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S6- MSK 2 > Week 5- Knee Clinical Presentations > Flashcards

Week 5- Knee Clinical Presentations Flashcards

1
Q

PART 1: COMMON PRESENTATIONS AND FRACTURE SCREENING

A

PART 1: COMMON PRESENTATIONS AND FRACTURE SCREENING

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2
Q

Knee Pain Common Clinical Presentations.

A
  • Patellar Fracture
  • Tendon Rupture
  • Osgood-Schlatter Disease
  • Articular Cartilage Defects
  • Meniscus Lesion
  • Cruciate & Collateral Ligament Sprains
  • Patellofemoral Instability
  • Patellofemoral Pain Syndrome
  • Osteoarthropathy
  • Arthrofibrosis
  • Genu Recurvatum
  • Patellar Tendinopathy
  • ITB Friction Syndrome
  • Plica Syndrome
  • Bursitis
  • Osgood-Schlatter Disease
  • Peripheral Nerve Entrapment
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3
Q

What are the 2 Decision Rules for Fracture Screening at the knee?

A
  • Pittsburgh Knee Decision Rule

- Ottawa Knee Decision Rule

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4
Q

What are the (3) criterion for the Pittsburgh Knee Decision Rule?

A
  1. ) Hx trauma/fall
  2. ) Instability to bear weight x 4 steps immediately and in ED
  3. ) Age <12 OR >50
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5
Q

What are the (5) criterion for the Ottawa Knee Decision Rule?

A
  1. ) TTP head of fibula
  2. ) Instability to bear weight x 4 steps immediately and in ED
  3. ) Age >/= 55 years
  4. ) Inability to flex knee 90 degrees
  5. ) Isolated TTP patella
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6
Q

What are the Pittsburgh and Ottawa Knee Rules used for?

A

-Used to identify which cases of knee injury require radiographic imaging.

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7
Q

PART 2: PATELLAR FRACTURE

A

PART 2: PATELLAR FRACTURE

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8
Q

Patellar Epidemiology:

  • Makes up ___% of all fractures.
  • Most common ___-___ y/o.
  • ______ 2x > _______
  • 50% ___-________
A
  • 1%
  • 20-50
  • males 2x > females
  • non-displaced
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9
Q

What are (2) common MOIs for patellar fracture?

A
  • Fall onto anterior knee.

- Sudden quad activation.

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10
Q

Patellar Fracture Symptomology:

-In a patellar fracture the patient will report ________ knee pain and painful/inability to _______ the knee.

A
  • anterior knee pain

- inability to extend knee

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11
Q

Patellar Fracture Physical Examination:

  • Palpable gap at fracture site.
  • Local tenderness.
  • Painful ___________ > _______ for knee extension.
  • Painful end-range _______ ROM.
  • Antalgic gait.
A
  • painful resistance testing > AROM

- painful end range flexion

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12
Q

PART 3: TENDON RUPTURE (PATELLAR AND QUAD)

A

PART 3: TENDON RUPTURE (PATELLAR AND QUAD)

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13
Q

Tendon Rupture Epidemiology:

  • _______ Tendon Rupture = < 40 y/o.
  • _______ Tendon Rupture = > 40 y/o.
  • Which tendon rupture is 4-8x more likely in males?
A
  • Patellar tendon rupture = <40 y/o
  • Quad tendon rupture = >40 y/o
  • Quad tendon rupture
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14
Q

What are the risk factors for tendon rupture? (7)

A
  • local steroid injection
  • prolonged corticosteroid use
  • RA/Lupus
  • CT (connective tissue)/infectious diseases
  • Arteriosclerosis
  • DM
  • Hyperthyroidism
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15
Q

Tendon Rupture History:

  • Related to _______ overload extensor mechanism/trauma.
  • Sudden onset f/b fall.
  • Quad rupture common MOI?
  • Patellar rupture common MOI?
  • Hx of what 3 things?
A
  • eccentric overload
  • rapid quad contraction (regaining balance)
  • jump landing
  • Hx of degenerative tendinopathy, TKA, and ACL reconstruction.
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16
Q

Tendon Rupture Symptomology:

-Where will patients with quad/patellar ruptures report pain?

