Soft tissue knee injuries

Question 1

What is the common cause of meniscal tears in younger patients?

Answer 1

In younger patients, the common cause of meniscal tears is usually a sporting injury, often due to a twisting force on a loaded knee.

Question 2

What are the primary symptoms associated with meniscal tears?

Answer 2

The primary symptoms of meniscal tears include pain and tenderness localized to the joint line, a feeling of knee instability, and catching or locking sensations.

Question 3

How does an acute locked knee differ from other meniscal tear symptoms?

Answer 3

An acute locked knee signifies a displaced bucket handle meniscal tear. This condition involves a large meniscal fragment that flips out of its normal position and obstructs full knee extension.

Question 4

What are the differences in prevalence between medial and lateral meniscal tears?

Answer 4

Medial meniscal tears are approximately 9-10 times more common than lateral meniscal tears.

Question 5

What signs might indicate a displaced bucket handle meniscal tear?

Answer 5

Signs indicating a displaced bucket handle meniscal tear include a springy block to extension (15°), heel height asymmetry, and a fixed flexion deformity.

Question 6

Why is the healing potential of meniscal tears limited?

Answer 6

The meniscus has limited healing potential as it only has an arterial blood supply in its outer third, causing radial tears not to settle.

Question 7

What percentage of ACL ruptures are accompanied by a meniscal tear?

Answer 7

Approximately 50% of ACL ruptures are accompanied by a meniscal tear.

Question 8

Which tests are used for meniscal provocation, and why are they unreliable?

Answer 8

Meniscal provocation tests like Steinman’s are used, but they are deemed unreliable for diagnosing meniscal tears.
(The Steinmann test, also known as the McMurray test)

Question 9

What type of injury signifies the first stage of knee osteoarthritis?

Answer 9

A seemingly innocuous injury in older patients, often in middle age onwards, can lead to atraumatic spontaneous degenerate tears, which probably represent the first stage of knee osteoarthritis.

Question 10

What type of meniscal tears are more prevalent in younger patients, and what treatment might be considered for these tears?

Answer 10

Younger patients tend to have a higher proportion of peripheral or bucket handle meniscal tears. Arthroscopic meniscal repair might be considered for these acute traumatic peripheral tears.

Question 11

What is the recommended management for irreparable meniscal tears in younger patients?

Answer 11

For irreparable tears in younger patients, consider arthroscopic meniscectomy if the tears result in recurrent pain, effusion, or mechanical symptoms that persist for over 3 months.

Question 12

Why might knees with degenerative changes on X-ray or MRI not benefit from arthroscopic meniscectomy?

Answer 12

Knees with degenerative changes on X-ray or MRI might not benefit from arthroscopic meniscectomy because the removal of meniscal tissue could increase stress on already worn or damaged surfaces.

Question 13

How does the healing potential vary with age in cases of meniscal tears?

Answer 13

Healing potential decreases with age, with poor healing rates seen in individuals over about 25-30 years old. Additionally, the likelihood of healing decreases with increased time from the injury.

Question 14

What is the role of corticosteroid injections in managing degenerative tears?

Answer 14

Corticosteroid injections may help alleviate symptoms in the early stages of degenerative tears.

Question 15

In what situations might arthroscopic meniscectomy be considered ineffective for meniscal tears?

Answer 15

Arthroscopic meniscectomy is ineffective for degenerative tears, as it’s only suitable for unstable tears with mechanical symptoms, not for cases involving pain alone.

Question 16

What potential outcome might occur if a bucket handle tear in the knee remains locked?

Answer 16

If a knee with a bucket handle tear remains locked, it may lead to the development of a permanent fixed flexion deformity.

Question 17

What interventions might be necessary for irreparable bucket handle tears?

Answer 17

Irreparable bucket handle tears may necessitate partial meniscectomy to unlock the knee and prevent further damage.

Question 18

What is the function of the menisci in the knee joint?

Answer 18

The menisci in the knee joint act as shock absorbers, help in distributing weight throughout the joint, and facilitate smooth movement between the femur and tibia.

Question 19

How do meniscal tears typically occur in younger patients versus older patients?

Answer 19

In younger patients, meniscal tears often occur during twisting movements while playing sports, whereas in older patients, tears might occur with minor twisting movements during routine activities.

Question 20

What are the symptoms associated with meniscal tears?

