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IPAP JUNIOR SEM. > ORTHO Knee And Peds > Flashcards

ORTHO Knee And Peds Flashcards

1
Q

Define Plica syndrome

A

Fold of synovium of the knee

5 plicae (suprapatellar, medial, infrapatellar, 2 minor folds)

Usually asymptomatic

Become inflamed and thickened from trauma, overuse

Most commonly medial plica

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2
Q

A pt presents with activity related aching anterior or anteriomedial knee pain
With TTP to the patella, with a pop o when the knee is extended from 90-60 degrees

Overuse injury

Think ? Tx ?

A

Plica syndrome

Tx: non op nsaids, profile limitation
Non op failure: arthroscopic resection

Dx order a AP, Lateral and patellofemoral rad, with MRI

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3
Q

What are the most common PCL injuries

A

Primary restraint to posterior translation of the tibia

Tears with actions that force the tibia posteriorly

Dashboard, fall with foot plantarflexed

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4
Q

What are the 4 MC events that lead to PCL injury

A

Dashboard injury (posterior force of anterior knee in flexion)

Fall onto knee with plantar flexed foot (direct impact to tibial tuberosity)

Pure hyperflexion injury

Hyperextension, after the ACL ruptures
—Frequently results in knee dislocation w/wo spontaneous reduction

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5
Q

What artery and nerve can a PCL injury effect

A

Popliteal artery and tibial nerve

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6
Q

What are two important exams in a PCL tear

A

Neurovascular exam and ABI

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7
Q

What is the Tx appracoh to a PCL tear

A

Non-operative-
Isolated PCL injury: Resolution of swelling followed by early physical therapy

Operative-
Recurrent instability and combined injuries = PCL reconstruction

Adverse outcomes of treatment-
—Popliteal artery and tibial nerve damage
—DVT
—Infection

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8
Q

What is the definition of shin splits

A

Medial tibial stress syndrome

Gradual onset of pain in the posteromedial aspect of the distal third of the leg

Periosteal reaction

Caused by Increased exercise, activity level
Diagnosis of exclusion

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9
Q

A pt presents with TTP distal to the 1/3 posterior medial crest of the leg
W/ Pain with resisted plantarflexion
+/-pes planus,

Think>? Dx? Tx?

A

Shin Splints,

AP/lateral leg (tib/fib) radiographs- Rule out stress fracture

Non-operative-
NSAIDs
Activity avoidance
Arch support shoes
Foot/ankle stretching/strengthening
Compression sleeve
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10
Q

What is the muscle specific to Shin splints

A

Tibialis posterior muscle

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11
Q

Describe bipartite patella

A

Failure of the ossification center of the patella to fuse

Superior lateral corner

Incidental finding

Symptomatic as result of direct blow or following repetitive flexion-extension exercises

Clinical Symptoms
Asymptomatic until fall
Pain after running, jumping in chronic cases
Localize tenderness/swelling to superolateral corner

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12
Q

A pt presents with TTP to the superior-lateral patella after a fall on the knee..

What physiologically “normal” incidental finding is common in this etiology

A

Bipartite patella

Tx: nsaids and rest 5-7 days
Op: surgical removal of ossicles if pain persists

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13
Q

How do you r/o a true bipartatite patella ?

A

X ray both knees

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14
Q

What are the risk factors for dysplasia of the hip in children

A

Risk factors- Family history, breech, oligohydramnios, first-born, swaddling, female

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15
Q

Define Hip dysplasia in peds

A

Relationship between the femoral head and acetabulum resulting in abnormal formation

Associated with metatarsus adductus, congenital muscular torticollis, hyperextension/dislocation of the knee

Neuromuscular HD with cerebral palsy, myelomeningocele, muscular dystrophy, flaccid weakness (spinal muscular atrophy or polio)

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16
Q

What are the ADE of hip dysplasia in peds

A

Longer the dislocation=closed reduction unsuccessful

Premature degenerative joint disease

Unilateral: limb-length discrepancies, ipsilateral knee pain and valgus instability, gait disturbances

Bilateral: Back problems

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17
Q

What is the ped hip exam for every child under 1 year ?

