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YEAR 4 SEMESTER 2 DIAGNOSTIC IMAGING > The Knee, Common Conditions & M.R.I (Finished) > Flashcards

The Knee, Common Conditions & M.R.I (Finished) Flashcards

1
Q

List some examples of sudden (acute) knee injuries.

A
  • Sprains, strains, or other injuries to the ligaments and tendons that connect and support the kneecap.
  • Meniscal tear/s
  • Ligament tear/s i.e. ACL, PCL, MCL, LCL
  • Fracture/s i.e. patella, lower protion of femur, upper part of tibia or fibula
  • Patella dislocation
  • Knee joint dislocation (rare)
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2
Q

List some common causes of sudden (acute) knee injuries.

A
  • Direct blow to the knee
  • Abnormal twisting motion through knee
  • Bending of the knee
  • Falling on the knee
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3
Q

What are some symptoms and signs associated with sudden (acute) knee injuries?

A
  • Pain
  • Bruising
  • Swelling
  • Pinching of/damage to nerves and/or blood vessels
  • Numbness of knee or lower leg
  • Weakness of knee or lower leg
  • Knee or lower leg may be cold, tingle, or appear pale or blue
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4
Q

Patella dislocation occurs most commonly in what demographic?

What is a possible complication of patella dislocation?

A
  • 13-18 year-old girls
  • Bone or tissue (loose bodies) from injury may get caught in the joint and interfere with movement
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5
Q

Knee overuse injuries occur with repetitive activites or repeated or prolonged pressure on the knee leading to irritation and inflammation.

What are some examples of such activities?

A
  • Stair climbing
  • Bicycle riding
  • Jogging
  • Jumping
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6
Q

What are some examples of knee overuse injuries?

A
  • Bursitis
  • Tendinitis
  • Tendinosis
  • Plica Syndrome
  • Patellofemoral Pain Syndrome
  • Iliotibial Band Syndrome
  • Apophysitis (Osgood Schlatter’s)
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7
Q

What is bursitis of the knee?

A

Inflammation of the small sacs of fluid that cushion and lubricate the knee.

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8
Q

What is tendinitis?

A

Inflammation of the tendon

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9
Q

What is tendinosis?

A

Small tears in the tendon.

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10
Q

What is Plica Syndrome?

A

Thickening or folding of the knee ligaments.

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11
Q

What is Patellofemoral Pain Syndrome?

A

Pain in the front of the knee from overuse, injury, excess weight, or problems in the kneecap.

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12
Q

What is Iliotibial Band Syndrome?

A

Irritation and inflammation of the band of fibrous tissue that runs down the outside of the thigh.

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13
Q

What is Osgood Schlatter’s Disease?

A

Osgood-Schlatter disease (OSD) is an inflammation of the bone, cartilage, and/or tendon at the top of the tibia, where the tendon from the patella attaches. It’s more of an overuse injury than a disease.

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14
Q

An MRI of the knee will evaluate what structures?

A
  • Bones
  • Cartilage
  • Tendons and ligaments
  • Meniscus
  • Soft tissues
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15
Q

What can knee MRI’s detect with regard to bone?

A
  • Bruising
  • Fractures
  • Cysts
  • Tumours
  • Infection
  • Dislocations

NOTE: Can also be used to determine extent of arthritis and to assist in pre-operative planning.

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16
Q

What can knee MRI’s detect with regard to cartilage?

A
  • Cartilage fraying (like frayed edges of jeans)
  • Fissuring (cracks, similar to a dry river bed)
  • Defects (the cartilage is missing)
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17
Q

What can knee MRI’s detect with regard to tendons and ligaments?

A
  • Injury the ACL
  • Injury to the PCL
  • Injury to the MCL and LCL
  • Injury to the quadriceps and patellar tendons
  • Injury to the popliteal tendon
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18
Q

What can knee MRIs detect with regard to Menisci?

A
  • Partial mensical tear
  • Complete meniscal tear
  • Meniscal degeneration
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19
Q

What can knee MRIs detect with regard to soft tissue?

A
  • Muscle tears
  • Muscle strains
  • Tumours
  • Infection
  • Baker’s Cyst
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20
Q

What is a Baker’s Cyst?

A

A herniation of synovial fluid through the posterior part of the capsule of the knee.

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21
Q

If it was suspected I had torn my ACL or medial meniscus playing football, who can refer me for imaging that would be covered by medicare?

A

A General Practitioner (GP)

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22
Q

Can you name all of these structures?

A
23
Q

What is the origin, orientation, and insertion of the ACL?

