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PHTH 517 - Ortho Midterm LE > Other pathologies of the KaNee > Flashcards

Other pathologies of the KaNee Flashcards

1
Q

What is a baker’s cyst?

A

odd amount of synovial fluid in the fatty layers of the popliteal fossa

the most common synovial cyst in the knee

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2
Q

What are the subjective findings of a baker’s cyst?

A

problems of tightness/swelling behind the knee
pain down the back of the leg for bigger cysts
no other hx of trauma

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3
Q

What are the objective findings for a Baker’s cyst?

A

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

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4
Q

What are the interventions used for Baker’s cyst?

A

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

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5
Q

What is the mechanism of injury for a medial gastroc strain?

A

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

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6
Q

What is the subjective findings of a medial gastroc strain?

A

nagging about pulling or tearing sensation of the calf

can keep ankle in PF (tippy toe) to keep tension out

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7
Q

What are the interventions for a medial gastroc strain dependent on?

A

Depends on the stage of healing

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8
Q

What is the main goal of interventions for during the acute phase of medial gastroc strains?

A

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)

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9
Q

When can sport-specific activites be done again for medial gastroc strain?

A

Once its pain free with full and even ROM with full strength

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10
Q

What is needed even after PT for medial gastroc strain?

A

stretching and strengthening for several months to avoid reinjury because of the built up scar tissue

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11
Q

What is the most common cause of mechanical sx of the knee?

A

a torn meniscus

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12
Q

What the mechanism of injury for meniscal lesions?

A

When they try to turn, twist or change direction when FWB
- can also be from damage to the lateral or medial aspect

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13
Q

What causes the pain sx of meniscal tears due to lack of pain fibers?

A

it is from the tearing and bleeding into peripheral attachments and possibly traction on the capsule

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14
Q

What is the expected subjective findings from a meniscus tear?

A

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 ______”

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15
Q

What is the function of meniscus?

A

load transmission
secondary stabilization

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16
Q

How does the meniscus help with load transmission?

A

50% load –> extension
85% load –> 90 deg of flexion

resection of 15-34% increases pressure by 350%

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17
Q

How does the medial meniscus help as a secondary stabilization?

A

provides anterior restraint especially in a bad/deficient ACL

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18
Q

What is the average movement of the meniscus during knee flexion?

A

medial - 5.2mm
lateral - 11mm

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19
Q

What are the objective findings of a meniscal tear?

A
  • 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
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20
Q

What are the special tests for meniscal tears?

A

McMurray (best)
Apley’s (minimal value to detect tear)
Steinmann I (moderate diagnostic ability)

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21
Q

What are interventions for meniscal tears dependent on?

A

On several factors;
- age
- activity demands
- size
- location of the tear

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22
Q

What are the main approaches for interventions for a meniscal tear?

A

rehab (US!!!)
menisectomy
meniscus repair
allograft transplantation (doesn’t happen often)

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23
Q

What is the Osgood schlatter’s?

A

Osteochondritis of the inferior patella
OR
Ostochondritis of the tibial tuberosity
OR
Tibial tubercle traction apophysitis

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24
Q

What is the Osgood schlatter’s also known for?

A

form of periostitis of the tibial apophysitis
- it comes up as a partial avulsion of the tib tuberosity with osteonecrosis of the bone fragment

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25
Q

When does Osgood schlatter happen?

A

young during growth spurts

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26
Q

What are the subjective findings of Osgood schlatter’s?

A

Gradual increase in pain and swelling below knee
- involvement in sporting activities that has to do with high pressure

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27
Q

What are the objective findings of Osgood Schlatter’s?

A
  • 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
28
Q

What is the prognosis of Osgood Schlatter’s?

A

self-limiting and spontaneously remitting over 6-24 months
- as tibial tubercle hardens

29
Q

What is patellar tendonitis?

A

an overuse injury because of eccentric overloading during deceleration activities

Activities like repeated jumping and landing, downhill running

30
Q

Where is the main area affected with patellar tendonitis?

A

inferior pole of the patella or it’s insertion at the tibial tubercle

31
Q

What is the subjective findings of patellar tendonitis?

A
  • 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
32
Q

What are the objective findings of patellar tendonitis?

A
  • localized tender at painful areas
  • AROM knee normal
  • pain with PROM hyperflexion of knee
  • pain with resisted knee extension
33
Q

What is the 1st stage of intervention for patellar tendonitis?

A

relative rest from aggravating activites

34
Q

What is the 2nd stage of intervention for patellar tendonitis?