A

Barlow +Ortolani test for hip dysplasia

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18
Q

What does a geleazzi sign tell you

A

Uneven knees on a baby indicates Dev Hip dysplasia

Will also have limited ROM

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19
Q

When should an US or X-ray be done for Dev Hip Dysplsia in Peds

A

Hip radiographs-difficult to interpret due to cartilage

Not obtained until patient is 4-5 months

Ultrasound- not done prior to 6 weeks because of high false-positive rate associated with normal neonatal laxity

US for increased risk of DDH, equivocal exam

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20
Q

What is the only modifiable risk factor for Hip Dysplsia in peds

A

Swaddling

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21
Q

What is the Tx approach to Dev. Dysplasia of the Hip

A

Non-operative-

  • Swaddling is only modifiable risk factor and should be avoided
  • Achieve concentric reduction so a normal acetabulum forms, maintain reduction
  • Pavlik harness less than 6 months

Operative-
Closed reduction + cast
Surgical reduction

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22
Q

Describe Genu Valgum

A

Aka Knock Knees

“Knock knees”

Tibia laterally deviated relative to the femur

NML ranges
Birth= 10-15 deg of varus
12-18m= neutral

2y (max 3-4y)=10-15 deg of valgus

11y (adult) 5-7 deg valgus (normal range 0-10)

Clinical Symptoms
Parent/Grandparent concern
-Asymptomatic
-Rarely have pain or gait disturbance

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23
Q

What are two common ADE of Pavlov harnesses

A

Femoral nerve palsy or hip necrosis

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24
Q

How do you measure genu valgum

A

Tibio femoral angel with a goniometer

Distance between medial malleoli with the medial femoral condyles touching

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25
Q

when should rads be ordered for Genu Valgum

A

Radiographs- Considered when valgus is more than 15-20 degrees, short stature
Full length lower extremity

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26
Q

What are the Tx options for Genu Valgum

A

Non-operative-
Observation treatment of choice for an otherwise normal 3-4 year old & asymptomatic

Operative-
Excessive deformity/symptomatic
hemi-epiphysiodesis
osteotomy

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27
Q

Obvious genu valgum after age 11 should get/..

A

Referral

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28
Q

What is Genu varum

A

AKA bowlegs

Most infants/young children have physiologic genu varum

Older/Adolescents- Blount disease, posttraumatic deformity, metabolic disease, skeletal dysplasias

Pain in the medial compartment

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29
Q

What are the NML measurement for Valgum/ Varum in kids

A

Birth= 10-15 deg varus

12-18m= neutral

2y (max 3-4y)=10-15 deg valgus

11y (adult) 5-7 deg valgus

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30
Q

When should Genu Varum be Rads

A

WB lower extremity radiographs delayed until 2 years old unless:

  • Less than 25th percentile for height
  • Severe for child’s age
  • Asymmetry
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31
Q

What is the Tx approach to Genu Varum

A

Non-operative-
Physiologic varus = reassurance

Blount- usually requires treatment

Bracing- less than 3 years and early in disease

Operative-
Surgery (osteotomy) successful if performed by 4 years

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32
Q

A pt presents with Genu Varum
At 5 years old

What should you do ?

A

Refer!

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33
Q

Describe in toeing vs out toeing

A

Intoeing=
foot deformities
inward tibial rotation (most common diagnosis)
inward femur rotation
Most common in children older than 4 years

Outtoeing=
External tibial torsion or external femoral torsion

Intoeing more common

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34
Q

What are the clinical S/s of in vs out toeing

A

Not pain, usually activity related tripping (intoeing) or inability to keep up (outtoeing)

Assess femur, tibia and foot
Foot progression angle, femoral rotation, thigh-foot angle (>10-15), foot alignment

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35
Q

What is the Tx approach to in and out toeing

A

Education and reassurance

Referral if:

  • Asymmetric
  • Not improving after 4 to 6 years of age
  • Other complaints (deformities)
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36
Q

Discribe Legg- Calve-Perthes Dz

A

Idiopathic osteonecrosis of the femoral head in children

Most commonly diagnosed in boys between 4-8 years old

Clinical symptoms can last up to 18 months, and radiographic healing up to 4 to 5 years

S/S:

  • Limping for 3-6 weeks by the time of initial visit
  • Limp worsens with activity
  • Symptoms worse at the end of the day
  • Aching pain in groin or proximal thigh
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37
Q

What measurement is important to get in in/out toeing

A

thigh-foot angle (>10-15),

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38
Q

A child presents with a limp x 3-6 wks, limp worsens with walking, with acing pain in the groin or proximal thigh, has decreased abduction and internal rotation of AROM, with guarding at extremes of motion, +flexion contracture,

Gait presents with abductor lurch/ trendelenberg gait
With a pos trendelenberg sign

Think ?
Tx?