A

-anterior knee

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17
Q

Tendon Rupture Physical Examination:

  • Absent/painful active knee __________.
  • Painful knee _______ ROM.
  • Palpable defect.
  • Antalgic gait/unable to walk.
A
  • Absent/painful active knee extension.

- Painful knee flexion ROM.

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18
Q

PART 4: OSGOOD SCHLATTER DISEASE

A

PART 4: OSGOOD SCHLATTER DISEASE

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19
Q

What is Osgood Schlatter Disease?

A

-Apophysitis (inflammation to growth plates) of tibial tubercle.

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20
Q

Osgood Schlatter Epidemiology/Hx:

  • What population is this most common in?
  • Involves repetitive loading into knee ________.
  • Common __________.
A
  • young adolescent (males (10-15) > females (8-13))
  • flexion
  • bilaterally
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21
Q

Osgood Schlatter Disease Symptomology:

-Patient will report pain in ________ knee and aggravation with _______/resisted knee ________.

A
  • pain in anterior knee

- aggravated with activity/resisted knee extension

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22
Q

Osgood Schlatter Disease Physical Examination:

  • Local TTP
  • Prominent ______ ______ on visual inspection.
  • Pain end-range knee ______ ROM.
  • Knee __________ pain with resistive testing > AROM.
  • Possibly painful with tuning fork.
A
  • prominent tibial tubercle
  • pain end-range knee flexion
  • knee extension pain resistive > AROM
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23
Q

PART 5: ARTICULAR CARTILAGE DEFECTS

A

PART 5: ARTICULAR CARTILAGE DEFECTS

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24
Q

What is Osteochondritis Dissecans?

A

-Type of articular cartilage defect involving the separation of articular cartilage from subchondral space.

