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Semester 2 PM Exam 8 > Nonsurgical Knee Disorders > Flashcards

Nonsurgical Knee Disorders Flashcards

1
Q

Differential dx - referral from lumbar spine, hip, or ankle

A

medial knee = L3

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2
Q

Differential dx - local musculoskeletal

A

strains, sprains, ligament, tendon, meniscus, bursitis, tendonitis, nerve, joint, bone

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3
Q

Differential dx - systemic disease

A 
thyroid
tumors
pyrogenic arthritis
hemophilic arthritis
inflammatory disease (RA, gout, reiters)
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4
Q

Differential dx - vascular system

A

arterial - intermittent claudication
venous - DVT
compartment syndrome

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5
Q

External tibial torsion

A

patella position compared to foot position

tibia has rotated so the distal tibia is lateral rotated compared to the proximal tibia

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6
Q

External tibial torsion
Mechanism
Can lead to

A

Congenital

Can lead to OA or patellafemoral pain/foot issues

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7
Q

If you see patient foot turning out but their knee cap is straight..

A

they likely have external tibial torsion - could be internal but is way less common

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8
Q

Miserable Mal-alignment syndrome

A 
Femoral anteversion
Genu valgum
VMO dysplasia
Lateral tibial torsion
Forefoor pronation
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9
Q

Patella alta - cause

A

can be congenital but more likely cause is tear of patellar tendon

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10
Q

Patella baja - cause

A

can be congenital but more likely cause is scarring/shortening in tendon secondary to surgery or tear of quad tendon

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11
Q

Camel sign

A

2 bumps when looking laterally
One is tibial tub and one is patella
Secondary to patella alta

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12
Q

Squinting patella

A

Patellas look at each other
Cause femoral anteversion
Weakness in post glut med and possible TFL tightness

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13
Q

TAKE HOME

A

almost all structural deviations can cause patella femoral pain

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14
Q

Articular disorders of the knee

A 
RA
Gout
Hemophilic arthritis
Pyogenic arthritis 
OA
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15
Q

OA site of disease

A

medial joint tends to be more impacted

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16
Q

RA site of disease

A

Kind of all over the place

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17
Q

CPPD (pseudogout) site of disease

A

?

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18
Q

RA - etiology

A

Chronic inflammatory disease

Can involve cardiovascular and pulmonary systems

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19
Q

RA - epidemiology

A

peak onset 30-40 yo

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20
Q

RA - pathology

A

Infiltration of immune cells into synovial fluid and destruction of capsule - massive inflammation and articular cartialge destruction and synovial hyperplasia
Usually in both joints

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21
Q

RA - Clinical presentation

A

In acute = hot and swollen

In chronic = joint deterioration with deformity, ROM limitations, gait abnormalities

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22
Q

RA treatment - Acute

A

Refer to physician for medical care

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23
Q

RA tx - Subacute

A

AROM, PROM, mobilization, stretching, strengthening

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24
Q

RA tx - chronic

A

Supportive devices, assistive devices, strengthening

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25
Q

Gout/Pseudogout - epidemiology

A

M-F 3:1

Usually age 40+

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26
Q

Gout Clinical presentation

A

swollen, hot knee, painful - refer to physician

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27
Q

Gout Clinical presentation post acute phase

A

ROM, infrequently seen by PT

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28
Q

Gout pathology

A

Elevated serum uric acid and deposition of urate crystals in joints soft tissues and kidneys

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29
Q

Pseudogout pathology

A

deposit of calcium psyrophosphate crystals

very often located in patellafemoral joint

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30
Q

Reactive arthritis - Reiters syndrome - Etiology

A

from microbial pathogen away from site

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31
Q

Reiters syndrome - Pathology

A

usually caused by VD or dysentery - triate of urethritis, conjunctivitis, and arthritis, common in HIV patients

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32
Q

Reiters syndrome - Epidemiology

A

Males, 30s, hx of infection

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33
Q

Reiters syndrome - clinical presentation

A 
Swollen knee
Inflammatory synovitis 
Erosion of insertion of ligaments and tendons
Edema of synovium
Often skin lesions
Hard to dx
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34
Q

Hemophilic Arthritis

A

knee most common joint

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35
Q

Hemophilic arthritis etiology

A

blood in joint leads to cartilage degeneration

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36
Q

Hemophilic arthritis - clinical presentation

A

swelling, warmth, motion limitations, pain

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37
Q

Hemophilic arthritis - treatment

A

medical emergency secondary to joint destruction - clotting factor given
Immobilization followed by cautious mobilization

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38
Q

Pyogenic Arthritis - Etiology

A

Bacterial infiltration primarily from gonococcal infections, lyme disease, TB, styphilis, knee most common