Answer 20

Symptoms of meniscal tears include pain, swelling, stiffness, restricted range of motion, locking of the knee, and sensations of instability or the knee “giving way.”

Question 21

What are the examination findings commonly observed in individuals with meniscal tears?

Answer 21

Examination findings associated with meniscal tears include localized tenderness on the joint line, swelling, and restricted range of motion.

Question 22

What are the traditional special tests for diagnosing meniscal tears, and why are they generally not recommended in clinical practice?

Answer 22

The traditional special tests for diagnosing meniscal tears are McMurray’s test and Apley grind test, but they are generally not used in clinical practice due to the potential to cause pain and worsen the meniscal injury.

Question 23

Aside from pain, what other sensations might a patient experience during the initial injury of a meniscal tear?

Answer 23

Besides pain, the initial injury of a meniscal tear might be accompanied by a “pop” sound or sensation.

Question 24

What ligaments are present in the knee, and what are their names?

Answer 24

The four ligaments in the knee are the anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament, and medial collateral ligament.

Question 25

How do the quadriceps muscles affect knee extension?

Answer 25

Contraction of the quadriceps muscles causes knee extension by pulling through the patella.

Question 26

How is the patella connected to the tibia in the knee joint?

Answer 26

The patella is attached to the tibia by the patellar ligament in the knee joint.

Question 27

How is McMurray’s test performed, and what does pain or restriction during the test indicate?

Answer 27

McMurray’s test involves flexing the knee and internally or externally rotating the tibia with varus or valgus pressure, respectively. Pain or restriction during the test indicates damage to the lateral or medial meniscus.

Question 28

Describe the procedure for the Apley Grind Test and what a positive result might suggest.

Answer 28

The Apley Grind Test requires the patient to lie prone with the knee flexed to 90 degrees while the tibia is internally and externally rotated, applying downward pressure. Pain indicates meniscal damage and can help localize the area affected (medial or lateral meniscus).

Question 29

What are the Ottawa Knee Rules, and what conditions might indicate the need for a knee x-ray according to these rules?

Answer 29

The Ottawa Knee Rules suggest the need for a knee x-ray if the patient is age 55 or older, presents with patella or fibular head tenderness, is unable to flex the knee to 90 degrees, or cannot weight bear.

Question 30

What imaging investigation is usually the first-line approach for diagnosing a meniscal tear, and what is the gold-standard investigation for this diagnosis?

Answer 30

An MRI scan is usually the first-line imaging investigation for diagnosing a meniscal tear, while arthroscopy is considered the gold-standard investigation for this diagnosis.

Question 31

According to the NICE clinical knowledge summaries on knee pain, what key symptoms suggest an urgent referral for a patient with an acute meniscal tear?

Answer 31

Key symptoms suggesting urgent referral for acute meniscal tear include a “pop,” rapid onset swelling, instability or giving way, and locking.

Question 32

What does the RICE mnemonic stand for, and how is it applied in the conservative management of meniscal tears?

Answer 32

The RICE mnemonic stands for Rest, Ice, Compression, and Elevation, used in the conservative management of meniscal tears to manage acute soft tissue injuries.

Question 33

What is the primary analgesic medication usually prescribed for musculoskeletal injuries like meniscal tears?

Answer 33

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are typically used as first-line analgesia for musculoskeletal injuries, including meniscal tears.

Question 34

What is the role of physiotherapy in the management of meniscal tears after the initial pain and swelling have subsided?

Answer 34

Physiotherapy is employed for rehabilitation once the initial pain and swelling have subsided in the management of meniscal tears.

Question 35

What are the surgical options available for treating meniscal tears, and what are the main procedures involved in these options?

Answer 35

Surgical options for treating meniscal tears include repair if feasible or resection of the affected portion of the meniscus, often performed through arthroscopy (keyhole surgery). Resection might result in osteoarthritis.

Question 36

What types of movements in sports activities commonly lead to knee ligament injuries?

Answer 36

Knee ligament injuries often result from rotational movements of the knee joint, such as cutting and pivoting movements in sports.

Question 37

How is the examination of an injured knee often affected in the immediate aftermath of the injury, and when is it recommended to re-examine these patients?

Answer 37

Pain and apprehension often limit the examination findings of an injured knee in the immediate aftermath. Patients should be re-examined in 2-7 days to assess the knee properly.