A
  • Arises anterior intercondylar area of the tibia
  • Passes posteriorly, superiorly, and laterally
  • Attaches onto the posterior part of the medial side of the lateral femoral condyle
24
Q

What is the origin, orientation, and insertion of the PCL?

A
  • Arises posterior intercondylar area of the tibia
  • Passes superiorly and anteriorly (medial to ACL)
  • Attaches onto the anterior part of the lateral surface of the medial condye of the femur.
25
Q

What is patella alta and baja?

A
  • Patella alta: a high riding patella
  • Patella baja: a low riding patella
26
Q

On an MRI, ligaments show up more hypointense. What does this mean?

A

They appear “more black”

27
Q

Name the structures the arrows are pointing to.

A
28
Q

Name the following structures.

A
  1. Patellar tendon
  2. Infrapatellar fat pad of Hoffa
  3. Lateral femoral condyle
  4. Medial femoral condyle
  5. Greater Saphenous vein
  6. Sartorius muscle and tendon
  7. Semitendinosus tendon
  8. Medial head of gastrocnemius muscle
  9. Posterior cruciate ligament
  10. Lateral head of gastrocnemius muscle
  11. Biceps femoris muscle and tendon
29
Q

What is the best plane in which to image the meniscal bodies?

A

Coronal Plane

30
Q

If ligaments of the knee or the menisci appeared hyperintense, what might this signify?

A

A tear.

31
Q

The medial collateral ligament (MCL) can be damaged in three main situations. What are these?

A
  1. When direct contact occurs from the lateral (outside) aspect to the knee
  2. In activities where the foot is fixed on the ground and an excessive valgus force is applied (i.e. foot is fixed and patient turns knee/twists knee)
  3. When a fall produces a valgus force on a flexed knee and the knee acts as a fulcrum
32
Q

True or false.

The knee is more stable in extension than it is when flexed.

A

True

33
Q

What are some signs and symptoms of an MCL sprain?

A
  • Pateint usually describes a sensation of the knee giving way medially
  • Swelling may be present if the joint capsule has been damaged also
  • Uncomfortabel to flex or fully straighten the knee
  • Palpation may reveal local swelling or thickening
  • Palpation may reveal local tenderness on/around the area
34
Q

Make notes on Grade 1 Ligament Sprains.

Include the following:

  • % of fibres torn
  • Healing time frames
A
  • Up to 50% of the fibres of the ligament have been damaged
  • Injury should take 3-4 weeks to treat before a full return to sport
35
Q

Make notes on Grade 2 Ligament Sprains.

Include the following:

  • % of fibres torn
  • Healing time frames
A
  • Between 50% to approx. 75% of ligament fibres damaged
  • Running can generally be commenced between 6-8 weeks provided quadriceps are at least at 80% of full strength and range of extension is full and painless
  • Before returning to sport, a full functional program will be necessary
36
Q

What is a Grade 3 Ligament Strain?

A
  • Indicates full rupture of the ligament
  • No dicernable end feel
37
Q

Which menicus is more prone to injury, the medial or the lateral? Why?

A

The Medial Meniscus.

This is because it is connected to the medial collateral ligament and the joint capsule, and thus it is less mobile.

38
Q

What is the ‘Unhappy Triad’?

A

Injury to the ACL, MCL, and medial meniscus

39
Q

What are some symptoms of Medial Cartilage Meniscus tear?

A
  • History of trauma or twisting the knee
  • Pain on the inner surface of the knee joint
  • Swelling of the knee within 48 hours of injury
  • Inability to bend knee fully - this may be associated with pain or a clicking noise
  • A positive sign (pain and/or clicking noise) during a McMurrays Test
  • Pain when rotating and pressing down on the knee in prone position - Appley’s test “locking” or “giving way” of the knee
  • Inability to weight bear on the affected side
40
Q

Describe a longitudinal mensicus tear.

A

This is a meniscus tear that occurs along the length of the meniscus and can vary in length. Bucket handle tears are an example.

41
Q

Describe a radial mensicus tear.

A

These tear from the edge of the cartilage inward

42
Q

Describe a Bucket-Handle meniscus tear.

A

This is an exaggerated form of a longitudinal meniscus tear where a portion of the meniscus becomes detached from the tibia forming a flap that looks like a bucket handle.

43
Q

Describe a ‘degenerative change’ type of mensicus tear.

A

This may lead to the edges of the meniscus becoming frayed and jagged, increasing the likelihood of a meniscus tear.

44
Q

Treatment for Medial Cratilage Meniscus Injury.

What can the athlete/patient do?