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39
Q

Pyogenic arthritis - pathology

A

microabcesses from in synovial membrane and break open into joint
Medical emergency
Total destruction of joint w/in 2-3 wks

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40
Q

Pyogenic arthritis - clinical presentation

A

painful, red, hot, may weep pus if open wound, pain, swelling, loss of function

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41
Q

Pyogenic arthritis - treatment

A

confirmed by aspiration and blood work, joint aspiration, rest (little to no movement), antibiotics

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42
Q

OA etiology

A

Usually in medial compartment or patella

Wear and tear due to age, post trauma

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43
Q

OA epidemiology

A

older adults or post trauma

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44
Q

OA pathology

A

wearing away hyaling cartilage to subchondral bone with lost of joint height and boney changes

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45
Q

OA diagnostic radiographic findings

A

Dec joint space, asymmetrically
Sclerosis subchondral bone
Osteophyte formation at joint margins
Subchondral cyst formation

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46
Q

OA clinical presentation (10)

A 
Osteophytes limit motion
Joint deformity occurs
Medial compartment more common (genu varus)
Altered mechanics
Activity inc pain, dec with rest
Pt complains of initial stiffness with movement initiation
Mild inflammation
Muscle atrophy
C/o instability 
Joint line tenderness
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47
Q

OA tx - medical

A

weight loss
NSAIDs
Hyaluronic acid injections
Glucosinamine/choidroiten sulfate

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48
Q

OA tx - surgical

A

arthroscopy
tibial osteotomy
total joint replacement

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49
Q

OA complications post TKA

A

DVT - some studies have placed occurrence at 70%
Infections (2.5%)
Dislocations or improper alignment
Neurovascular

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50
Q

OA PT post surgery

A 
AROM PROM, must achieve 90 degrees flexion before d/c
Continuous passive motion machines
Pain control
Protected WB with gait
Strengthening
Functional mobility
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51
Q

PT for OA

A

Compression for swelling
Minimize forces around knee with assistive devices
Strengthening
Mobilization
Bracing and heel wedges
Transition to ex program w/o stressing knee

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52
Q

Meniscal injuries - Incomplete

A

Partial through the body of the meniscus

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53
Q

Meniscal injuries - Complete

A

across the entire body

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54
Q

Meniscal injuries - Horizontal

A

most often chronic degenerative type of tear

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55
Q

Meniscal injuries - Vertical

A

traumatic, more common (bucket handle)

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56
Q

Meniscal injuries - Radial

A

central part of the meniscus

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57
Q

Meniscal injuries - Flap

A

progression of degenerative changes

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58
Q

Etiology of meniscal tears

A

cause primarily in a cutting motion during sport, quick rotation or degeneration

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59
Q

Meniscal tear - most likely to occur

A

in 30 degrees of flexion

often associated with ACL and MCL injury if caused by trauma

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60
Q

Meniscal tear - pathology

A

symptomatic when torn portion is mobile and moves into abnormal position
Poor blood supply except for outer edge of meniscus leads to poor healing

61
Q

Meniscal tear - clinical presentation

A 
Locking - unable to extend
Instability
Pain, sharp with ache
May click or snap
Swelling not suddenly
62
Q

Meniscal tear - special tests

A 
joint line palpation
valgus/varus stress tests
Apley's compression and distraction
McMurray
Arthrogram
MRI
63
Q

Meniscal tears - non surgical treatment

A

goal is to protect articular cartilage
Progressive strengthening of lower quadrant
NSAIDs

64
Q

Meniscal tears - surgical treatment

A

Menisectomy

Meniscus repair - protective phase is longer with repair

65
Q

Ligamentous injuries

A 
WB injuries with stress 
Inability to WB after injury
Immediate swelling
May hear pop or feel tear
May have associated injuries of other ligaments, meniscus, or capsule
66
Q

ACL etiology

A

contact and noncontact
hyperextension (femur pushed post) OR flexed/abducted/valgus/ER
(tibia ant with abd/ER force)

67
Q

ACL epidemiology

A

More frequent in females

68
Q

ACL clinical presentation

A

often audible pop, swelling, knee flexion secondary to protection from hams

69
Q

ACL special tests

A

Lachmans, ant drawer, pivot shift

70
Q

ACL treatment

A

surgical repair may not be needed - each patient is different

71
Q

Post surgical rehab for ACL

A 
swelling reduction
ROM
quad activation/hamstring strengthening
normalize gait
proprioception/balance
functional activities
72
Q

KT 1000/2000 tests

A

machine to assess tibial translation and how functional one can be with ACL injury

73
Q

PCL etiology

A

posterior tibial translation
most often MVA with tibia into dashboard
Falling onto flexed knee
Hyperextension with force through tibia