Question 38

What role does an early MRI play in cases of suspected significant knee injuries with potential multiple ligament involvement?

Answer 38

An early MRI is useful for delineating the extent of injury in cases suspected to be significant, especially with a suspicious history and potential multiple ligament injuries.

Question 39

How are knee ligament injuries classified based on severity?

Answer 39

Knee ligament injuries are classified into Grade 1 (sprain), Grade 2 (partial tear), and Grade 3 (complete tear).

Question 40

What instabilities are associated with injuries to the MCL, ACL, PCL, and the posterolateral corner of the knee?

Answer 40

MCL rupture leads to valgus instability, ACL rupture to rotatory instability, PCL rupture to recurrent hyperextension or instability descending stairs, and posterolateral corner rupture to varus and rotatory instability. Multiligament injuries can result in gross instability.

Question 41

What is the typical mechanism of injury for an MCL injury?

Answer 41

The mechanism of injury for an MCL injury typically involves valgus stress with possible external rotation, such as in a rugby tackle from the side.

Question 42

What are the clinical features indicative of an MCL injury?

Answer 42

Clinical features of an MCL injury include knee swelling with ecchymosis, pain, deformity, instability, medial joint line tenderness, medial joint laxity, and pain on valgus stress.

Question 43

What investigations are utilized to diagnose an isolated MCL tear, and what is their primary purpose?

Answer 43

Isolated MCL tear is diagnosed clinically, but x-rays and MRI can be used to rule out associated injuries.

Question 44

How is an isolated MCL tear typically managed, and what is the usual course of pain associated with this injury?

Answer 44

Usually, an isolated MCL tear heals well even if it’s a complete tear. Pain associated with this injury can take a few to several months to settle. Acute tears are generally treated with a hinged knee brace.

Question 45

What treatments are available for chronic MCL instability?

Answer 45

Chronic MCL instability can be treated with MCL tightening (advancement) or, in rare cases, reconstruction with a tendon graft.

Question 46

What is the most common mechanism of injury for an ACL (anterior cruciate ligament) injury?

Answer 46

An ACL injury typically occurs due to a twisting sports injury, involving higher rotational force and turning the upper body laterally on a planted foot, commonly seen in activities like football, rugby, and skiing. The ACL primarily stabilizes the internal rotation of the tibia.

Question 47

What are the typical clinical features observed after an ACL injury occurs?

Answer 47

Clinical features of an ACL injury often include an audible pop at the time of injury, followed by immediate deep knee pain and swelling (hemarthrosis) within an hour. Subsequently, pain settles but leaves behind rotatory instability, leading to the knee “giving way” due to excessive internal rotation of the tibia.

Question 48

Which specific tests are used to diagnose an ACL injury, and what indications do these tests show in the case of an ACL tear?

Answer 48

The anterior drawer test and Lachman test are utilized to diagnose an ACL injury. Positive results in these tests indicate excessive anterior translation of the tibia, signifying an ACL tear.

Question 49

What type of fluid accumulation might be observed in the joint after an ACL injury, and what diagnostic tool is often used to confirm the injury?

Answer 49

ACL injuries may result in joint aspiration, revealing hemarthrosis. An MRI is often used to confirm the extent and specifics of the injury.

Question 50

How might an ACL injury manifest in terms of long-term consequences, especially in terms of arthritis?

Answer 50

ACL injuries may cause minimal problems in some individuals, while others may experience substantial functional issues. Most individuals, even those who have had surgery, display radiographic evidence of arthritis within 10 years.

Question 51

What factors might indicate the need for ACL reconstruction with a tendon graft?

Answer 51

ACL reconstruction with a tendon graft is mainly indicated in cases of rotatory instability that do not respond to physiotherapy. Other indications include its use in multi-ligament reconstruction or in professional athletes.

Question 52

What role does intensive rehabilitation play in the management of ACL reconstruction, and how long might it take for an individual to return to high-impact sports after the surgery?

Answer 52

After ACL reconstruction, intensive rehabilitation is essential. It may take up to a year for an individual to return to high-impact sports following the surgery.

Question 53

What injuries are LCL (Lateral Collateral Ligament) injuries often associated with?

Answer 53

LCL injuries often occur in combination with PCL (Posterior Cruciate Ligament) or ACL (Anterior Cruciate Ligament) injuries.

Question 54

What are the typical mechanisms of injury leading to LCL injuries?

