MSK - the knee Flashcards
Name 2 common arthrogenic hypothesis for a knee injury and name their mechanisms, who they affect most commonly and what pain/ symptoms they produce
1. Osteoarthritis Insidious mechanism (gradually progresses) Likelihood increase with age, common over 55 Deep ache, often occurring with activity 2. Intra-articular Trauma mechanism Common under the age of 40 Locking/giving way of joints
Name 2 common myogenic hypothesis for a knee injury and name their mechanisms, who they affect most commonly and what pain/ symptoms they produce
1. Tendonitis Caused by overload, or change in activity Normally occurs in those under 55 Pain increases at start and post-activity 2. Soft tissue/muscular injury Trauma or sudden onset Affects any age Pain is local to tissue in question
Name 2 common hypothesis which are a combination of myogenic and arthrogenic for a knee injury and name their mechanisms, who they affect most commonly and what pain/ symptoms they produce
- AKP (anterior knee pain)
- PFPS (patellofemoral pain syndrome)
Anterior pain
Insidious mechanism
Ache, position and activity dependant
Name a red flag hypothesis for a knee injury and name the mechanisms, who they affect most commonly and what pain/ symptoms they produce
- Bone tumour
Likelihood increases with age
Constant pain - pain at night and rest
Name 2 arthrogenic red flag hypotheses for a knee injury and name their mechanisms, who they affect most commonly and what pain/ symptoms they produce
1. Inflammatory or infectious (e.g gout) Insidious mechanism Common in 40-60 year olds Constant but variable pain. Am stiffness>30 mins 2. Fracture Trauma onset Common in adolescent and older (osteoporosis) Aggravated by activity, eases with rest
Name a myogenic red flag hypothesis for a knee injury and name the mechanism, who it affects most commonly and what pain/ symptoms it produces
- Rupture of tendon
Caused by over-load
Most common in men aged 30-40
immediate pain then a loss of function
What are the Ottawa knee rules?
Set of criteria that guide a clinician as to when an X-ray of the knee is required.
It provides a fast and accurate decision-making tool.
What is the set of criteria laid out by Ottawa knee rules?
X-ray should be performed if any of the criteria are met:
- Aged 55 years or greater
- Isolated patellar tenderness
- Tenderness of the fibular head
- Inability to flex knee to 90degrees
- Inability to weight bear immediately after injury and in the emergency department
What special questions should be asked for the knee in a subjective examination?
- 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
What should be asked for past medical history in a subjective examination?
THREADS: Thyroid Rheumatoid (or other) Arthritis Epilepsy Asthma Diabetes Surgery
What red flags could be brought up?
- 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)
What would you palpate during the objective assessment?
- joint lines of the knee
- patellofemoral
- soft tissue tendon insertions
- mid muscle
- posteriorly
Name some functional tests that could be carried out for the knee objective assessment.
What should be considered when performing these?
Squat Sit to stand Single leg balance Step up Gait analysis Consider: - power - ROM - pain response - proprioception - balance
Describe the tests for ACL involvement
- Lachmans test
- bring knee to 45degrees
- one hand holds femur on the outside, other hand holds the tibia on the inside
- move knee back and forth - Draw test
- bring knee to 90degrees and hip to 45degrees
- sit on foot to maintain position
- hands around knee, with fingers in the back and thumbs on the patella
- thumbs palpate joint lines
- move tibia anteriorely
Positive result = soft end feel
Describe the test for PCL involvement and what a positive result looks like
Posterior sag test
Lay patient in the supine position, flex knees to 90degrees and hips to 45degrees
Compare position of tibia to femur
OR
Raise leg so hips and knee and flexed to 90degrees
Support the leg under the calf
Compare position of tibia to femur
Positive result = Posterior drop of the tibia
Negative result = Tibia remains straight
Name and describe the test for an MCL tear and what a positive result would look like.
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
Name and describe the test for a LCL tear and what a positive result would look like.
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
Name and describe 3 tests for meniscal damage and what a positive result would look like.
- 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 - 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 - 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
Name and describe the test for patellofemoral pain and what a positive result would look like.
Patellofemoral sweep/compression
- place webspace on superior border of patella
- patient contracts quads
- apply a downward and inferior pressure onto the patella
- positive result = pain on movement or inability to complete the test
Name and describe the test for patella dislocation and what a positive result would look like.
Patella apprehension test
- begin in a supine position
- both thumbs press on medial side of patella
- repeat by pushing on the lateral side
- positive result = uncomfortable when it reaches point of maximal lateral/medial displacement
Describe how ligament injuries can be classified
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
How would you measure ROM at the knee
Goniometer
Axis on the lateral epicondyle of the femur
Moving arm on the lateral midline of the fibula, pointing at the lateral malleolus
The stationary arm on the lateral midline of the femur, pointing at the greater trochanter
ALWAYS COMPARE WITH THE GOOD SIDE
Suggest an exercise for improving strength at the knee joint
Quad sets = Sit on plinth with the injured leg out straight, and pillow below the knee. Press the back of your knee into the pillow by tightening the muscles of your thigh. Dorsiflex your ankle to help.
Hamstring curls = hold onto plinth, bring injured leg up towards bottom and hold for 5 seconds
Suggest an exercise for improving ROM at the knee joint
Seated scoots = Sit all the way back in a chair with your feet flat on the floor. Scoot forward, while keeping your feet firmly on the floor. You should feel a stretch along the front of your knee. Hold for 20 seconds.
What are the muscles of the hamstring group called?
What action do they perform?
Biceps femoris, Semitendinosus, Semimembranosus
Prime movers of leg flexion at the knee.
Name the origin and insertion of the biceps femoris
Arises from 2 heads (long head and short head)
Origin;
Ischial tuberosity (long head)
Linea Aspera (short head)
Insertion;
Head of the fibula and lateral condyle of tibia
Name the origin and insertion of the semitendinosus
Origin; Ischial tuberosity
Insertion; Medial condyle of the tibia
Name the origin and insertion of the semimembranosus
Origin; Ischial tuberosity
Insertion; Medial condyle of the tibia
What nerve supplies the hamstring muscles?
The group is innervated by the sciatic nerve
How do you palpate the medial collateral ligament?
Begin with the leg in flexion
Find the joint line, above the tibial tuberosity
Run your finger along the joint line posteriorly until your finger is “pushed out”.
Name the muscles on the anterior of the thigh
Quadricep group; Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius
Name the origin and insertion for all muscles in the quadricep group
All 4 muscles originate from;
anterior inferior iliac spine and linea aspera
All 4 muscles insert into;
patella and tibial tuberosity via the patellar ligament