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25
Osteochondritis Dissecans Epidemiology: - What is the most common site? - Is it more common in males or females? - Greatest ___-___ y/o active individuals. - Common _________.
- Most common on lateral side of medial condyle. - males > females - 10-20 y/o active individuals - bilaterally
26
Osteochondritis Dissecans Hx: - Traumatic MOI (40-60%) juveniles vs. insidious. - ___________ within 2 hours. What is this?
-Hemiarthrosis within 2 hours. Hemiarthrosis is articular bleeding into the joint cavity.
27
Osteochondritis Dissecans Symptomology: - ___________ knee pain. - Does activity make it better? - Stiffness/swelling with activities. - ________/________/_______
- non-specific knee pain - No, activity makes it worse and rest makes it better. - grinding/locking/catching
28
Osteochondritis Dissecans Physical Examination: - TTP at the femoral _______, medial and lateral joint lines. - Antalgic gait - Knee effusion. - Limited painful knee _________.
- TTP at femoral condyle | - limited/painful knee ROM (flexion/extension)
29
What are some common surgical interventions used for articular cartilage defects? Explain each.
Arthroscopic lavage & debridement -Probe with debridement of loose fragments. Microfracture -If chondral, drill holes leading to bone supply for vascularization. Autologous Osteochondral Mosaicplasty Grafting -Cartilage taken from other areas and placed. Autologous Chondrocyte Implantation (ACI) -Grow in lab, place back in. Osteochondral Autograft Transfer (OAT procedure) - Osteochondral Allograft Transplantation -
30
PART 6: MENISCUS LESION
PART 6: MENISCUS LESION
31
Meniscus Lesion Epidemiology/Hx: - Incidence 12-14% - What injury is often concomitant with a meniscus lesion? - Audible "pop" during _____________. - Delayed _________ (__-__ hours following injury)
- ACL Injury - directional change - delayed effusion (6-24hrs)
32
Meniscus Lesion Symptomology: - _______/_______/__________ at the knee. - Local knee pain.
-catching/locking/giving way of knee
33
Meniscus Lesion Physical Examination: - Pain at end-range knee _________. - Pain/limited _______ ROM. - Painful/weak ___________ resistive testing. - What 4 tests may be + if Meniscus Lesion is present?
- end-range knee extension - pain/limited flexion ROM - flex/ext resistive testing - + McMurray's, Thessaly, Appley's. Varus/Valgus Stress Tests
34
PART 7: ACL, PCL, MCL, LCL
PART 7: ACL, PCL, MCL, LCL
35
- What is the function of the ACL? - What is the function of the PCL? - What is the function of the MCL? - What is the function of the LCL?
- ACL = Prevent anterior translation of tibia on femur. - PCL = Prevent posterior translation of tibia on femur. - MCL = Prevent valgus collapse. - LCL = Prevent varus collapse.
36
ACL Epidemiology: - What is a common issue that occurs years after ACL injury? - ACL injury increases the risk to what else?
- Knee OA | - Stabilizers of the knee.
37
ACL Clinical Correlations: - _______ 2-9x more likely. Why? - Decreased ________/_____ strength. - Duration of activity/fatigue. - Dry/artificial turf. - High BMI.
- Females 2-9x due to jump landing mechanisms, greater Q angle, narrower intercondylar notch, and hormone laxity. - Decreased hamstring/core strength.
38
ACL Hx: - Are ACLs more likely from contact or non-contact? - What are some MOIs? - Contact injury MOI involves varus/valgus stress imposing shear force on joint.
- More likely from non-contact. - Pivoting with planted foot and extended knee, cutting maneuvers, landing in full knee extension, hyperextension/hyperflexion.
39
ACL Symptomology: - Feelings of ________ at knee. - C/o severe pain with audible _____ and immediate _______.
- Feelings of instability. | - C/o severe pain with audible "pop" and immediate swelling.
40
ACL Physical Examination: - ________-________ posture - Knee joint effusion - Antalgic gait - AROM/PROM/Resistive painful/limited in what plane? - _____/________ end-feel. - Excessive laxity with KT-1000 arthrometer test. - What 3 tests may be + with ACL Sprain?
- weight-shifted posture - AROM/PROM/Resistive limited/painful in ALL PLANES. - Boggy/guarded end-feel - + Pivot Shift, Anterior Drawer, Lachman's Tests