Answer 54

LCL injuries usually occur due to varus stress and hyperextension of the knee.

Question 55

What clinical features are commonly observed in individuals with an LCL injury?

Answer 55

Typical clinical features in individuals with LCL injuries include knee swelling with ecchymosis, pain, deformity, instability, lateral joint line tenderness, and laxity identified through the varus stress test.

Question 56

How is an isolated LCL tear diagnosed, and what role do x-rays and MRIs play in this diagnosis?

Answer 56

An isolated LCL tear is primarily a clinical diagnosis, but x-rays and MRI scans are used to rule out associated injuries.

Question 57

What is the urgency of repair for a complete rupture of the LCL if diagnosed early, and what approach is taken if diagnosis occurs later?

Answer 57

In the case of a complete rupture of the LCL diagnosed early (within 2-3 weeks), urgent repair is necessary. However, if the diagnosis is delayed, reconstruction with a tendon graft is typically pursued.

Question 58

What potential complications might arise in the case of an LCL injury, particularly in terms of instability and nerve-related issues?

Answer 58

LCL injuries that don’t heal adequately can cause varus and rotatory instability. There’s a high incidence of common fibular nerve palsy associated with this injury.

Question 59

What long-term consequence might be observed in individuals with LCL injuries in relation to the knee joint?

Answer 59

Long-term consequences of LCL injuries often include a high incidence of early osteoarthritis of the knee joint.

Question 60

What is the common mechanism of injury for a PCL (Posterior Cruciate Ligament) injury?

Answer 60

PCL injuries tend to occur following a direct blow to the anterior tibia, such as in dashboard injuries or motorcycle accidents.

Question 61

Is an isolated PCL rupture a common occurrence or a rare event? If rare, what is often associated with PCL ruptures?

Answer 61

An isolated PCL rupture is rare. It usually occurs in combination with other knee injuries.

Question 62

What are the typical clinical features observed in individuals with a PCL injury?

Answer 62

Clinical features of a PCL injury often include popliteal knee pain and bruising, a positive posterior drawer test, and a positive sag sign.

Question 63

What are the recommended investigations used to diagnose a PCL injury?

Answer 63

X-rays and MRIs are the recommended investigations used to diagnose a PCL injury.

Question 64

In the management of isolated PCL injuries, when is reconstruction typically considered necessary?

Answer 64

In the management of isolated PCL injuries, reconstruction isn’t commonly required. However, if a patient develops instability such as recurrent hyperextension or feeling unstable when going downstairs, reconstruction might be considered.

Question 65

In cases of combined knee ligament ruptures, what usually determines the necessity for surgical reconstruction?

Answer 65

In cases of combined knee ligament ruptures involving multiple ligaments, the degree of instability resulting from higher degrees of force usually necessitates surgical reconstruction due to the level of instability.

Question 66

What are the typical causes of knee dislocation in terms of the energy involved, and is this consistent for all age groups?

Answer 66

Knee dislocations commonly result from serious high-energy injuries but can occasionally occur due to low-energy incidents in the elderly.

Question 67

What are the various directions in which the knee dislocation can occur?

Answer 67

Knee dislocations can occur in various directions, including posterior, anterior, medial, lateral, and even involve rotatory movements.

Question 68

What are the primary clinical features associated with knee dislocation?

Answer 68

Primary clinical features of knee dislocation include pain and instability of the knee joint.

Question 69

What initial assessments and imaging techniques are recommended for investigating knee dislocations?

Answer 69

For investigations, it’s essential to check the neurovascular status immediately. Imaging involves X-rays and, if concern exists over the neurovascular status, a CT angiogram might be required. If no concern over neurovascular status, an MRI is recommended.

Question 70

How is the immediate management of a knee dislocation handled?

Answer 70

Immediate management involves emergency reduction under sedation and rechecking of the neurovascular status. Temporary stabilization may be necessary, and emergency fix might be required if the medial femoral condyle is button-holed through the medial capsule.

Question 71

What is the necessity and process of emergency reduction in some severe knee dislocations?

Answer 71

Emergency theatre reduction may be needed if certain conditions are met in severe cases of knee dislocation.

Question 72

What complications might arise following a knee dislocation, particularly in terms of neurovascular and ligamentous injuries?