A

Legg-Calve-Perthes Dz

Order Ap/ Frog lateral pelvis Rads
(Pos crescent sign= subchondral fx)
(Smaller epiphysis and angular changes)

Tx:

Non-operative-
Normalize femoral head via bed rest, NSAIDs, range of motion

Patients less than 5=excellent outcome

Operative-
Possible, early consult is appropriate

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39
Q

What is the referral criteria for legg-calve-perthes Dz

A

Younger than 6 years with great involvement or less than 40 deg abduction!

All patients older than 6 years

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40
Q

Describe Osgood-Sclatter disease

A

Overuse injury in growing child that results from repetitive stress when a too-tight quad pulls on the apophysis of the tibial tubercule during rapid time of growth

Active in sports, boys

Apophysitis @ tibia tubercle= O-S

Apophysitis @ distal patella = Sinding-Larsen-Johansson

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41
Q

describe Sinding-Larsen-Johansson

A

Apophysitis @ distal patella

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42
Q

A 5 year old presents with pain exacerbated by quad activities
And pain with prolonged sitting with knees flexed (theater sign)

Think ?
Tx?

A

O-S Dz

Order AP/Lateral on the knee
(Normal or soft tissue swelling
+Heterotopic ossification
+Unfused apophysis)

Tx: Non-operative-
Initial treatment-
Mild to moderate symptoms-NSAID, RICE, knee pad, stretching
Severe/recalcitrant- immobilization

Operative-
Complete avulsion of ossification center or removal of heterotopic ossification

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43
Q

Describe Slipped Capital femoral epiphysis

A

Progressive displacement of upper portion of the femur relative to capital femoral epiphysis

Occurs thru the physis, typically during adolescent growth spurt

SH1 proximal femur fracture

Overweight (95th percentile), black, boys 13-15y, girls 11-13y

Bilateral-40-50%

44
Q

An overweight black obese adolescent male, presents with pain worse with activity and a limp
On PE you find an externally rotated hip, unable to ambulate ever with crutches, Loss of internal rotation on exam

Alarm for ?
TX;

A

Slipped Capital Femoral epiphysis

order Ap/Frog-lateral pelvis views
(Should inspect for lateral capital femoral epiphysis)
Order Rads if inconclusive

Ranked MILD (less than 30) mod to severe (>50)

Tx Percutaneous Screw Fixation
Profile non wt bearing
Avoid necrosis and maximize function

45
Q

When should you refer pt with Slipper capital femoral epiphysis

A

ALL PTs! Do not delay!

make pts non wt bearing upon Dx

46
Q

Describe transient synovitis of the hip

A

Sterile effusion (not bacterial) of the joint that resolves without therapy or sequelae (4-6 wks)

Common source of limping in 2-7 yo males

Etiology is unknown

Mild trauma for some cases

History of viral illness (URI or GI) days to weeks prior to limping

Clinical Symptoms
Limp (painless or associated with discomfort) and pain localized in groin, proximal thigh, or knee

47
Q

What is the Kline line

A

Line drawl to assess SCFE

48
Q

A young male (2-7) year old presents with a limp

What is chief DDx

A

Transient Synovitis of the Hip

Not septic

49
Q

A 2-7 year old male presents with transient synovitis

What would you find on PE

A

Decreased ROM (particularly in ABduction and IR)

Gait abnormalities (abductor lurch/Trendenlenburg gait)