What can a Sports Injury Professional do?

A
  • Athlete/Patient:
    • Apply RICE to the injured knee
    • Wear a knee compression support
    • Try to keep the knee moving using mobility exercises
    • Gentle exercises to maintain quadriceps strength (nto so much as to aggravate ssx)
    • Take glucosamine/joint healing supplement
    • Consult a Sports Injury Professional
  • Sports Injury Professional:
    • Assess the knee to confirm the injury
    • Refer you for an MRI scan (then decide if conservative Rx will be effective or if surgery may be required)
45
Q

List some advantages for using MRI to image the knee?

A
  • Able to obtain different images in several planes
  • Does not expose the patient to ionising radiation
  • Does not normally involve the intravenous administration of contrast material, the use of which is associated with a small but definite number of adverse effects
  • Does not require joint manipulation
  • Painless and can be performed in less than 35 minutes
  • Does not require the intra-articular injection of iodinated radiographic contrast material, which is needed for arthrography
46
Q

Write notes on bucket handle meniscus tears.

Include the following:

  • Quick definition/overview
  • Idenification and Signs
A
  • A bucket-handle meniscus tear is a severe form of longitudinal or vertical tear where the central part of cartilage tissue gets detached from the tibia and is displaced from its position.
  • Is typically characterised by locking of the knee
  • Knee joint cannot be fully extended or straightened
  • Other symptoms include knee pain (which aggravates with squatting), stiff and swollen knees, clicking knee etc.
47
Q

Breifly outline the treatment for a bucket-handle meniscus tear.

A
  • First diagnosed with help of its symptoms and and physical examination of the injured knee
  • Then confirmed with imaging (i.e. MRI)
  • Initailly, doctors may monitor for a while and allow the tear to heal wihtout any surgery.
  • If it does not heal on its own, then doctors opt for arthroscopic surgery. If the location of the tear is at the extreme egde of the meniscus, then it can be repaired. Otherwise, the torn part of the meniscus has to be shaved away.
  • Rocovery time for minor tear is 2-3 weeks. However, if surgery is required could be anywhere from 6 weeks to 2-3 months.
48
Q

Cruciate ligament injuries.

What are some mechanisms of injury?

A
  • Landing from a jump or when running, suddenly side stepping or changing directionby decelerating, flexing and internally rotating the knee. (ACL).
  • Hyper-extension of the knee occurs in gymnasts or basketballers when landing awkwardly on coming down from a height (i.e. jumping)
  • A twisting injury in contact sports with a valgus force apllied to the outer knee in lateral rotation. In these injuries the medial ligament tends to tear before the anterior cruciate.
  • Acute hyper-flexion of the knee is uncommon
49
Q

True or False.

ACL injury is the most common injury affecting the knee joint.

A

True

50
Q

True or False.

About 70% of all serious knee injury involve damage to the ACL, and about 80% of these injuries occur without any contact (i.e. jumping, landing etc.)

A

True

51
Q

Most ACL injuries occur when we decelerate, come to a sudden stop, or land with improper technique while placing too much pressure on the knees.

What are some ways we can decrease the pressure/stress on our knees when exercising?

A
  • Dominate with our hamstrings, hips and glutes during movement
  • Make sure our knees do not protrude far out in front of our feet when decelerating, landing, and squatting.
  • Making sure our hamstrings are strong. As when our quadriceps are much stringer than our hamstings, this can cause ACL injury.
52
Q

What are some early post-surgical exercises patients can do post ACL op even before any significant amount of weight is placed on leg?

A
  • Ankle pumps
  • Ankle circles
  • Heels slides
  • Quadriceps setting
  • Straight leg raise
53
Q

Knee MRI - Anatomy Review

A
  1. Lateral condyle of femur
  2. Femur
  3. Patella
  4. Quadriceps Tendon
  5. Patella Tendon
  6. Tibial Tuberosity
  7. Lateral condyle of tibia
  8. Tibia
  9. Suprapatella Fat Pad
  10. Infrapatella Fat Pad
  11. Transverse Meniscal Ligament
  12. Anterior horn of lateral meniscus
  13. Posterior horn of lateral meniscus
  14. Tibial nerve
  15. Medial Sural Cutaneous nerve
  16. Gastrocnemius (lateral head)
  17. Soleus
  18. Popliteus or part of popliteal artery
  19. Plantaris
  20. Gastrocnemius (lateral head)
  21. Superior lateral genicular vessels
  22. Fat
54
Q
A

YEAR 4 SEMESTER 2 DIAGNOSTIC IMAGING (17 decks)

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