Answer 72

Complications of knee dislocation include a high incidence of neurovascular injury (such as popliteal artery injury, common peroneal nerve injury), ligamentous injury, arthrofibrosis, stiffness, and ligament laxity. Reperfusion after prolonged ischaemia might lead to compartment syndrome, requiring fasciotomies.

Question 73

What are the common causes or mechanisms that lead to patellar dislocation?

Answer 73

Patellar dislocation can occur due to a direct blow or sudden quadriceps contraction with a flexing knee.

Question 74

Which demographic group often experiences patellar dislocation, and is there a notable gender difference in incidence?

Answer 74

Patellar dislocation is more common in teenagers, with a higher incidence in females.

Question 75

How does the patella typically dislocate, in terms of direction?

Answer 75

The patella always dislocates laterally.

Question 76

What risk factors contribute to the likelihood of experiencing patellar dislocation?

Answer 76

Risk factors for patellar dislocation include ligamentous laxity/hypermobility, increased Q-angle (genu valgum, femoral neck anteversion), high riding patella, hypoplastic lateral femoral condyle, and lateral quads insertions or weak vastus medialis.

Question 77

What symptoms are commonly reported by individuals experiencing patellar dislocation?

Answer 77

Patients with patellar dislocation commonly report a clear history of the patella dislocating laterally, often self-relocating.

Question 78

What clinical signs are observed in patients with patellar dislocation?

Answer 78

Clinical signs in patellar dislocation include pain medially (from torn medial patella retinaculum tendon), effusion (haemarthrosis), and a positive patella apprehension test.

Question 79

What is the characteristic X-ray appearance associated with patellar dislocation, and what might an X-ray reveal?

Answer 79

The characteristic X-ray appearance associated with patellar dislocation is lipo‐haemarthrosis. A small opacification on X-ray may suggest an osteochondral fracture.

Question 80

How is patellar dislocation managed, especially concerning reduction and subsequent treatment?

Answer 80

Patellar dislocations may spontaneously reduce when the knee is straightened or may require manual manipulation back into position (reduction with knee extension). Management involves aspiration (rarely), braces, and physiotherapy.

Question 81

What complications are associated with patellar dislocation, and what is the risk of recurrent dislocation after the first instance?

Answer 81

Complications of patellar dislocation include tears in the medial patellofemoral ligament and osteochondral fracture. The risk of recurrent dislocation after the first instance is approximately 10%. Physiotherapy to strengthen the quadriceps may help reduce the risk. Patients with recurrent dislocations may benefit from surgical interventions such as lateral release or medial patellofemoral ligament (MPFL) reconstruction, and the risk of recurrent instability decreases with age.

Question 82

What are the synonymous terms used to describe disorders of the patellofemoral articulation resulting in anterior knee pain?

Answer 82

Disorders of the patellofemoral articulation causing anterior knee pain encompass several diagnoses, such as chondromalacia patellae, adolescent anterior knee pain, and lateral patellar compression syndrome.

Question 83

Who is more commonly affected by these conditions, and are there any particular age and gender tendencies?

Answer 83

These conditions are common in adolescence, especially affecting girls.

Question 84

What factors might contribute to the development of disorders in the patellofemoral articulation?

Answer 84

The exact cause is unclear, but factors such as muscle imbalance, ligamentous laxity, and subtle skeletal predispositions (such as genu valgum, wide hips, femoral neck anteversion, internal rotation) might contribute.

Question 85

What typical symptoms are associated with these conditions?

Answer 85

Typical symptoms include anterior knee pain that worsens when descending hills, a grinding or clicking sensation in the front of the knee, and stiffness after prolonged sitting leading to ‘pseudolocking’ of the knee.

Question 86

How are these conditions diagnosed?

Answer 86

Diagnosing these conditions is primarily clinical.

Question 87

What is the primary approach to managing such conditions, especially in cases that are often self-limiting?

Answer 87

The majority of cases are self-limiting, and physiotherapy is the mainstay of treatment, aimed at rebalancing the quadriceps muscles.

Question 88

What specific focus does physiotherapy have in treating these conditions, and what muscle group is particularly targeted?

Answer 88

Physiotherapy primarily focuses on rebalancing the quadriceps, particularly by strengthening the vastus medialis obliqus (VMO).

Question 89

Is there a typical pattern of resolution in younger patients with these conditions, and what interventions might be considered for resistant cases?

