Regional Peri-Atricular Pain - Knee Flashcards
What are the causes of peri-atricular knee pain?
Osgood-Schlatter's disease Meniscal tears Ligament injuries Bursitis Popliteal swellings
What are the main types of ligament injury?
Ant Cruciate tear (most common)
Medial Collat tear
Mixed
What are the main types of bursitis?
Pre-patellar
Infra-patellar
Anserine
What are the main types of popliteal swelling?
Semimebranosus bursa
Popliteal/baker’s cyst
What is Osgood-Schlatter’s disease?
Traction injury of patellar ligament leading to prominent/tender tibial tuberosity
-common in adolescents
What is the management of Osgood-Schlatter’s disease?
Spontaneous recovery takes time
Restricting sporting activity
What causes meniscal tears?
Twisting strain on flexed, weight bearing knee
- degenerative tears seen in knee OA
- little force req in older adults (fibrosis)
Which meniscus tears most commonly?
Medial
- less mobile
- associated w/ ACL tears
What is the prognosis for meniscus tears?
Mainly avascular (apart from lat 25%) Will not heal spontaneously after tear OR heal after surgical repair
How do meniscal tears present?
Initial pain (intermittent)
Variable swelling hrs later
Locking of knee/spontaneous giving way of knee
What are the signs on examination of meniscal tears?
Effusion
Fixed flexion deformity
Medial joint line tenderness
What investigations may be appropriate in meniscal tears?
X-ray (AP/lat/skyline) - normal, exclude fractures/OA
MRI - mainstay of dx
What is the management of meniscal tears?
Arthroscopic repair
-tears in vascular zone amenable to repair
-partial meniscetomy reduces mechanical sx
-total meniscetomy avoided due to risk of 2o OA
Conservative management
-in degenerative tears 2o to OA
What is the main complication of untreated meniscal tears?
Propagation to 2o arthritis
What causes ligament injuries?
When a force greater than the tensile strength of the ligament occurs e.g. sporting injuries/trauma
In which groups are ligament injuries most common?
Women more susceptible
Men more commonly injured
In what position are the collateral ligaments most susceptible to injury?
When knee is extended
-ligaments tight in extension, loose in flexion
How do ligament injuries present?
Pop at time of injury
Pts cannot bear weight bear after injury/knee feels very unstable
Swelling in 1st hour indicates complete rupture
What are the signs on examination of ligament injuries?
Soft end point as surrounding soft tissues stop the force
Pain when testing
Lachman’s +ve (ant/post drawer_
What is the Lachman’s test? (ant/post drawer)
Detects ACL tear
Knee flexed at 20-30o
Examiner places one hand behind tibia & one on thigh
Intact ACL prevents forward translational movement
What investigations may be appropriate in ligament injuries?
X-ray (AP/lat/skyline) - shows displacements, exclude OA, show fractures
MRI (90% of ligament injuries)
Diagnostic arthroscopy
What is the conservative management of ligament injuries?
Patient education
Physiotherapy
Active movement w/ a brace
What is the surgical management of ACL injuries?
Arthroscopic tendon graft repair
-hamstring/semitendinosus as donor tendon
What is the surgical management of PCL injuries?
Optimal management not known
-bony avulsion most common indication
What is the time limit for surgical management of collateral ligament injuries?
If fixed surgically should be performed w/i 2wks of injury
What causes Pre-patellar bursitis?
Housemaid’s knee
Caused by unaccustomed kneeling
What causes Infra-patellar bursitis?
Clergyman’s bursitis
Caused by unaccustomed kneeling
How do pre-patellar/infra-patellar bursitis present?
Ant knee pain
Fluctuant swelling
How are pre-patellar/infra-patellar bursitis managed?
Avoidance of kneeling
Corticosteroid injection
What is anserine bursitis?
Pain/bursa in insertion of MCL into upper tibia
How does anserine bursitis present?
Pain
-worse on standing/stressing the MCL
In which groups is anserine bursitis more common?
Obese women
Breast stroke swimmers
How is anserine bursitis managed?
Physiotherapy
Local corticosteroid injections
What is a semimembranosus bursa?
Bursa b/w semimembranosus & medial head of gastrocnemius becomes enlarged
How does a semimembranosus bursa present?
Painless lump behind knee
What is a popliteal/Bakers cyst?
Bulging of post capsule of knee w/ synovial herniation leading to a swelling in popliteal fossa
What are the causes of popliteal/Bakers cyst?
RA
OA
How do popliteal/Bakers cyst present?
Bulging of post capsule of knee
Swelling/pain in calf
What is the management of popliteal/Bakers cysts?
Aspiration (if non-ruptured)
Hydrocortisone injection