74
Q

Epidemiology of PCL

A

much rarer than ACL

75
Q

Clinical presentation PCL

A

Acute hemarthrosis, no pop or snap; pain

76
Q

Special tests PCL

A

post drawer, post sag, reverse lachmans

77
Q

PCL - surgical

A

using infra or supra patellar tendon graft

78
Q

PCL non surgical

A

Protected ROM (0-60 at first)
Strength
WB exercises
Avoid isolated hams during first 3-4 wks

79
Q

MCL etiology

A

valgus stress (contact) - most injuries with rotational forces will damage other structures too

80
Q

MCL clinical presentation

A

swelling, pain, instability, point tenderness, limited motion due to pain

81
Q

MCL special tests

A

valgus stress test (0 and 30)

Grades 1-3, Grade 1 slight sprain, grade 3 = complete tear

82
Q

MCL treatment

A

usually monsurgical
bracing - long leg immobilizer 2 wks progressing to brace - lateral supports for 6 wks
Stretch/strengthen, proprio, functional

83
Q

Quad tendon rupture etiology

A

overuse or trauma
more common in people over 40
tight quad is risk factor
tends to happen at 90 degrees knee flexion

84
Q

Quad tendon rupture clinical presentation

A

palpable defect in suprapatellar tendon

pain, swelling, unable to actively extend knee, decreased ability to WB

85
Q

Quad tendon rupture treatment

A

operative repair

86
Q

Quad tendon rupture post surgical rehab

A

gradual WB, gradual strengthening, soft tissue mob, patellar mob

87
Q

Patella tendon rupture - etiology

A

usually forceful eccentric contraction

88
Q

patella tendon rupture - epidemiology

A

more common in those under 40, usual underlying problem prior to rupture

89
Q

patella tendon rupture - treatment

A

surgery

prolonged rehab with flexion cautions

90
Q

Patellofemoral pain etiology

A

idiopathic, multi factorial, malalignment causing abnormal compression, chondromalacia

91
Q

Patellofemoral pain clinical presentation

A

inc pain with quad loading; possible palpable tenderness

92
Q

Patellofemoral pain treatment

A

EMG/biofeedback, stretch/strength, posture/alignment, stress reduction, HIP STRENGTHENING, patella taping
Surgical lateral release

93
Q

Patella subluxation/dislocation etiology

A

tends to sublux more frequently than dislocate, instability with giving way when cutting away from affected side

94
Q

Patella sub/dis epidemiology

A

females: males
3: 2

95
Q

Patella sub/dis clinical presentation

A 
click, slide and lock felt
Vastus medialis atrophy
Vastus lateralis hypertrophy
\+ apprehension test
Tenderness around patellar border and lots of swelling
96
Q

Patella tendonitis etiology

A

overuse, repetitive jumping, running

97
Q

Patella tendonitis pathology of tendonitis

A

inflammation of the tendon - acute presentation with pain, swelling warmth

98
Q

Patella tendonitis - pathology of tendinopathy

A

repeated bouts of inflammation causing pain, scarring, poor circulation to tendon

99
Q

Epidemiology of tendonitis

A

common age 20-40 yo

100
Q

Clinical presentation of tendonitis

A

insidious onset, pain at inf patellar pole, inc with knee ext and dec with rest

101
Q

Treatment of patella tendonitis

A

stretch quads, progressive quad strength, patellar mobs, tendon compression/bracing/taping, posture alignment, stress reduction
Surgical excision of necrotic fibers is rare

102
Q

Pre patellar bursitis etiology

A

prolonged kneeling

repetitive falls onto knees

103
Q

Pre patellar bursitis clinical presentation

A

pain to palpation of swollen pre patellar bursa, swelling, ROM is WNL but feels tight

104
Q

Pre patellar bursitis treatment

A

aspiration of excision if sever, activity modification, physical agents if needed

105
Q

Chondromalacia patellae etiology

A

trauma, multiple subluxations, overuse

106
Q

Chondromalacia patellae patholgoy

A

softening/flaking off of cartilage on undersurface of patella

107
Q

Chondromalacia patellae clinical presentation

A

inc pain with quad loading

108
Q

Chonromalacia patellae treatment

A

physical agents, stretch tight muscles, strengthen LE, posture/alignment, reduce stress to patella with tape or brace
Can do arthroscopic shaving too

109
Q

Fat pad syndrome etiology

A

irritation of infrapatellar fat pad
mostly due to impingement of fat pad btw femoral condyles and patella
patient often genu recurvatum

110
Q

Fat pad syndrome treatment

A

lontophoresis, corticosteroid injection, orthosis, taping of patella, treat causative factor behind the irritation

111
Q

Distal femur fracture etiologyu

A

trauma with result soft tissue injury

112
Q

Distal femur fracture treatment

A

usually surgical - if not will cast brace with knee ROM of 30-40 degrees NWB to TTWB