Answer 89

Most younger patients tend to “grow out” of the condition. For resistant cases, taping might help, while surgery, such as tibial tubercle transfer, may be considered in some cases where the forces on the patella need to be shifted. However, results from surgery can be unpredictable.

Question 90

What age groups are more susceptible to patellar tendon versus quadriceps tendon ruptures, and what activities or sports might contribute to these injuries?

Answer 90

Patellar tendon ruptures tend to occur in individuals younger than 40, often engaged in running or jumping sports, while quadriceps tendon ruptures are more common in individuals over 40 involved in similar activities.

Question 91

What events or actions can lead to patellar or quadriceps tendon ruptures, and are there differences in the typical causes for each tendon rupture?

Answer 91

The rapid contractile force on the tendons, such as after lifting a heavy weight, falling, or degenerate tendon structures, can lead to patellar or quadriceps tendon ruptures. These injuries might also be associated with blunt or penetrating trauma.

Question 92

What are the common risk factors associated with tendon ruptures of the extensor mechanism of the knee?

Answer 92

Risk factors for tendon ruptures of the extensor mechanism of the knee include previous tendonitis, steroid use/abuse, chronic renal failure, the use of quinolone antibiotics like Ciprofloxacin, diabetes, and rheumatoid arthritis.

Question 93

What symptoms and signs are typically seen in individuals with a patellar or quadriceps tendon rupture?

Answer 93

Common symptoms include knee pain and weakness. Signs observed in individuals with these ruptures include the inability to perform a straight leg raise, a palpable gap in the extensor mechanism, and in partial tears, reduced extensor mechanism function with decreased power.

Question 94

What imaging techniques are used for diagnosing these tendon ruptures, and how does imaging aid in diagnosis, especially in obese patients?

Answer 94

X-rays may display effusion or abnormal patellar positioning, which differs for patellar and quadriceps ruptures. Ultrasound or MRI is useful for visualizing partial or complete tears. In obese patients, ultrasound may be crucial due to the lack of obvious gaps in X-rays.

Question 95

What is the recommended approach for managing patellar or quadriceps tendon ruptures, and what does post-surgical management typically involve?

Answer 95

Urgent surgical repair is typically required for patellar or quadriceps tendon ruptures, followed by physiotherapy to gradually increase range of motion. Small partial tears of the quadriceps may be managed with immobilization and physiotherapy.

Question 96

What is the suggested treatment for small partial tears of the quadriceps, and what precaution should be taken in individuals with tendonitis of the knee extensor mechanism?

Answer 96

Steroid injections for extensor mechanism knee tendonitis should be avoided due to the high risk of tendon rupture.

Question 97

What causes bone bruising, particularly in the context of joint injuries?

Answer 97

Bone bruising occurs due to the impact on the articular surface, resulting in a microscopic fracture of the trabecular bone, leading to bleeding and inflammation.

Question 98

In what scenarios is bone bruising commonly observed, especially concerning other joint injuries?

Answer 98

Bone bruising is a significant source of pain following meniscal tears and ligament injuries.

Question 99

Which imaging modality is typically used to diagnose bone bruising?

Answer 99

MRI is the standard imaging modality used to diagnose bone bruising.

Question 100

How long does it usually take for bone bruising to resolve, and is there any known treatment to expedite the recovery process?

Answer 100

Bone bruising typically settles with time, usually within around 3 months, although it can take over a year to completely resolve. There is no known treatment that expedites the resolution of bone bruising.

Question 101

What potential consequence might occur over time with the hyaline cartilage in the area affected by bone bruising?

Answer 101

Over time, the hyaline cartilage over the area affected by bone bruising may deteriorate, potentially leading to a full-thickness chondral defect.

Question 102

What causes the formation of loose bodies within the knee joint, and what conditions or injuries might contribute to their development?

Answer 102

Loose bodies within the knee joint can be caused by trauma, osteochondritis dissecans, or joint degeneration, which results in detached fragments of cartilage or bone in the joint.

Question 103

How do loose bodies within the knee joint evolve over time, and what complications might they cause?

Answer 103

Over time, loose bodies can grow and obtain nutrition from synovial fluid, potentially leading to painful locking or catching. Some may adhere to the synovium or fat pad, no longer being “loose.”

Question 104

What are the typical clinical manifestations that suggest the presence of a loose body in the knee joint?

Answer 104

A history of a mobile lump, occasional sharp pain, and episodes of locking or catching in the knee suggests the presence of a loose body. Constant, generalized, or severe pain is not typically associated with loose bodies.

