DM, obesity, gout, renal disease)

Quad: palpable defect above knee
Patellar: palpable defect below knee
-Both: inability to extend knee and perform straight leg raise

25
Q

On radiographs, what is seen with a Quad tendon rupture vs patellar tendon rupture?

A

-Quad: Patella baja (low riding)
-Patellar: Patella alta (high riding)

26
Q

Treatment for patellar tendon or quad tendon rupture

A

-Knee immobilizer, non or partial weight bearing
-Surgical repair within 7-10 days

27
Q

What type of ankle sprain is MC? What is the main ligament injured in this type?

symptoms of an ankle sprain?

A

-Lateral: Anterior talofibular ligament (ATFL) is the main stabilizer during inversion.

Felt a pop followed by swelling, pain, inability to bear weight. May be ecchymotic.

28
Q

What test can be performed to assess ATFL integrity?

A

Anterior Drawer Test

29
Q

What are the Ottawa Ankle Rules to get radiographs of the ankle?

How about of the foot?

A

Ankle: pain along lateral malleolus, pain along medial malleolus, inability to walk 4 steps at time of injury and in the ER

Foot: Navicular (mid foot) pain, 5th metatarsal pain, inability to walk 4 steps

30
Q

Treatment for an ankle sprain?

A

-Conservative: RICE, NSAIDs, crutches for first 2-3 days. ACE wrap or brace for support.

31
Q

what are some risk factors for an Achilles tendon rupture?

What are some symptoms?

A

-Fluoroquinolone use, corticosteroid injections, 30-50 years old, weekend warrior, episodic athletes

-Sudden heel pain after push off, pop, sudden sharp calf pain
-Inability to bear weight
-Positive Thompson Test: weak, absent plantar flexion when gastroc is squeezed

32
Q

What is the best diagnostic study for an Achilles tendon rupture?

A

MRI

33
Q

Nonoperative management for Achilles tendon rupture?

Surgical?

A

-Splint in mild plantar flexion with gradual dorsiflexion toward neutral

Surgery allows for early ROM

34
Q

With a medial ankle sprain, what ligament is injured?

A

Deltoid ligament (eversion stabilizer)

35
Q

Explain the Weber Ankle Fracture Classification System.

What is A, B, C

A

Weber A: Fibular Fx BELOW syndesmosis and all ligaments intact

Weber B: Fibular Fx AT LEVEL of syndesmosis

Weber C: Fibular Fx ABOVE Mortise. Deltoid ligament damage or medial malleolar fracture. Widening of talofibular joint. Needs ORIF, unstable!

36
Q

What is a Maisonneuve Fracture?

A

Spiral fracture of proximal 1/3 of fibula associated with distal medial malleolar fracture or rupture of deep deltoid ligament

37
Q

True or False: Anyone with a distal ankle fracture should have proximal films performed to rule out a Maisonneuve fracture?

A

True!

38
Q

A pilon (tibial plafond) fracture is a fracture of the distal tibia interrupting the ankle joint space and extends into the ankle joint. What does this require?

A

ORIF

39
Q

What is a stress (march) fracture? Who does it MC occur in?

What bones are MC involved?

A

-Fracture due to overuse or high-impact activities (athletes, military)
-Females at increased risk.

-MC bones involved are metatarsals (3rd metatarsal MC)

40
Q

Symptoms of a stress fracture

Explain the significance of the radiographs

A

-Insidious onset of localized aching pain, tenderness, and swelling that increases with activity. Localized bone tenderness at fracture site.

-50% of radiograph will be negative initially (especially in first 2 weeks) so mainly a clinical diagnosis.

41
Q

Treatment for a stress fracture

A

-Conservative: rest, avoid high impact activities, ice, splint, post-op shoe, analgesia
-Ortho surgery if high risk fracture (5th metatarsal)

42
Q

What is tarsal tunnel syndrome?

What are some symptoms?

A

-Posterior tibial nerve compression as it travels through tarsal tunnel

-Compression Symptoms: pain and numbness at medial malleolus, heel, and sole. Pain increases throughout the day, is worse at night and with dorsiflexion and pain does NOT improve with rest

43
Q

What test can you do in the office for tarsal tunnel syndrome?

What confirms the diagnosis?

A

Tinel Sign: tapping at posterior medial malleolus to produce pain

EMG

44
Q

Treatment for Tarsal Tunnel Syndrome

A

-Conservative: initial TOC
-Surgical release if refractory

45
Q

Plantar Fasciitis is inflammation and microscopic tears of the plantar fascia due to overuse (especially in those with flat feet, high arches, or heel spurs)

What are some symptoms of this condition?

Is this mainly a clinical diagnosis or is there an imaging study that can be done?

A

-Inferior heel pain: sharp, often worse after period of rest (first few steps in the morning), decreases throughout the day and return of pain at night.
-Local point tenderness to underside of heel
-Pain increases with dorsiflexion of toes (stretches the plantar fascia)

This is mainly a clinical diagnosis.

46
Q

Treatment for plantar fasciitis

A

-Conservative
-Steroid injections if no relief with NSAIDs
-Surgery if refractory

47
Q

A bunion (hallux valgus) is a deformity of the first metatarsophalangeal joint with ________ of the proximal phalanx.

What is usually in the history of patients with these?

What is the treatment?

A

-Lateral deviation of the proximal phalanx

History of wearing poorly-fitted, tight, or pointed shoes common, pes planus (flat feet), RA, female gender

Conservative treatment

48
Q

On the other hand, a hammer toe is a deformity of what joint? Explain this.

What symptoms do they have?

A

-Deformity of PIP joint. Flexion of PIP joint and hyperextension of MTP and DIP joint.

PIP pain (due to contact with shoe)

Pance Re-Up (76 decks)

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