113
Q

Distal femur fracture - surgical tx

A

ORIF with intermedullary rod

WB depends PWB from 4-12 wks

114
Q

Distal femur fracture - classified orthopedic trauma association
Type A
Type B
Type C

A 
A = extraarticular
B = unicondylar
C = bicondylar
115
Q

Proximal tibial fracture etiology

A

Often associated with othe rknee trauma, may be missed initially

116
Q

Proximal tibial fracture treatment

A 
nonoperative = casting for 3 to 6 weeks 
operative = depending on severity, NWB 12 weeks
117
Q

Patella fracture etiology

A

usually occur with direct blow to patella (MVA to dashboard) - avulsion can occur

118
Q

Patella fracture treatment

A

surgery = required for displaced more than 3mm

Non surgical = knee immobilizer WBAT

119
Q

Patella fracture PT treatment when healed

A

progressive ROM, strength function

120
Q

Patella fracture classification by ortho trauma association
Type A
Type B
Type C

A 
A = extraarticular with apex avulsion
B = partial articular with preserved extensor mechanism
C = articular with disruption of extensor mechanism
121
Q

Proximal fibula fracture

A

usually occur with proximal or distal tibia fracture

Less common

122
Q

Osgood Schlatter’s disease AKA tibial apophysitis - etiology

A

overuse injury in young athletes

123
Q

Osgood Schlatter’s disease AKA tibial apophysitis - pathology

A

osteochondrosis of tibial tub

124
Q

Osgood Schlatter’s disease AKA tibial apophysitis - Clinical presentation

A

tenderness to palpation at tibial tuberosity; inc with quad loading

125
Q

Osgood Schlatter’s disease AKA tibial apophysitis - treatment

A

physical agents, stretch/strength, posture/alignment, stress reduction

126
Q

Osteochondritis Dissecans - etiology

A

separation of cartialge and subchondral bone
Pieve becomes necrotic, loose body in joint space
Cause is unknown but htought to relate to poor vascular suply
Most commonly medial condyle

127
Q

Osteochondritis Dissecans - epidemiology

A

adolescent, young adult

128
Q

Osteochondritis Dissecans - Clinical presentation

A

deep pain in knee, quadriceps atrophy, may have tenderness to palpation, feelings of instability and intermittent locking

129
Q

Osteochondritis Dissecans - special tests

A

rediography

130
Q

Osteochondritis Dissecans - treatment

A

operative excision or fixation may be needed

131
Q

IT band friction syndrome etiology

A

overuse, common in runner and cyclists

132
Q

IT band friction syndrome - pathology

A

irritation of ITB at lateral femoral condyle

133
Q

IT band friction syndrome - Clinical presentation

A

localized tenderness over lateral femoral condyle

134
Q

IT band friction syndrome - Treatment

A

physical agents, deep friction, stretch/strength, posture/alignment, orthotics, stress reduction, hydrocortisone injection, surgical release

135
Q

IT band friction syndrome - special tests

A

noble stress test, obers

136
Q

Bakers cyst etiology

A

herniated synovial linign

137
Q

Bakers cyst clinical presentation

A

observable and palpable lump in popliteal fossa, presents as a mass
Might mimic intermittent claudication s/s, could rupture, knee flexion contracture is common

138
Q

Bakers cyst treatment

A

drained or surgical excision if nuisance
Hams and gastroc stretching
Hams strengthening

139
Q

Pes Anserine Bursitis - etiology

A 
overuse injury (tendinopathy)
may also have tendinitis
140
Q

Pes Anserine Bursitis - Clinical pres

A

localized tenderness to pes, insidious onset

141
Q

Pes Anserine Bursitis - diff dx

A

hams tendinopathy, tibial stress fx, DJD, peudogout, meniscus

142
Q

Pes Anserine Bursitis - special test

A

resisted contraction of mm inserting into area
Sartorius
Semitend
Gracilis

143
Q

Pes Anserine Bursitis - Treatment

A

physical agents, stretch/strength (medial hams) posture/alignment stress reduction

144
Q

Popliteus tendonitis etiology

A

overuse injury (runners, banked surfaces or downhill)

145
Q

Popliteus tendonitis clinical pres

A

localized tenderness at femoral insertion

146
Q

Popliteus tendonitis treatment

A

physical agents, transverse friction massage, stretch/strength, posture/alignment, stres reduction

147
Q

Plica syndrome etiology

A

embryological synovial tissue, chronic irritation, diagnosis is often one of exclusion

148
Q

Plica syndrome clinical pres

A

symptoms present more commonly in medial aspect of knee

pseudo locking, pain, aches at rest

149
Q

Plica syndrome treatment

A

physical agents, hamstring stretches, quad strengthening, limit repetitive motion that irritates plica initially

Semester 2 PM Exam 8 (5 decks)

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