Musculoskeletal Diff Diagnosis Lab (10/14c) [Examination/Intervention] Flashcards
Ottawa Knee Rules (aka when to image)
Age ≥55
Isolated tenderness of the patella (no other bony tenderness)
Tenderness at the fibular head
Unable to flex knee to 90°
Unable to bear weight both immediately and in ED (4 steps, limping is okay)
Diff Dx - Bone Problem
Specific tenderness over bony prominence
Difficulty weight bearing
Diff Dx - Contractile Problem
Muscle or tendon problem
Isometric test midrange will be positive
Diff Dx - Ligamentous Cartilage Problem (Noncontractile)
Special tests point in this direction
Cartilage locking, catching, giving way
Joint line tenderness
Diff Dx - Ligament Problem (Noncontractile)
Tenderness to palpation of ligament
Immediate onset of swelling
Joint laxity (positive valgus/varus tests)
Pain Location - Joint Line
Medial - medial meniscus or MCL
Lateral - lateral meniscus or LCL
Pain Location - Tibial Tuberosity (young pt)
Osgood-Schaletters
Pain Location - Anterior
Patellofemoral
Pain Location - Medial Tibial Plateau (2” below joint line)
Pes anserinus bursitis
Pain Location - Posterior
Baker’s cyst
Injury Mechanism - Ligament Problem
deceleration injury or twist of the knee
immediate swelling and pain
may hear a pop sound
Injury Mechanism - Meniscus Problem
twisting or deceleration injury
delayed swelling until minutes/hours after injury, or no swelling
no popping
Injury Mechanism - Chronic Onset
patients with osteoarthritis, patellofemoral syndrome, and Osgood-Schlatter’s syndrome have a more chronic onset of symptoms
Characteristic - Grinding
characteristic of osteoarthritis
Characteristic - Locking and Catching
characteristic of meniscus injuries and osteochondritis dissecans