Other pathologies of the KaNee Flashcards
What is a baker’s cyst?
odd amount of synovial fluid in the fatty layers of the popliteal fossa
the most common synovial cyst in the knee
What are the subjective findings of a baker’s cyst?
problems of tightness/swelling behind the knee
pain down the back of the leg for bigger cysts
no other hx of trauma
What are the objective findings for a Baker’s cyst?
put the patient in prone with full knee extension = there should be an oblong (lol) mass there that can be seen and palpated
- found in the medial popliteal fossa
AROM knee flexion = 10-15deg limitations with a bigger cyst
What are the interventions used for Baker’s cyst?
Non-invasive = RICE
- no contraindications = use pain relievers or anti-inflammatory for pain relief
Bigger cysts that affect function = aspirate
aspirate = taking the fluid out
What is the mechanism of injury for a medial gastroc strain?
acute, super hard push off during hill running, jumping or tennis (change in direction)
↑ volumes of running loads (especially after period of inactivity)
- Acceleration and deceleration
- fatgiue conditions or play or performance
What is the subjective findings of a medial gastroc strain?
nagging about pulling or tearing sensation of the calf
can keep ankle in PF (tippy toe) to keep tension out
What are the interventions for a medial gastroc strain dependent on?
Depends on the stage of healing
What is the main goal of interventions for during the acute phase of medial gastroc strains?
we want to be able to control the pain and inflammation (RICE LOL)
Easy AROM and PROM exercises then progressing slowly towards PF strength (bike, leg presses and heel raises)
When can sport-specific activites be done again for medial gastroc strain?
Once its pain free with full and even ROM with full strength
What is needed even after PT for medial gastroc strain?
stretching and strengthening for several months to avoid reinjury because of the built up scar tissue
What is the most common cause of mechanical sx of the knee?
a torn meniscus
What the mechanism of injury for meniscal lesions?
When they try to turn, twist or change direction when FWB
- can also be from damage to the lateral or medial aspect
What causes the pain sx of meniscal tears due to lack of pain fibers?
it is from the tearing and bleeding into peripheral attachments and possibly traction on the capsule
What is the expected subjective findings from a meniscus tear?
reports of major twisting injury to the knee
- careful with older pt’s with degenerative tear can hx of min or no trauma
typical sx: popping, catching, clicking or swelling
joint line pain with hard time during twisting or squating movements
pt will say “damn i wisted my knee during ______”
What is the function of meniscus?
load transmission
secondary stabilization
How does the meniscus help with load transmission?
50% load –> extension
85% load –> 90 deg of flexion
resection of 15-34% increases pressure by 350%
How does the medial meniscus help as a secondary stabilization?
provides anterior restraint especially in a bad/deficient ACL
What is the average movement of the meniscus during knee flexion?
medial - 5.2mm
lateral - 11mm
What are the objective findings of a meniscal tear?
- medial or lateral joint line tenderness
- some effusion
- forced flexion and circumduction (IR and ER of the foot) with constant pain on the side of the knee
What are the special tests for meniscal tears?
McMurray (best)
Apley’s (minimal value to detect tear)
Steinmann I (moderate diagnostic ability)
What are interventions for meniscal tears dependent on?
On several factors;
- age
- activity demands
- size
- location of the tear
What are the main approaches for interventions for a meniscal tear?
rehab (US!!!)
menisectomy
meniscus repair
allograft transplantation (doesn’t happen often)
What is the Osgood schlatter’s?
Osteochondritis of the inferior patella
OR
Ostochondritis of the tibial tuberosity
OR
Tibial tubercle traction apophysitis
What is the Osgood schlatter’s also known for?
form of periostitis of the tibial apophysitis
- it comes up as a partial avulsion of the tib tuberosity with osteonecrosis of the bone fragment
When does Osgood schlatter happen?
young during growth spurts
What are the subjective findings of Osgood schlatter’s?
Gradual increase in pain and swelling below knee
- involvement in sporting activities that has to do with high pressure
What are the objective findings of Osgood Schlatter’s?
- bump over tibial tubercle
- mild swelling
- pinpoint tenderness
- PROM limits of knee flexion
- AROM painful at end-ranges
- pain during resisted knee extension
- shorteninng of the HS, quads and calf muscles
What is the prognosis of Osgood Schlatter’s?
self-limiting and spontaneously remitting over 6-24 months
- as tibial tubercle hardens
What is patellar tendonitis?
an overuse injury because of eccentric overloading during deceleration activities
Activities like repeated jumping and landing, downhill running
Where is the main area affected with patellar tendonitis?
inferior pole of the patella or it’s insertion at the tibial tubercle
What is the subjective findings of patellar tendonitis?
- hx of jumping or kicking sports
- anterior knee pain
- pain right after end of exercise or lack of activity
- pain with sitting, squatting or kneeling
- pain with climbing or descending stairs, jumping or running
What are the objective findings of patellar tendonitis?