Most children are afebrile

50
Q

A 2-7 year old male presents with transient synovitis of the hip

What would you find on X-ray

A

Order a Ap/Frog- lat of the pelvis

Usually normal or show widening of joint space due to effusion

Septic arthritis suspected- Urgent US and aspiration at same time

MRI- useful to rule out osteomyelitis, psoas abscess or early Legg-Calve-Perthes

51
Q

What is the Tx for Transietn Synovitis of the Hip

A 
Non-operative-
Activity restriction (bed rest) and NSAIDs

Limp improves with 3-14 days, but can take up to 4-6 weeks for resolution

Sick or substantial discomfort = aspirate + admit for observation

52
Q

Describe Hip impingement

A

Femoral Acetabular Impingement

S/s at the extremes of motions
Assoc with labral Tera’s

Either Cam or Pincer abnormalities

Presents with decreases flexion and internal rotation

53
Q

Describe Hip impingement

A

Femoral acetabulr impingement

Cam or Pincer AbNML

Pain at extremes of motion

Can be acute or insidious

S/S catching, loving, clicking or popping

PT states pain is in a C shape around the lateral hip

Provocked by sitting, stair climbing, rotational movements activities

54
Q

What is the FADDIR test, and what Dz can it Dx

A

Place hip in maximum flexion, adduction, and internal rotation (FADDIR)

Can Dx FAI

55
Q

What Rads should be ordered for Hip impingment

A

Plain films-
-AP/lateral of hip
-decreased femoral head-neck offset (cam) on AP or lateral
Crossover sign (pincer)

Pure Cam impingement- bump on anterior femoral neck that impinges on anteriosuperior labrum with flexion, causing labral tears, cartilage damage

MRI or CT 3D recon- better anatomy of hip

MRI arthrogram- more accurate for labral tears, osseous abnormalities

56
Q

How do you treat FAI

A

Non-operative-
Initial treatment-NSAID, activity modifications, PT

Fluoro guided hip injection

All hip injections need guidance
—Diagnostic and therapeutic

Operative-
Non-operative treatment failure

57
Q

What are three common ADE of Tx for FAI

A

Lateral femoral cutaneous nerve damage

Heterotropic ossification

Or a DVT

58
Q

Define Osteonecrosis of the hip

A

Any disruption of blood supply from trauma or deficient circulation to the hip

59
Q

What are the major Risk Fx for Osteonecrosis of the Hip

A 
OA 
Prior truama or fx 
Corticosteroid use
ETOH abuse 
Sickle cell 
RA 
Lupus
60
Q

A pt with Osteonecrosis of the hip will present with what PE

A

Decreased ROM and Painful ROM with internal rotations

Pain with straight leg raise

And an antalgic gait followed by trendelenberg gait

61
Q

What Rads Should be ordered for Osteonecrosis of the hip

A

AP pelvis, AP and frog lat
With crescent sign
—subchondral fracture

62
Q

What are the only Tx options for Osteonecrosis

A

Operative only

Various complex procedures

  • Core decompression
  • grafting
  • allografting
  • Total hip arthroplasty
63
Q

Describe snapping hip

A
  1. IT band at greater trochanter- most common
  2. Iliopsoas at pelvis- pectineal eminence
  3. Intraarticular labral tears
64
Q

What is the difference between Snapping hip from the IT band vs Illiopsoas vs Labrum

A

IT band- walking, rotation of hip (no pain)
Localized to greater trochanter

Iliopsoas – hip extension from flexion (i.e. rising from a chair) (no pain)
Localized to groin

Labrum- mechanical symptoms (disabling pain)

65
Q

What are the Rads for Snapping Hip

A

Radiographs- normal

Labrum= MRI- intra-articular contrast

66
Q

What are the special tests to evaluate snapping hip

A

Test the IT band with the Ober test

Can evaluate the iliopsoas with snapping felt with hip extensions from a flexed position of the knee

Labrum will present with restricted rotation

67
Q

What rads should be ordered to R/o disorders in snapping hip

A

AP Pelvis and lateral hip
Exclude bony pathology or intra articular disease
Determine if Normal

CT Arthrogram- r/o loose bodies

MRA- r/o tear of the labrum

68
Q

What is the treatment approach to snapping Hip

A

Non-operative-
Not painful- Education and reassurance

Guided by pathology- NSAIDS, PT, avoidance

Operative-
Labrum only

69
Q

Describe transient osteoporosis of the hip

A

Uncommon, idiopathic condition characterized by spontaneous onset of hip pain associated with radiographic osteoporosis of the femoral head and neck

