Week 4 Flashcards
Presentation of ligamentous knee injury
- A loud “pop” or a “popping” sensation in the knee
- Severe pain and inability to continue activity
- Swelling that begins within a few hours
- Loss of range of motion
- A feeling of instability or “giving way” with weight bearing
Normal range of motion (with degrees) of the knee joint.
- Extension: 0 degrees- leg straight
- Flexion: 135 degrees
Grades of knee effusion with stroke test
- 0: no wave produced on down stroke
- Trace: small wave on medial side with downstroke
- 1+: larger wave on medial side with down stroke
- 2+: effusion spontaneously returns to medial side after upstroke
- 3+: so much fluid that it is not possible to move the effusion out of the knee
Anterior drawer test
ACL; flex knee at 90, sit on foot, thumbs on tibial tuberosity fingers behind knee, pull forward, checking for hard barrier
Posterior drawer test
PCL; flex knee at 90, sit on foot, thumbs on tibial tuberosity fingers behind knee, push backwards, checking for hard barrier
Varus/valgus testing
MCL and LCL; will do at 0 and 30 degrees; outside hand on lateral aspect of knee, inner hand on shin, apply varus (pull knee laterally, push shin medially) and valgus pressure (push knee medially, pull shin laterally
Anatomical arrangement of ligaments in knee joint
-ACL and
PCL are intracapsular, in joint space, and lie in between the femur and tibia, cris-crossing each other
-MCL and LCL are extracapsular, oustide joint space, and lie on outside of femur and fibula (LCL) or femur and tibia (MCL)
-menisci lie at anterior articulations of femur and tibia
Unhappy triad
-ACL, MCL, Medial meniscus (can include lateral meniscus instead)
Indications for surgical reconstruction of ligaments
- adults
- children
- multiple
- Active adult patients involved in sports or jobs that require pivoting, turning or hard-cutting as well as heavy manual work are encouraged to consider surgical treatment.
- In children surgery has possibility of damaging growth plate and doctors may allow to postpone surgery until closer to skeletal maturity, children also tend to heal faster/better so may not need surgery
- In cases with multiple ligaments/menisci damage it is recommended to provide better stability of joint
Common etiologies of Achilles injury
jumping, running, use of steroids, obesity, sudden increase in activity, age
Thompson test
- examines the integrity of the Achilles tendon by squeezing the calf
- patient lies prone (if pregnant can flex knee to 90 degrees and kneel on chair) with foot over end of table; examiner squeezes the calf resulting in plantar flexion
- positive test is when patient cannot plantar flex, and points to rupture of achilles
Clinical features of Achilles injury identified on physical examination
- inspection
- palpation
- motion
- testing
- increased resting dorsiflexion in prone position with knees bent; calf atrophy
- paplable gap
- weakness to plantar flexion; increased passive dorsiflexion
- positive thompson test
Clinical indications for MRI of achilles injury
-equivocal physical exam findings
Findings of MRI with achilles rupture
- acute rupture: retracted tendon edges, small gap
- a full-thickness tear often shows a tendinous gap filled with edema or blood
Treatment plan based on age, pre-existing conditions, associated risk factors
- Conservative versus non-conservative treatment have been shown to have the same results. Therefore, any patients that have any factors that would result in poor-wound healing (diabetes, smoking, chronic alcohol use, etc.) or who are older should follow a conservative treatment plan.
- high performing athletes should receive surgical treatment if wanting to resume normal activity in future