- localized tender at painful areas
- AROM knee normal
- pain with PROM hyperflexion of knee
- pain with resisted knee extension
What is the 1st stage of intervention for patellar tendonitis?
relative rest from aggravating activites
What is the 2nd stage of intervention for patellar tendonitis?
- Regain pain free active motion
- flexibility of quads and HS
- exercise focusing on pain-free quad strengthening
What is the 3rd stage of intervention for patellar tendonitis?
gradual resumption of the activities that caused the sx
What is the prognosis of patellar tendonitis?
self limiting and responds to rest
stretching
eccentric strengthening
bracing
What is patellofemoral pain syndrome?
common disorder that is diagnosed on the presence of anterior or retropatellar knee pain
- happens with prolonged sitting or with wt-bearing activities that load the PF joint
What is the subjective findings of patellofemoral pain syndrome?
- anterior knee pain with going up or down stairs or even hills
- patellar instability with activities
- no hx of trauma and swelling is uncommon
- more common in females than male patients
What are the objective findings of patellofemoral pain syndrome?
- can see valgus alignment of the knees
- femoral anteversion (increased IR to ER)
- abnormal tracking
- quad weakness
- laxity of patellofemoral ligaments
- hip weakness
- poor eccentric quad control
What are the special tests for patellarfemoral pain syndrome?
Clarke’s sign
Fairbank apprehension test for patellar instability
What is the specificity and sensitivity of clarke’s sign?
Specificity: 0.67-0.95
Sensitivity: 0.29-0.49
What is the specificity and sensitivity of Fairbank’s Apprehension test?
High specificity (0.70-0.92)
Lower sensitivity (0.07-0.37)
More specific than sensitive
- positive test would help rule in patellofemoral instability
What is plica syndrome?
Becomes inflamed and thickened because of trauma or overuse
= joint interference
What is the subjective findings of plica syndrome?
- insidous (but related to fall or injury????)
- achy in the anterior or anteromedial aspects of the knee
- painful snapping or popping
What are the objective findings of plica syndrome?
- tenderness according to the location of sx plica (usually medial)
- be able to reproduce snapping or popping at around 60 deg of knee flex with passive extension
What are the possibe interventions for plica syndrome?
Conservative:
- stretching of quads, HS and gastroc
- strengthening
- ice
- patellar bracing
- NSAIDs
- Altered sports training
Possibly surgical if conservative fails
What is prepatellar bursitis?
inflammation or infection of prepatellar bursa
- can be due to a truama to anterior knee
- things like a direct blow or chronic irritation
What is the subjective findings of prepatellar bursitis?
complaints of knee swelling
knee pain just in front of the knee
What is the objective findings of prepatellar bursitis?
- swelling straight over the inferior portion of the patella
- palpation = bursal sac tenderness (acute) or bursal sac thickening (chronic)
- normal AROM of the knee
- no specific special test
What are the interventions of prepatellar bursitis?
- decrease inflammation thru cryotherapy
- pt education on activity modifications
- adaptive shortening of quads, HS or IT band
- instruction in stretches
What is the prognosis of prepatellar bursitis?
- half of traumatic bursitis solves out of nowhere
- around 10% progress towards chronic and need bursectomy
What is IT band tendonitis?
too much friction between ITB and lateral femoral condyle
What population is IT band tendonitis common in?
runners and cyclist
What are the subjective findings of ITB tendonitis?
- pain @ lateral knee
- intially sx starts after a certain period of activity
- which turns to pain with activity
What are the objective findings of ITB tendonitis?
- Tender @ lateral feemoral condyle (around 3cm proximal to the joint line)
- Soft tissue swelling and crepitus
- no joint effusion
What are the special tests for ITB tendonitis?
Ober’s
Noble’s
What are the interventions of ITB tendonitis?
Rest
Ice
NSAIDs
Stretching
Cortisone
Platelet-rich plasma
What is the prognosis of ITB tendonitis?
LONG recovery
gets better with rest
What is the population of patellar dislocation?
- young, active patients at highest risk (~ 13-20 y/o)
- common in football and bball
- more women
How is the reoccurence of patellar dislocation?
Reoccrence is common
- especially if the first dislocation is under 15
What is the mechanism of injury for patellar dislocation?
- indirect trauma most common
- strong quad contraction while leg is in valgus and foot planted
- other knee ligament can occur
What are the subjective findings of patellar dislocation?
- a “pop” and immediate pain
- knee deformity
- painful
- can’t bend knee
- can relocate and feel unstable
What are the objective findings of patellar dislocation?
- laterally shifted patella
- swelling
- (+) for patellar apprehension
What are the interventions for patellar dislocation?
- NSAIDs
- Ice
- brace
- PR with quick ROM, quad strength and electrical stimulation
Can be solved by surgery if its constantly unstable
What is the prognosis of patellar dislocations?
reccurent instability is common
- rehab is needed and very useful