Question 105

Why might the identification of loose bodies be prone to overdiagnosis on X-rays, and what imaging modalities can aid in confirming their presence accurately?

Answer 105

Loose bodies in the knee joint are often overdiagnosed due to an opacification observed on X-rays. A fabella, an accessory ossicle in the lateral head of the gastrocnemius, is commonly misdiagnosed as a loose body. MRI or serial X-rays are better for accurately determining the presence of a loose body.

Question 106

What is the primary approach for managing troublesome symptoms related to loose bodies in the knee joint, and is there any impact on degenerative joint pain?

Answer 106

Arthroscopic removal is the primary method for managing troublesome symptoms caused by loose bodies in the knee joint. However, this procedure won’t alleviate degenerative joint pain.

Question 107

What anatomical region does a Baker’s cyst occur in, and what structures form the boundaries of this area?

Answer 107

A Baker’s cyst occurs in the popliteal fossa, bordered by the tendons of the semimembranosus and semitendinosus (superior and medial), the biceps femoris tendon (superior and lateral), and the medial and lateral heads of the gastrocnemius (inferior and medial/lateral).

Question 108

What is the primary pathophysiological mechanism behind Baker’s cysts in adults, and what conditions or injuries are they commonly associated with?

Answer 108

In adults, Baker’s cysts are usually secondary to degenerative changes in the knee joint, often associated with conditions such as meniscal tears, osteoarthritis, knee injuries, and inflammatory arthritis, causing synovial fluid to collect in the popliteal fossa.

Question 109

How do patients with Baker’s cyst typically present in terms of symptoms, and what is Foucher’s sign?

Answer 109

Patients may present with localized symptoms such as pain, discomfort, fullness, pressure, a palpable lump or swelling, and restricted knee motion, while Foucher’s sign refers to the reduction in the size of the lump when the knee is flexed to 45 degrees.

Question 110

What complications might arise if a Baker’s cyst ruptures, and what critical condition should be considered in differential diagnosis?

Answer 110

Ruptured Baker’s cysts can lead to inflammation in surrounding tissues and calf muscles, manifesting as pain, swelling, and erythema. A critical differential diagnosis is a deep vein thrombosis (DVT), and rarely, a ruptured cyst might cause compartment syndrome.

Question 111

What are the key differential diagnoses for a lump in the popliteal fossa aside from a Baker’s cyst?

Answer 111

Key differential diagnoses for a lump in the popliteal fossa include DVT, abscess, popliteal artery aneurysm, ganglion cyst, lipoma, varicose veins, and tumors.

Question 112

Which imaging modalities are used for diagnosing Baker’s cyst, and what additional information might an MRI provide?

Answer 112

Ultrasound is the primary investigation for confirming the diagnosis and ruling out a DVT. MRI can further evaluate the cyst and underlying knee pathology, such as meniscal tears, particularly before surgical intervention.

Question 113

What are the non-surgical and surgical management approaches for symptomatic Baker’s cysts, and what complications might be associated with surgical intervention?

Answer 113

Non-surgical management involves modified activity, analgesia, physiotherapy, ultrasound-guided aspiration, and steroid injections. Surgical management usually involves arthroscopic procedures addressing underlying knee pathology contributing to the cyst, although resection of the cyst is difficult and likely to recur, especially in the presence of other knee pathologies.

Question 114

What anatomical structures are involved in bursitis, and what is the primary function of bursae in the body?

Answer 114

Bursitis involves the inflammation of bursae, which are small sacs lined with synovium located around joints. Bursae serve to reduce friction between tendons, bones, muscles, and skin.

Question 115

What are some common types of bursitis and their associated anatomical locations?

Answer 115

Common types of bursitis include pre-patellar bursitis, olecranon bursitis, and bursitis over the medial 1st metatarsal head in hallux valgus, also known as bunions.

Question 116

How does bursitis typically develop, and what may lead to its secondary infection and formation of an abscess?

Answer 116

Bursitis often develops due to repeated pressure or trauma, leading to soft tissue swelling. In some cases, it may become secondarily infected, forming an abscess typically due to bacterial infections from small wounds on the limb.

Question 117

What is the usual course of inflammatory bursitis, and what issues might arise with persistent thickening of the bursal sac?

