The Knee Lecture Powerpoint Flashcards
Patellar reflex tests ___ nerve root, achilles tendon is ___
L4, S1
Sunrise view x ray
Knee x ray view that should be very frequently done as it is the only x ray that can see the patellofemoral joint
Tunnel notch x ray
Allows for view of femoral tunnel at the patella to assess for avulsion or fracture, cannot assess ACL or PCL integrity
Gradual onset of swelling around knee after falling indicates ___ type injury, while immediate is more likely___
meniscal tear, ACL
Meniscal tears signs and symptoms (3)
- pain usually well localized
- pain with full flexion (inability to duck walk)
- may have knee locking (inability to fully extend knee)
Best special test to evaluate meniscal tear
Mcmuray’s test
Meniscal tear treatment options (3)
- compression, dressing, ice, elevation, crutches, ROM therapy
- aspirate if tense painful effusion only
- remove, debride, repair meniscus
Aspiration of fluid from knee joint analysis (3)***
- mostly blood indicative of ACL tear
- clear yellowish fluid without fat cells or significant blood is meniscal tear
- blood and globules of fat is intra-articular fracture of the bone
Baker’s (popliteal) cyst definition and management***
Normal variant enlargement of semimembranous bursae in medial popliteal space, may be found incidentally, may cause pain/paresthesias if nerve impingement if very inflamed and large, typically imaged on ultrasound or MRI, does NOT need to be excised often unless significantly problematic, often erroneously referred to ortho, can consider aspiration, rarely removed, may recur, treat any underlying cause
MCL injury
- due to valgus stress applied to weight bearing knee
- more common than LCL injury, association with other tears
- unable to bear weight
MCL diagnostic studies (2)
- plain films to rule out derangement or growth plate injury
- MRI
MCL treatment options (2)
- knee immobilization, crutches, progress to ROM
- surgical repair results same as non-op
LCL injury
- less common
- caused by varus stress on weight bearing knee
LCL treatment options (2)
- sprain ROM brace and progress to ROM, crutches
- tears need surgical treatment
ACL tear signs and symptoms (3)
- often audible pop after noncontact injury
- immediate effusion/hemearthrosis
- may be able to ambulate
ACL tear diagnostic studies (2)
- x ray
- MRI shows torn ligaments
ACL tear treatment options (2)
- young active athletes need reconstruction
- for those with limited activity or not surgical candidate, bracing may be possibility
Chondromalacia patella (CMP) (runner’s knee) (patellofemoral syndrome)
Anterior knee pain syndrome very common cause of knee pain in young adult, present with peripatellar pain, snapping, catching, crepitus, aggravated by stairs, squats, sitting, may be due to tracking problems (can be treated with tibial tubercle transfer) and may be overuse injury
Q angle
Angle from knee to ASIS compared to tibial tubercle, widened in females creating greater likelihood of knee pathology
Diagnostic studies for Chondromalacia patella (CMP) (runner’s knee) (patellofemoral syndrome) (1)
-x rays, sunrise view important
Chondromalacia patella (CMP) (runner’s knee) (patellofemoral syndrome) treatment options (4)
- stretch strengthen
- tracking brace
- NSAIDS
- footwear mod
Patellar sublaxation/dislocation definition/diagnostic studies (1)/treatment options (2)
- Patellar malalignment usually lateral that can occur with repeating episodes, due to retinacular instability, can see significant pain around kneecap and lateral condyle but relocating it manually relieves
- x ray including sunrise and lateral
- rehab*** surgery for repeated episodes including lateral retinacular release or patellar realignment
Plica syndrome definition
Synovitis of the folds of the knee, most often medial and may be due to trauma, overuse, treated with rest, activity restriction
Osteochondritis dissecans definition
Localized subcondral necrosis of the lateral aspect of the medial femoral condyle most commonly, possibly from trauma
Osteonecrosis of the femoral condyle
Avascular necrosis of the femoral condyle possibly caused by steroid use, alcoholism, etc.
Prepatellar bursitis (housemaid’s knee)
Pain anterior and inferior well localized to the patella, have to rule out septic cause before treating conservatively
Patellar tendonitis (jumper’s knee) treatment options (4)
- DO NOT INJECT
- rest, rehab, NSAIDS
- x ray for calcium deposits
- surgery for tendon debridement
Tibial plateau fractures definition, diagnostic study (1), treatment (2),
- very common fracture most often on the lateral plateau
- oblique x ray***
- immobilize and splint or ORIF