Most common in mid-aged men
Females in 3rd trimester pregnancy

Spontaneous resolution after 6-12 months

70
Q

A pt presents with spontaneous onset of pain in the groin, lat hip, or buttock with increased pain with weight bearing that resides with rest

Is either an older male or pregnant female

Think of what condition and Tx

A

Transient osteoporosis of the hip

Tx:
Radiographs= Diffuse osteoporosis of the femoral head/neck
MRI= rule out other diagnoses and for confirmation of osteoporosis
Or bone marrow edema

Rx: Non-operative-
Self limiting process with spontaneous resolution in 6-12 months

Crutches with limited weight bearing until symptoms resolve and normal bone density on repeat radiographs

71
Q

Describe trochanter in bursitis

A

Inflammation/hypertrophy of bursa without cause or due to previous surgery, limb-length issues, lumbar spine disease

S/s

  • First motion and again over 30 minutes of exercise
  • Night pain from laying on their side
  • IT band friction at the hip
72
Q

A pt presents with TTP to the greater trochanter with pain on active abduction

W/ Pain on First motion and again over 30 minutes of exercise

Night pain from laying on their side

IT band friction at the hip

Think what D/o and Tx

A

Trochanteric bursitis

Non-operative-
Initial management-NSAIDS, modify activities, stretching

Steroid injection

Operative-
Failure of non-operative treatment
—Bursectomy

Adverse outcomes of treatment-
—Infection

73
Q

Describe ACL tear

A

Tear results from rotational +/- hyperextension force applied to knee joint (non-contact)
—Plant, pivot, pop

Often accompanied by meniscal tear, MCL tear

Rarely lateral ligamentous complex or PCL

Multi ligamentous tear uncommon but result in gross instability

74
Q

What is the primary stabizer of the knee

A

ACL

75
Q

A pt presents with Sudden pain and giving way of the knee; with an audible “pop” at POI

+lachmans test
+anterior drawers test

A

ACL tear

Non-operative-
Acute- Rest, ice, crutches (RICE)
—Aspiration of hemathrosis to relieve pain
—Early physical therapy for ROM

Elderly= rehab

Rehab goals-Decrease pain and inflammation with RICE

Operative-
Young= ACL reconstruction

76
Q

How would an ACL tear show on Rads

A

Radiographs- AP/lateral and tunnel

Usually only positive for effusion

Segond fracture (avulsion of the lateral tibia)

Most common in patients with open physes

MRI- sensitive and specific
best for ACL, other path

77
Q

Describe Bursitis of the knee

A

Overuse (housemaid’) vs trauma induced inflamation of the bursa

Prepatellar= septic and aseptic

—septic = Staph aureus and Strep spp (skin flora)

Pes anserine= beneath insertion of Sartorius, gracilis, semitendinosis muscles
—Commonly due to medial compartment OA

78
Q

OA in the medial compartment of the knee often leads to what inflammatory condition,..

A

Bursitis of the knee

Pes aneserine

79
Q

A pt presents with intense joint pain, effusion, erythema, guarding with motion, limited ROM, low-grade fever, and inflammation of the knee

Think what D.o and treatment

A

Septic bursitis

Order: AP/ Lateral rads to r/o fx

Aspiration- gram stain and culture, cell count, and eval for crystals

Tx:
Non-operative-
Rule out septic arthritis with KNEE aspiration

Oral antibiotics= early, mild

IV antibiotics= more severe

Non-infectious- NSAIDs, Ice, modifications

Adverse outcomes of treatment-
—Iatrogenic infection if aspiration performed

80
Q

What is the referral criteria for knee bursitis

A

Septic bursitis

Pes anserine bursitis secondary to OA

Recurrent prepatellar bursa infections

81
Q

Describe Claudication of the knee

A

Activity-associated discomfort in the legs
Either:
1. Neurogenic- spinal stenosis

  1. Vascular- Peripheral vascular
    disease, compromised arterial flow

Both result in similar leg pain presentations

82
Q

Describe the diff of Neurogenic vs Vascular Claudication

A

Neuro: Does not resolve immediately
Improves with stationary bike
Is distributed proximal to distal
And worse when walking down hill

Vascular: resolves immediately
Worsens with stationary bike
And is distal to proximal In distribution

