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MSK 1 > triage of knee issues > Flashcards

triage of knee issues Flashcards

1
Q

Ottawa Knee Rules

A

Age 55+

Isolated tenderness of the patella
OR
Tenderness over fibular head

Unable to flex the knee past 90

Unable to bear weight immediately, or in the ED for 4 steps

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2
Q

what population is more prone to fractures

A

Younger and older pop are more prone to fracture

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3
Q

Pittsburgh Knee Rules

A

Blunt trauma or a fall as MOI plus one of the following:

Age under 12

Age over 50

Unable to bear weight in the ED for 4 steps

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4
Q

how do you use Ottawa Knee Rules
and pittsburgh knee rule

A

IF ANY ONE OF THE CRITERIA ARE PRESENT AFTER AN ACUTE INJURY, RADIOGRAPHS SHOULD BE ORDERED

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5
Q

with a knee injury when should we send pt to the ED

A

Open Injury

Neurovascular Injury with
Diminished or absent distal pulses

Absent sensation

Obvious fracture OR
Positive Ottawa Ankle/Knee Rules - high index of suspicion​

Gross misalignment of limb

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6
Q

knee issue - Continue Exam;
Refer out when finished:

A

Positive Ottawa Ankle/Knee Rules - low index of suspicion​

Tibiofemoral or Patellofemoral Dislocation
No neurovascular issues
Normal alignment (spontaneous reduction)
No tendon ruptures

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7
Q

proximal tibias into articular surface is the biggest problem for what population

A

more a problem in younger pt because of growth plates, can lead to weird growth

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8
Q

does the knee fracture often

A

no

Only 6% of knee injuries have fractures

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9
Q

when can we start to move with a fracture

A

depends on how stable to the fracture is

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10
Q

normal treatment for a fracture

A

Treat non-operatively
Closed reduction
Immobilize for 4-6 weeks

NWB or PWB for 4-6 weeks

Usually has a 0-90° ROM restriction

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11
Q

is any training during the healing process of the fracture

A

“Light strengthening” allowed

Submaximal resistance that is not producing pain

body weight

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12
Q

what is the point of rehab​ ring the immobilization phase

A

Goal = reduce the effects of immobilization

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13
Q

what does “Toe touch”

A

a type of PWB

Only toes touch the ground

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14
Q

what is “Touch-down”

A

type of PWB

Foot flat on ground

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15
Q

what is swelling a good indicator of

A

the knee is not ready to progress

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16
Q

the focus of Rehabilitation after Prolonged Immobilization

A

Symptom Modulation and Impairment Resolution

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17
Q

what impairment do we see with prolonged immbolization

A

joint effusion and edma

Improve Muscle Activation and Decrease Atrophy

Restore Limited Motion, Decrease Joint Stiffness

Restore Normal Movement Patterns

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18
Q

Wolff’s Law

A

do not use it you will lose it, the bone response to load (stress), this has to be controlled and progressive with time – weightbearing ease into it

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19
Q

what is the most common knee dislocation

A

anterior dislocation

the tibia displaced anteriorly on the femur

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20
Q

when we suspect a dislocation what should we look at

A

Evaluate sensation and pulse to look at complications

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21
Q

why are dislocations dangerous and need immediate attention

A

they are limb threatening because of neurovascular compromise

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22
Q

what nerves are we worried about with disloction

A

peroneal nerve , tibial nerve

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23
Q

what Arteries are we worried about with dislocations

A

Popliteal is primary concern; genicular anastomosis also; check all distal pulses

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24
Q

what ligaments a injured​ with dislocation

A

Cruciate and collateral ligaments are injured in some combination

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25
Q

treatment for dislocation​

A

immobilization, likely surgical reconstruction of any structures that have torn

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26
Q

Prognosis for dislocations

A

long rehab to return to function, continued instability is common. Not good…

27
Q

Long term complications of knee dislocations include

A

Quadriceps atrophy
Joint stiffness
Osteoarthritis
Avascular necrosis of femoral or tibial condyles

28
Q

Posterior knee joint dislocation can impact what artery

A

popliteal artery

Check posterior tibial pulse

29
Q

Posterolateral knee joint injury can impact supply to what artery

A

anterior tibial artery

Check dorsalis pedis pulse

30
Q

what is Deep Vein Thrombosis

A

Clotting/Blockage of a distal vein

31
Q

what procedure increases the occurrence​ of DVT

A

More common after surgery (hip, knee, leg/calf, abd, chest)

32
Q

Some of the reasons why surgery can increase DVT risk:

A

Tissue debris, protein, and fats may move into veins following surgery.