41
PCL Epidemiology/Hx: - __-__% of knee injuries. - Audible _____ with injury. - What are some common MOIs?
- 3-20% of knee injuries - audible "pop" - Posterior force at proximal anterior tibia, violent hyperextension, fall on flexed knee with PF.
42
PCL Symptomology: - Local _________ knee pain aggravated with deceleration and kneeling. - Feeling of LE _________.
- local posterior knee pain | - Feeling of LE giving way (instability)
43
PCL Physical Examination: - Limited knee _______ in stance phase of gait. - Effusion - Limited/painful knee _______ ROM. - Painful with resistive testing of extension > 90 degrees. - What test may be + with PCL Sprain?
- limited knee extension in stance phase - Limited/painful knee ext/flex - + Posterior Drawer Test
44
MCL Epidemiology: - Is this injury concomitant with other ligamentous injuries at the knee? - Correlation with soccer/football/hockey. - High grade injuries may lead to chronic knee ___________. - What do we need to worry about with deep MCL tears?
Yes, involved in ~42% of ligament injuries at the knee. - chronic knee instability - Worry about connection with meniscus.
45
MCL Hx: - Is this more common in younger/older, and male/female? - What is a common MOI?
- Younger, males (2x) | - Valgus force (external force at lateral knee)
46
MCL Symptomology: - ______ knee pain. - Aggravated with ________, change in _______, and ______ force.
- medial knee pain | - Aggravated with activity, change in direction, and valgus force.
47
MCL Physical Examination: - Swelling/bruising - Antalgic gait - Potential limited/painful knee ROM - Local TTP - What test may be + with MCL Sprain?
- + Valgus Stress Test (pain/laxity)
48
LCL Hx: | -What is a common MOI?
-Varus trauma at knee.
49
LCL Symptomology: - _______ knee pain. - Aggravated with change in _______ during ambulation.
- lateral knee pain | - Aggravated with change in direction
50
LCL Physical Examination: - Local lateral knee effusion - Local TTP - Guarded/boddy end-feel with end range ROM flexion and extension. - What test may be + with LCL Sprain?
- + Varus Stress Test at 0 and 30 degrees
51
PART 8: PATELLOFEMORAL INSTABILITY
PART 8: PATELLOFEMORAL INSTABILITY
52
What is Patellofemoral Instability?
-Concern with tracking of patella and distribution of loading that can have subsequent dislocations commonly.
53
Patellofemoral Instability is often concomitant with _________ lesion.
-Osteochondral lesion
54
Patellofemoral Instability Predispositions: - _____ patella, ______ groove - Patella ____/_____ - Quad muscle imbalance - Generalized ligamentous laxity
- small patella, shallow groove | - alta/baja
55
Patellofemoral Instability Hx: | -_________/________ of patellofemoral joint.
Subluxation/dislocation
56
Patellofemoral Instability Symptomology: - ________ of LE - _____-_______ pain
- "Giving way" of LE | - peri-patellar pain
57
Patellofemoral Instability Physical Examination: - Peripatellar TTP. - ______mobility of patellofemoral joint. - ___________ sign. - Acchymosis/swelling/effusion in ______ stages.
- Hypermobility - Apprehension sign - acute stages
58
Recurrent Patellofemoral Instability is an indication for surgical management. What may be done?
-May cut lateral retinaculum so it can't pull patella out and dislocate.
59
PART 9: PFPS (PATELLOFEMORAL PAIN SYNDROME)
PART 9: PFPS (PATELLOFEMORAL PAIN SYNDROME)
60
- What population is at risk for PFPS? | - Common with what activities?
- Active individuals and adolescents. | - Weight-bearing activities.
61
PFPS Clinical Correlations: - Altered patellar tracking thought to contribute to aberrant loading patterns of patellofemoral joint. - _______ weakness/muscle imbalance - Soft tissue tightness - Increased __-_____ - Hip weakness (ABD/ER) - Altered ___/____ kinematics (subtalar pronation) - Increased femoral angle of ________ - Increased femoral _________
- Quad weakness/imbalance - Increased Q-angle - Altered foot/ankle kinematics - Increased femoral angle of inclination - Increased femoral anteversion
62
PFPS Hx: - Athletes - ______ gender - _______ onset
- female gender | - insidious onset
63
PFPS Symptomology: - ______/________ knee pain - What are some aggravating factors? - Knee __________ - Catching at knee