83
Q

What is an ABNML ABI in Claudication

A

Less than 0.9 is ABNML

84
Q

A pt presents with Diminished/absent pulses below the waist, cool extremities, ulcerations with an ABI of 0.8

What is the Dz and Tx

A

Claudication

Order AP/ LAt of the spine to r/o neurogenic cause

Doppler US to visualize decrease blood flow

Tx:
Non-operative-
Neurogenic- NSAIDS, epidural steroid injections, PT

Vascular- Supportive measures
Meticulous foot care, well-fitting and protective shoes

Operative-

  • Spinal decompression/fusion
  • Vascular surgery-bypass grafting
85
Q

What is stage I-II-III laxity grading in MCL and LCL tears

A

Laxity grading-
I= <5mm
II= 5-10mm
III= >10mm

86
Q

What are the different Rads findings in MCL vs LCL

A

MCL; avulsion on the femoral origin

LCL; avulsion on the fibular head

87
Q

What are the Tx options for MCL and LCL tears

A

Non-operative-
Grade I and II LCL and MCL

MCL III- proximal and midsubstance
RICE, crutches, NSAIDs, brace, ROM early

Operative-
LCL III, within 7 days
—Often involves PCL injuries

88
Q

Describe Illiotibial band synonyms

A

Relational to lateral femoral condyle (at the KNEE)

Knee extended-ITB sits anterior to femoral condyle

Knee flexed >30-ITB moves posterior to condyle

Population

  • long distance runners
  • cyclists
89
Q

A pt presents with TTP at anteriolateral knee 3cm to the proximal joint line
With a positve ober test

What is the syndrome and Tx

A

Illiotibial band syndrome

Tx:
Non-operative-
Initial treatment-NSAIDs, modifications, PT

Corticosteroid injection if no improvement with above

Operative-
Few options (rare)
—ITB lengthening

90
Q

Describe a Gastrocnemius Tear

A

Acute strains or ruptures at medial head (musculotendinous junction)

From Tennis, running on a hill, jumping

Most commonly greater than 30 years old

CAN HAVE A DVT DUE TO TRUAMA/ Inactivity

91
Q

a pt presents with Pulling/tearing sensation in the calf
W/ Diffuse pain, swelling, tenderness
Unable to perform a calf raise,
+Thompson test

Think what Tear and Tx

A

Gastrocnemius Tear

Tx:
Non-operative-
NSAIDs, RICE, CAM boot with heel lift, compression sleeve, crutches

Most return to previous functional level in 6-8 weeks

Operative-
Repair- Large (palpable defect)

Adverse outcomes of treatment-
—Loss of dorsiflexion and atrophy of the calf

92
Q

A pt presents with twisting injury of the knee, yet continued to play through the injury

Later they have pain that worsens with twisting/ squatting activities

Think what tear and Tx?

A

Meniscal Tear

Tx:
Non-operative-

No mechanical symptoms and degenerative tear- RICE, NSAIDs, Early w/ physical therapy ROM

Locked knee?- May need sedation and should be managed surgically

Operative- Younger people, locked knee, older patients without response to nonsurgical treatment

Peripheral tears= repair
Large tears= arthroscopic debridement

Adverse outcomes of treatment-
Less meniscus= less shock absorption = more OA

93
Q

What is the referral criteria for meniscal tear

A

Mechanical symptoms

Ligamentous instability

Peripheral tear

Failure of nonsurgical management

94
Q

Describe Ocetonecrosis of the femoral condyle

A

“Bone death”

Etiology unknown- stress fracture with combination of trauma and altered blood flow

Weight bearing medial femoral condyle most commonly involved

Causes: Idiopathic, chronic steroid therapy, SLE, sickle cell, etc.

Women (3:1), older than 60

95
Q

A pt presents with a sudden sharp pain to the medial compartment of the leg, with constant pain that worsens with activity,

TTP at the median femoral condyle beside the patella

Think? Tx?

