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MSK block > The Knee > Flashcards

The Knee Flashcards

1
Q

What are the 3 compartments of the knee?

A
  1. Patello-Femoral compartment
  2. Medial Tibio-Femoral compartment
  3. Lateral Tibio-Femoral compartment
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2
Q

List 3 things which stabilise the knee joint

A

ligaments, capsule and muscles

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3
Q

Using the mnemonic “SLIP”, how do we take a knee history?

A
  1. Swelling
  2. Locking ➞ meniscal tears, loose bodies
  3. Instability (giving way) ➞ ligament problems (eg ACL tear), patellofemoral problems
  4. Pain
  • Site - medial/lateral/anterior/posterior
  • exacerbating factors
  • mechanical, rest or night pain
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4
Q

Exacerbating factors such as stairs or hills are associated with what knee problems?

A

Patellofemoral disorders

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5
Q

If a patient presents with knee pain, but examination and investigation are unremarkable… what MUST we consider?

A

Hip and/or spine problems!

Pain is commonly referred to the knee from the hip and/or spine

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6
Q

What questions must we ask in a history of a sports injury?

A
  1. Mechanism of injury
  • Pivoting/non-pivoting
  • Contact/Non-contact
  • Direction of impact (varus/valgus/anterior etc)
  • Deformation
  1. Swelling immediate or delayed
  • Haemarthrosis (occurs within 90 minutes)
  • Effusion (occurs after 6-12 hours)
  1. Able to finish the activity ?
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7
Q

What are we looking for in a knee examination?

A
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8
Q

What are we feeling for in a knee exam?

A
  1. Temperature
  2. Swelling
  3. Tenderness
  4. Crepitus
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9
Q

Which tests would be used to assess small/moderate/large amounts of joint effusion in the knee?

A

Small - “bulge test”
Moderate - patellar tap
Large (tense) - ballotment

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10
Q

What are we testing when we move the knee in an examination?

A
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11
Q

List 3 special tests which can be used to assess the ACL

A

Lachman’s test (Most sensitive for ACL rupture)

Pivot Shift

Anterior drawer

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12
Q

List 2 special tests which can be used to assess the PCL and explain each

A
  1. Posterior sag ➞ In supine position, hip and knee are flexed to 90°. Examiner supports leg in the air.
    * Positive sign is a posterior sag of the tibia caused by gravitational pull
  2. Posterior drawer ➞ same as Anterior drawer BUT tibia is pushed back
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13
Q

How do we test the medial and lateral collateral ligaments?

A

Valgus stress test (MCL) and Varus stress test (LCL)

Performed at 20° flexion AND at full extension

Move the knee from side to side and assess the amount of opening (always slightly more movement laterally).

Check for an end point, there should not be over opening or pain. If there is either, it indicates CL problem

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14
Q

What does this X-ray show?

A

Medial Collateral Ligament Rupture

X-ray shows huge opening of medial side of joint

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15
Q

What “One Special Test” is used to test each ligament of the knee?

A

ACL – Lachman @ 20o

PCL – (Sag) + Posterior Draw @ 90o

MCL – Valgus @ 20o

LCL – Varus @ 20o

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16
Q

What 2 tests are used to assess for a medial or lateral meniscal tear?

A
  1. McMurray’s test
  2. Appley’s ➞ Grinding and distraction tests

If pain is ellicited in either test it indiactes tear

17
Q

What 2 tests can be used to assess the Patellofemoral Joint?

A
  1. Patellar glide test (Sage sign)
  • Knee at 30o flexion
  • Translate patella medially and laterally
  1. Patellar apprehension test
  • Push patella laterally with the knee at 30o flexion
  • If positive patient will react with apprehension or try to push examiner away
18
Q

List 4 investigations we can do for knee pathologies and when each is indicated

A
  1. X-ray ➞ fracture, arthritis
  2. MRI Scan ➞ meniscal tear, ACL and CL ruptures
  3. Aspiration (culture and cytology) ➞ gout, pseudogout
  4. Blood tests ➞ rhumatological fators
19
Q

What does the X-ray below show?

Explain this pathology

A

Pseudogout (Chondrocalcinosis)

Calcium pyrophosphate deposition on soft tissue, here it is on both the medial and lateral meniscus

20
Q

What is Osteochondritis Dessicans (OCD)

A

Occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply

As a result the small piece of bone, and the cartilage covering it begin to crack and loosen

21
Q

What structure and age group is most commonly affected by Osteochondritis dissecans?

A

Usually afftects the medial femoral condyle of the distil femur and occurs in children

22
Q

What is the treatment for Osteochondritis Dessicans?

A

Conservative ➞ rest, NSAIDs, Intra-articular steroid, splint/orthotics, physiotherapy, modification of activity, weight loss

Operative ➞ arthroscopic/open, excision/repair of meniscus, removal of loose body, ligament reconstruction, patella realignment, osteotomy, joint replacement (partial/total)

23
Q

Give 5 features of patient history/presentation which may indicate ACL rupture

A
  1. Severe pain
  2. Immediate swelling (within 1 hour)
  3. Says they did not finish the game
  4. Sudden ‘popping’ sound on injury
  5. Tenderness is uncommon
24
Q

In a suspected ACL rupture, what does a history of immediate swelling tell us and why?

A

Haemarthrosis (80% assoc ACL rupture) as the ligament is highly vascular, hence rupture results in a haemarthrosis

25
Q

What are the 2 ways in which ACL ruptures usually occur and which is the most common?

A
  1. Pivot, non contact ➞ abrupt stopping or changing of direction (most common)
  2. contact-related ➞ knee forced into hyperextension
26
Q

In an ACL rupture, usual presentation may be delayed. What else may the patient experience meanwhile?

A

Instability may be evident, in which the patient describes the leg ‘giving way’ recurrently

27
Q

ACL ruptures are often associated with what?

A

Meniscal damage

28
Q

Give 5 features of patient history/presentation which indicate a Meniscal Tear?

A
  1. ‘tearing’ sensation in their knee
  2. Intense sudden-onset pain, rarely finished game
  3. delayed swelling (4-6 hours)
  4. knee may be locked in flexion
  5. Joint line tenderness (good predictor of meniscal tear)
29
Q

What is the recovery of a meniscal tear?

What may be an indication for surgery?

A

Most small tears will initially swell but the pain will subside over the next few days as the tear heals.

Larger tears or those who experience recurrent locking or persistant pain may require surgery (arthroscopy)

30
Q

How do meniscal tears usually occur?

A

Activities that cause direct contact or pressure from a forced twist or rotation ➞ sudden pivot or turn, deep squatting, heavy lifting

Can also be caused by degerative diseases

31
Q

Which meniscus is more prone to tearing and why?

A

The medial meniscus as it is tethered to the MCL and joint capsule medially. The lateral meniscus is much more free

32
Q

What knee conditions/pathologies are associated with the following:

  • children
  • sports injurys
  • seniors
A
33
Q

What is shown on the X-ray below?

Explain this pathology

A

Severe osteoarthritis affecting the medial compartment of the right knee (osteophytes, slerosis, cysts, loss of joint space)

Moderate osteoarthritis affecting the medial compartment of the left knee

34
Q

How do we assess which treatment is needed for knee osteoarthritis

A

History and evaluation of the following:

  • mechanical, rest and/or night pain?
  • walking distance?
  • analgesia requirements?
  • response to conservative measures?
  • associated medical conditions?
35
Q

If all conservative measures for knee osteoarthritis fail, what is our surgical option?

A

Total Knee Replacement

MSK block (30 decks)

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