- Anterior/peri-patellar - Aggravated with (prolonged) sitting, stair ambulation, inclined walking, squatting - Knee crepitus
64
`PFPS Physical Examination: - Patella ____/_____ - Abnormal __-______ - Painful squat - Possible peri-patellar swelling and antalgic gait - Painful/limited knee _______ AROM - Painful/limited knee _______ PROM - Hip ER/ABD weakness - What test may be + with PFPS?
- Patella alta/baja - Abnormal Q-angle - Painful/limited knee flex/ext AROM - Painful/limited knee flex PROM - + Clarke's Test
65
What does the CPG say about diagnosis of PFPS?
1. ) Should use reproduction fo retropatellar or peri-patellar pain during squatting as a diagnostic test for PFP. Can also use performance/functional activites that load PFJ in a flexed position such as stairs. (A GRADE) 2. ) Should make diagnosis of PFP using criteria (1) Presence of retropatellar or peri-patellar pain (2) Reproduction of retropatellar or peripatellar pain with squatting, stair climbing, prolonged sitting, etc in flexed position of PFJ (3) Exclusion of all other conditions. (B GRADE) 3. ) May use the patellar tilt test with the presence of hypomobility to support diagnosis of PFPS.
66
PART 10: OTEOARTHROPATHY (OA)
PART 10: OTEOARTHROPATHY (OA)
67
What is OA?
-Any disease of the bones and joints.
68
- What joint is most commonly affected by OA? - Patients with a previous ______ injury are more likely to develop knee OA. - Can be ____________.
- Knee - ACL injury - asymptomatic
69
- Early OA = joint _______ | - Late OA = joint ________
- Early OA = joint gapping | - Late OA = joint narrowing
70
OA Hx: - ______ onset - Hx trauma/prior knee Sx - Family Hx - _________ - Knee ______mobility - Joint shape abnormality - Extreme physical activity levels - Age >___ y/o - _______ gender
- insidious onset - obesity - knee hypermobility - age > 50 - female > male
71
OA Symptomology: - ________ pain - Aggravated with w/b activities, squatting, stairs, prolonged sitting - _________
- Retropatellar pain | - Crepitus
72
OA Physical Examination: - Antalgic gait - Swelling/warmth at knee - TTP joint lines - Painful/limited knee _________ - Painful/limited resistive testing
-Painful/limited knee flex/ext
73
PART 11: ARTHROFIBROSIS
PART 11: ARTHROFIBROSIS
74
- What is arthrofibrosis? - Is inflammation present? - May lead to ___________ joint changes.
- Dense proliferative intra-articular and extra-articular scar tissue formation with related limitations in knee ROM. - Yes - degenerative joint changes
75
Arthrofibrosis Symptomology: - Stiffness(worse in _________) - Knee swelling - ________ - ______ knee pain
- Stiffness (worse in morning) - Crepitus - Diffuse knee pain
76
Arthrofibrosis Physical Examination: - Limited knee __________ in stance. - Limited/painful knee _______. - _____mobile patellofemoral glides - Knee effusion/swelling - Inhibited/weak/painful knee __________
- extension - limited/painful knee ext/flex - hypomobile - Inhibited/weak/painful knee extension
77
PART 12: GENU RECURVATUM
PART 12: GENU RECURVATUM
78
Genu Recurvatum involves hyperextension of the knee >___ degrees.
- >10 degrees
79
Genu Recurvatum Epidemiology: - Are females of males affected more? - Correlated with joint laxity, Hx knee injury, and poor muscular control. - May predispose patient to what injuries? (4)
- females - ACL injury, compressive anterior tib-fib joint injury, tensile posterior joint supporters injury, posterior corner capsulo-ligamentous avulsion injury
80
Genu Recurvatum Hx: - Forced knee ________ injury. - Jump landing in extension. - Force to anteriomedial proximal tibia. - Noncontact hyperextension with planted foot. - Concomitant ____ injury.
- extension | - PCL injury
81
Genu Recurvatum Symptomology: - C/o knee ____________. - ____________ vs ____________ knee pain
- C/o knee instability | - Anteriomedial vs posteriolateral knee pain
82
Genu Recurvatum Physical Examination: - Knee hyperextension (impaired __________) - Edema, ecchymosis - TTP locally - ___________ screening exam - Antalgic gait - Hypermobility posterior glide with posteriolateral bias.
- Knee hyperextension (impaired proprioception) | - Neurovascular screening
83
PART 13: PATELLAR TENDINOPATHY