A

Osteonecrosis of the femoral condyle

Rads will show early sclerosis and flattening of the joint space

Tx: Limit activists and brace
NSAIDs, steroids for pain
Early surgical referral

96
Q

Define patellar/ Quad tendonitis

A

Aka Jumpers knee
Or extenso mechanisms tendinitis

Overuse or overload syndrome involving either the quadriceps tendon at its insertion on the superior pole of the patella or the patellar tendon at the inferior pole or tibial tuberosity

Younger (<40)- Jumping/kicking sports

Older- lifting, change in exercise level, weight gain

97
Q

A pt presents with anterior knee pain

States it gets worse when climbing/descending stairs, running, jumping, squatting

TTP at bony attachments of the quad/ patellar tendon

With puffiness around the infrapettelar bursa

Knee rom is NML but has increased pain with resisted extension and at extremes of passive flexion

Think? Tx?

A

Patellar/ Quad tendonitis

Rads will show

Radiographs- AP/lateral often normal but may show enthesophytes or heterotopic ossification at upper/lower pole of patella

When at tibial tubercle= history of Osgood-Schlatter

MRI- recalcitrant cases

Tx:

Non-operative-
Initial treatment= Rest from aggravating activities

Regaining pain-free ROM, flexibility, THEN strengthening

Gradual resumption of activities

98
Q

define patellar/ quad tendon rupture

A

Displaced patellar fracture or rupture of the quad/patellar tendon can disrupt the extensor mechanism of the knee = results in inability to actively extend the knee fully

Fall on a partially flexed knee

Quad= white male 40-60;
Patella= black male 40-60

99
Q

What is the clinical triad of Patellar/ Quad tendon ruptures

A

Clinical triad:

  1. palpable defect
  2. inability to extend
  3. change in patella height on x ray
100
Q

A pt presents with a large effusion and palpable defect at the knee,
Unable to extend the leg against gravity and can not perform a straight leg raise

Think /?
Tx?

A

Petal/Quad tendon rupture

Rads will show:

AP/lateral plain films (30 degrees on lateral)-
patella alta= patellar
patella baja= quadriceps

MRI- will confirm a tendon rupture but rarely necessary if clinical triad present

Tx: Non-operative-
Rare and only for incomplete
—Knee immobilizer/cylinder cast
Operative- 
—All complete ruptures or fractures= surgical
101
Q

What is the likely time frame to retear the Patellar/quad tendon after repair

A

Retear in the 1st 6 months

102
Q

When should Patellar/quad ruptures be referred

A

All complete ruptures should be referred in 1 week

103
Q

Describe patellofemoral maltracking

A

Spectrum of conditions defined by abnormal motion of the patella
—Lateral patellar overload syndrome
—Recurrent patellar instability

Most commonly lateral

Medial patellofemoral ligament- torn or stretched

Subluxation or dislocation

104
Q

A pt presents with a patella that can dislocate and spontaneously reduce
With retropatellar pain with climbing stairs, + Theater sign +TTP at the patellofemoral ligament
+j sign
+apprehension test

Think ?
Tx?

A

Patellofemoral maltracking

Rads with show

Plain films- AP, lateral and sunrise (Merchant or Laurin)
-Relationship of patella to femoral trochlea
MRI= bone bruising, medial patellofemoral ligament injury

Tx: Depends on chronicity
Non-operative-
Acute patellar subluxation or dislocation
—Initial treatment- NSAIDs, bracing, Ice, modified weight bearing (up to 4 weeks)
Followed by ROM and strengthening

Chronic recurrent maltracking
—Quad strengthening and flexibility, bracing, PT

Operative-
Non-operative treatment failure
Medial patellofemoral ligament reconstruction

105
Q

Descibe patellofemoral pain

A

Constellation of problems
Diffuse, aching anterior knee pain
—Not “chondromalacia”

Multifactorial- related to overuse and overloading of the patellofemoral joint

106
Q 
A pt presents with Diffuse, aching, anterior knee pain with prolonged sitting (theater sign)
W/ Quad activities pain 
- climbing stairs, jumping, squatting 
W/ a hx of direct blow to the patella
\+patellar grind 
\+apprehension test 
\+J sign

Think?>?

Tx?

A

Patellofemoral pain

Order Plain films- AP, lateral and sunrise (Merchant or Laurin)

Non-operative-
PT hallmark of treatment for PFPS
NSAIDs, weight loss (Obese)

Adverse outcomes of treatment-
—Avoid aggressive quad activities during or later in rehab period

IPAP JUNIOR SEM. (43 decks)

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