A
  • Regain pain free active motion
  • flexibility of quads and HS
  • exercise focusing on pain-free quad strengthening
35
Q

What is the 3rd stage of intervention for patellar tendonitis?

A

gradual resumption of the activities that caused the sx

36
Q

What is the prognosis of patellar tendonitis?

A

self limiting and responds to rest
stretching
eccentric strengthening
bracing

37
Q

What is patellofemoral pain syndrome?

A

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

38
Q

What is the subjective findings of patellofemoral pain syndrome?

A
  • 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
39
Q

What are the objective findings of patellofemoral pain syndrome?

A
  • 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
40
Q

What are the special tests for patellarfemoral pain syndrome?

A

Clarke’s sign
Fairbank apprehension test for patellar instability

41
Q

What is the specificity and sensitivity of clarke’s sign?

A

Specificity: 0.67-0.95
Sensitivity: 0.29-0.49

42
Q

What is the specificity and sensitivity of Fairbank’s Apprehension test?

A

High specificity (0.70-0.92)
Lower sensitivity (0.07-0.37)

More specific than sensitive
- positive test would help rule in patellofemoral instability

43
Q

What is plica syndrome?

A

Becomes inflamed and thickened because of trauma or overuse
= joint interference

44
Q

What is the subjective findings of plica syndrome?

A
  • insidous (but related to fall or injury????)
  • achy in the anterior or anteromedial aspects of the knee
  • painful snapping or popping
45
Q

What are the objective findings of plica syndrome?

A
  • 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
46
Q

What are the possibe interventions for plica syndrome?

A

Conservative:
- stretching of quads, HS and gastroc
- strengthening
- ice
- patellar bracing
- NSAIDs
- Altered sports training

Possibly surgical if conservative fails

47
Q

What is prepatellar bursitis?

A

inflammation or infection of prepatellar bursa
- can be due to a truama to anterior knee
- things like a direct blow or chronic irritation

48
Q

What is the subjective findings of prepatellar bursitis?

A

complaints of knee swelling
knee pain just in front of the knee

49
Q

What is the objective findings of prepatellar bursitis?

A
  • 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
50
Q

What are the interventions of prepatellar bursitis?

A
  • decrease inflammation thru cryotherapy
  • pt education on activity modifications
  • adaptive shortening of quads, HS or IT band
  • instruction in stretches
51
Q

What is the prognosis of prepatellar bursitis?

A
  • half of traumatic bursitis solves out of nowhere
  • around 10% progress towards chronic and need bursectomy
52
Q

What is IT band tendonitis?

A

too much friction between ITB and lateral femoral condyle

53
Q

What population is IT band tendonitis common in?

A

runners and cyclist

54
Q

What are the subjective findings of ITB tendonitis?

A
  • pain @ lateral knee
  • intially sx starts after a certain period of activity
  • which turns to pain with activity
55
Q

What are the objective findings of ITB tendonitis?

A
  • Tender @ lateral feemoral condyle (around 3cm proximal to the joint line)
  • Soft tissue swelling and crepitus
  • no joint effusion
56
Q

What are the special tests for ITB tendonitis?

A

Ober’s
Noble’s

57
Q

What are the interventions of ITB tendonitis?

A

Rest
Ice
NSAIDs
Stretching
Cortisone
Platelet-rich plasma

58
Q

What is the prognosis of ITB tendonitis?

A

LONG recovery
gets better with rest

59
Q

What is the population of patellar dislocation?

A
  • young, active patients at highest risk (~ 13-20 y/o)
  • common in football and bball
  • more women
60
Q

How is the reoccurence of patellar dislocation?

A

Reoccrence is common
- especially if the first dislocation is under 15

61
Q

What is the mechanism of injury for patellar dislocation?

A
  • indirect trauma most common
  • strong quad contraction while leg is in valgus and foot planted
  • other knee ligament can occur
62
Q

What are the subjective findings of patellar dislocation?

A
  • a “pop” and immediate pain
  • knee deformity
  • painful
  • can’t bend knee
  • can relocate and feel unstable
63
Q

What are the objective findings of patellar dislocation?

A
  • laterally shifted patella
  • swelling
  • (+) for patellar apprehension
64
Q

What are the interventions for patellar dislocation?

A
  • NSAIDs
  • Ice
  • brace
  • PR with quick ROM, quad strength and electrical stimulation

Can be solved by surgery if its constantly unstable

65
Q

What is the prognosis of patellar dislocations?

A

reccurent instability is common
- rehab is needed and very useful

PHTH 517 - Ortho Midterm LE (10 decks)

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