Vein walls can become damaged, which may also release substances that promote blood clotting.

Prolonged bed rest is common following surgery.

33
Q

where do we check for the Dorsalis Pedis Pulse

A

Top of the foot, lateral to EHL tendon

Distal to navicular

34
Q

where do we check for the Posterior Tibial Pulse

A

Posterior to medial malleolus

35
Q

Risk of deep vein thrombosis increases

A

age

especially after age 60

36
Q

what lifestyles lead to a higher risk of DVT

A

Sitting or inactivity for a long time

Extra weight/obesity

Current use of hormonal contraceptive pills or patches

Smoking

37
Q

Signs and Symptoms of DVT

A

Swelling in one or both legs

Pain or tenderness in one or both legs, which may occur only while standing or walking

Warmth in theskinof the affected leg

Red/ purple or other discolored skin in the affected leg

Visible surface veins

Legfatigue

38
Q

result of wells score

A

3 points: high risk (75%);
1 to 2 points: moderate risk (17%)
;<1 point: low risk (3%).

39
Q

Common Peroneal Nerve Motor Function

A

Ankle DF
Great toe extension
Toe extension

40
Q

Common Peroneal Nerve Sensory Function

A

1st web space
Dorsal surface of toes

41
Q

Tibial Nerve Motor Function

A

Plantarflexion
Toe flexion
~Inversion

42
Q

Tibial Nerve Sensory Function

A

Plantar aspect of calcaneus
Plantar aspect of 5th toe

43
Q

what is Antalgic Gait

A

pain when they are walking and are showing it when they are walking

  • limbing
44
Q

Flexed Knee Gait

A

Avoids terminal knee extension

45
Q

potential reasons for flexed knee gait

A

Quadriceps avoidance gait
Co-contraction of the quadriceps and hamstrings to limit motion
Limited passive extension ROM

46
Q

what strutures for Lateral Joint Line (meniscus) and Tibial Plateau

A

Fibular head, LCL,
Biceps fem Tendon, lateral Gastrocnemius
ITB & Gerdy’s Tubercle

47
Q

what structures for Medial Joint Line (meniscus) and Tibial Plateau

A

MCL, medial hamstring tendons & gastroc (posteriorly), pes anserine (bursa and muscle)

48
Q

what strutures for Patella

A

Superior patella and quadriceps tendon

Medial patella and vastus medialis

Lateral patella, lateral retinaculum, vastus lateralis

49
Q

what structure for Tibial Tubercle

A

Patellar tendon, fat pads, distal patella

50
Q

Empty end-feel

A

pain before the restriction

Indicates high irritability

51
Q

Pain pushing into the restriction indicates

A

Usually indicates low symptom irritability

52
Q

Pain at the point of restriction

A

Capsular end-feel
Indicates moderate irritability
Can likely handle some loading

53
Q

Boney changes cause what kind of end feel

A

hard end feel

54
Q

strong and painless

A

normal

55
Q

strong and painful

A

Minor Muscle Injury
(Contractile Tissue)

56
Q

weak and painless

A

Nerve lesion or
“complete muscle tear”

57
Q

weak and painful

A

“Serious Pathology” or
significant muscle injury

58
Q

when we are doing a quad set what are we looking for

A

Should see a full tetanic contraction with evidence of VMO contraction

Should see evidence of a superior patella glide

59
Q

what are we looking at with a SLR

A

Lift 6” off of bolster for goniometer

60
Q

What is Joint Effusion

A

Fluid contained WITHIN a body/joint cavity

61
Q

what is the largest synovial cavity in the body

A

the knee joint

62
Q

what would lead to an intra-articular injury

A

Intra-articular injury

not a extra-articular injury

63
Q

Joint Edema in relation to effusion

A

All effusions are edemas, not all edemas are effusions

this is general term for swelling

MSK 1 (14 decks)

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