Answer 117

In cases of inflammatory bursitis, the fluid component of the swelling usually subsides, but it may leave a thickened bursal sac. Recurrence might occur, and a thickened bursal sac can lead to persisting problems.

Question 118

In what circumstances might excision be considered for managing bursitis, and what potential complications or challenges can arise from this procedure?

Answer 118

Excision may be considered for managing bursitis if recurrence is an issue, but complications can arise due to scarring and potential challenges with scarring after the procedure.

Question 119

What is the definition of olecranon bursitis, and how is it typically related to the olecranon and the underlying bone?

Answer 119

Olecranon bursitis refers to the inflammation and swelling of the bursa over the elbow, particularly the bony lump known as the olecranon, which is part of the ulna bone.

Question 120

What are bursae, and what role do they play in the body?

Answer 120

Bursae are small sacs lined with synovial membranes and filled with synovial fluid, found at bony prominences in the body. They reduce friction between bones and soft tissues during movement.

Question 121

What are the primary causes of bursitis in the context of the olecranon, and how might these causes lead to the inflammation of the bursa?

Answer 121

The primary causes of olecranon bursitis include repetitive movements, trauma, inflammatory conditions like rheumatoid arthritis or gout, and in some cases, infection leading to septic bursitis.

Question 122

Why might olecranon bursitis be termed “student’s elbow,” and what occupations or behaviors could contribute to its development?

Answer 122

The term “student’s elbow” is used due to students leaning on their elbows for extended periods while studying, leading to mild trauma and friction causing bursitis. Occupations such as plumbing or driving that involve leaning on the elbow can also contribute to its development.

Question 123

What are the common presentations of olecranon bursitis, and how can one differentiate between aseptic bursitis and infected (septic) bursitis?

Answer 123

Olecranon bursitis typically presents as a swollen, warm, tender, and fluctuant (fluid-filled) elbow. Distinguishing features between aseptic bursitis and infected bursitis include signs of infection like warmth, increased tenderness, spreading erythema, fever, and systemic symptoms such as tachycardia, hypotension, and confusion. Septic arthritis may be considered if swelling is primarily within the joint and is associated with painful, reduced elbow motion.

Question 124

What is olecranon bursitis, and what is another term for it?

Answer 124

Olecranon bursitis refers to inflammation and swelling of the bursa over the elbow. Another term for it is “student’s elbow”.

Question 125

What are the common causes of olecranon bursitis?

Answer 125

Common causes of olecranon bursitis include friction from repetitive movements, trauma, inflammatory conditions (like rheumatoid arthritis or gout), and infection.

Question 126

What is the typical presentation of a person with olecranon bursitis?

Answer 126

A typical presentation of a person with olecranon bursitis includes a swollen, warm, tender, and fluid-filled elbow.

Question 127

What are the signs that indicate an infection in olecranon bursitis?

Answer 127

Signs indicating infection in olecranon bursitis include the affected area being hot to touch, more tender, erythema spreading to the surrounding skin, fever, and features of sepsis.

Question 128

What differential diagnosis should be considered for a swollen joint in the elbow?

Answer 128

Septic arthritis should be considered as a differential diagnosis for a swollen joint in the elbow.

Question 129

What does aspiration of fluid from the bursa reveal, and how does it help in diagnosis?

Answer 129

Aspiration of fluid from the bursa provides clues for diagnosis. Pus indicates infection, straw-colored fluid suggests infection is less likely, blood-stained fluid may indicate trauma, and milky fluid indicates gout or pseudogout.

Question 130

What are the management options for olecranon bursitis?

Answer 130

Management options for olecranon bursitis include rest, ice, compression, analgesia, protecting the elbow, fluid aspiration, and sometimes steroid injections.

Question 131

What antibiotics are recommended for treating olecranon bursitis suspected to be infectious?

Answer 131

Flucloxacillin is recommended as the first-line antibiotic for treating infectious olecranon bursitis, with clarithromycin as an alternative.

Question 132

What steps are recommended for managing a patient with olecranon bursitis if they are systemically unwell?

Answer 132

Systemically unwell patients with olecranon bursitis need hospital admission for further management, including blood tests, IV antibiotics, and fluids.

Question 133

What is the significance of fluid appearance during aspiration in olecranon bursitis?

Answer 133

The appearance of fluid during aspiration in olecranon bursitis provides information that helps identify the underlying cause, aiding in appropriate treatment.