The Knee Flashcards
Pre-patellar bursitis clinical features
Housemaids knee Bursa above the patellar Excessive kneeling Localised pain and tenderness Swelling
Pre-patellar bursitis specific tests
Balloon sign
Fluctuant
Swelling
Pre-patellar bursitis investigations
Aspiration with gram stain and culture
USS
Pre-patellar bursitis management
Conservative
- compression
- NSAIDS
- aspiration
Surgery
-bursectomy
Intra patellar bursitis clinical features
Clergymans knee Above the patellar lig Pain just bellow knee cap Swelling Kneeling
ACL rupture clinical features
LFC-> anterior tibia 50% also have a meniscal tear Fixed foot with knee flexion and internal hip rotation Felt pop Deep knee pain 70% immediate swelling
ACL rupture specific tests
Anterior draw test-> no end point and pain
Lack mans -> hold leg with knee in 30 flexion and pull tibia anteriorly
ACL rupture investigations
X RAY -> segond # convulsion proximal tibia
MRI
ACL rupture management
Conservative
- activity modification
- physio
- analgesia
Surgery
-ACL reconstruction
PCL rupture clinical features
Posterior tibial sulcus -> anteriomedial femoral condyle
Direct blow to proximal tibia
Non contact hyper flexion with plantar flexed foot
Posterior knee pain
Knee instability
PCL rupture specific tests
Posterior draw test
Posterior draw test
PCL rupture investigations
X Ray -> avulsion #
Lateral stress view
MRI
PCL rupture management
Conservative
- protected wt bearing
- physio
- immobilisation in extension 4w
Surgery
- # / other ligs / unstable
Medical collateral ligament rupture clinical features
Most commonly injured ligament of the knee
Valgus and external rotation to the lateral knee
Felt pop
Medical joint line pain
Instability
Swelling
Medical collateral ligament rupture specific tests
Valgus stress test at 30 flexion -> no end point and pain
Medical collateral ligament rupture investigations
X Ray
MRI
Medical collateral ligament rupture management
Conservative -> incomplete
- NSAIDS
- rest
- physio
- bracing
Surgery
- repair
- reconstruction
LCL rupture clinical features
Rarely an isolated injured Direct blow to wt bearing medial knee Excess virus and external rotation Instability in extension Difficulty with stairs Lateral joint line pain Swelling
LCL rupture specific tests
Varus stress test at 30 flexion
Hyper extension when walking
LCL rupture investigations
X Ray
MRI
LCL rupture management
Conservative -> intact/partial
- limited immobilisation
- progressive ROM
- physio
Surgery
-repair
Meniscal injury clinical features
Common with ACL rupture
Medical more common
Localised pain and tenderness
Mechanical locking
Delayed/intermittent swelling
-twisting/flexion injury
Meniscal injury specific tests
Joint line tenderness
Mc Murrays-> flexion and external rotation, slowly extend-> pain and locking
Meniscal injury investigations
X Ray normal
MRI
Meniscal injury management
Conservative
- rest
- NSAIDS
- physio
Surgery
- repair
- partial menisectomy
Patellar dislocation clinical features
Instability
Anterior knee pain
Swelling
Non contact twisting injury with knee extended and feet externally rotated
Often relocate by reflexive quads contraction
Patellar dislocation specific tests
Increased patellar translocation
Patellar apprehension on lateral translation
J sign -> lateral subluxation of the patellar on flexion
Patellar dislocation investigations
X Ray -> #, trochlear dysplasia
-CT-> measure trochlear grove
MRI -> soft tissue damage
Patellar dislocation management
Conservative
- NSAIDS
- short term immobilisation
- activity modification
- physio
Surgery
- arthroscopic debridement
- MPFL repair
Pes Anserine Bursitis clinical features
Bursa under the pes anserine muscles -> sartorius, gracillis, semitendinosus
Tight hamstrings Direct blow to medial knee Localised pain and tenderness Worse on stairs Swelling Sport
Pes Anserine Bursitis management
Conservative
- rest
- NSAIDS
- physio/stretching
- steroid
Surge
-decompression