PART 13: PATELLAR TENDINOPATHY
84
- Patellar Tendinopathy is often called "Jumper's Knee" and involved an __________ overload. - Average ___ months pain/functional limitations. - ___% of affected athletes quit sport. - What sports are more prone to this injury?
- eccentric overload - Average 32 months - 53% - basketball and volleyball
85
Patellar Tendinopathy Symptomology: - ________ knee pain - Aggravated with _________/ extensor mechanism
- anterior knee pain | - aggravated with jumping
86
Patellar Tendinopathy Physical Examination: - TTP at what areas? - Painful squat - Pain end-range _______ ROM - Pain ______ > ________
- TTP at patellar tendon and inferior pole of patella - Pain end-range flexion - Pain resisted > AROM extension
87
PART 14: IT BAND FRICTION SYNDROME
PART 14: IT BAND FRICTION SYNDROME
88
- IT Band Friction Syndrome involves increased compression on soft tissue structures between lateral femoral ______ and ____. - Involved with thickening of bursa.
lateral femoral condyle and ITB
89
IT Band Friction Syndrome Hx: - ___________ - Also downhill skiers, jumpng sports, weight lifters, cycling
-Long distance runners
90
IT Band Friction Syndrome Symptomology: - _______ knee pain - Aggravated with activity, repetitive knee ______/_______, and stairs.
- lateral knee pain | - Aggravated with activity, repetitive knee flex/ext, and stairs
91
IT Band Friction Syndrome Physical Examination: - Local TTP - Hip ROM painful end-range _______ - Potentially painful hip ________ resistance testing - What test may be positive with ITB Friction Syndrome?
- end-range ADD - ABD resistive testing - + Ober Test
92
PART 15: HOFFA'S SYNDROME
PART 15: HOFFA'S SYNDROME
93
What is Hoffa's Syndrome?
-Hypertrophy/iniflammation of intrapatellar fat pad that can cause impingement between femoral condyles and tibial plateaus.
94
Hoffa's Syndrome Hx: | -Trauma vs repetitive _______ microtrauma
-extension
95
Hoffa's Syndrome Symptomology: - _________ (infrapatellar) knee pain - Aggravated by activities that require (repetitive) knee _________.
- anterior knee pain | - knee extension
96
Hoffa's Syndrome Physical Examination: - Painful knee _________ ROM - Local TTP (medial/lateral to ___________)
- painful knee extension ROM | - Local TTP (medial/lateral to patellar tendon)
97
PART 16: PLICA SYNDROME
PART 16: PLICA SYNDROME
98
What is Plica Syndrome?
- A plica is a fold in the thin tissue that lines your knee joint. There are 4 (supra/medio/infra/lateropatellar plica) of these plica, and they let you bend and move your leg with ease. - Plica Syndrome is when one of these gets irritated from injury or overuse.
99
``` Plica Syndrome Suggested Clinical Dx: -Supportive Hx. -Failure with conservative management. -Arthroscopic observation of fibrotic plica with impingement in patellofemoral joint during knee _______. No other likely diagnostic hypothesis. ```
-flexion
100
Plica Syndrome Hx: - ______trauma - Can happen at any age but greatest risk with __________. - Initial knee injury with secondary inflammation to plica.
- microtrauma | - adolescents
101
Plica Syndrome Symptomology: - ________ knee pain. - clicking/catching/locking/giving way - Aggravated with activity, prolonged standing/sitting, squatting
-anterior knee pain
102
Plica Syndrome Physical Examination: - __________ plica ________ effusion. - Local TTP - Painful knee ______ ROM, less pain with active _________. - Painless _______ PROM.
- Hypertrophied plica without effusion - Painful knee flexion ROM; less pain with active extension - Painless extension PROM
103
PART 17: BAKER'S CYST
PART 17: BAKER'S CYST
104
What is Baker's Cyst?
A fluid-filled cyst behind the knee, may rupture.
105
Baker's Cyst Symptomology: | -________ knee pain.
posterior knee pain
106
Baker's Cyst Physical Examination: - Local swelling proximal to popliteal fossa - Pain knee ________ - Prominence of cyst increases with resisted knee _______.
- painful knee flex/ext | - Prominence increases with resisted knee flexion
107
PART 18: BURSITIS
PART 18: BURSITIS
108
What are the (3) areas this can occur?
- Superficial & deep infrapatellar (nun’s knee) = Direct mechanical irritation - Prepatellar = Recurrent anterior knee trauma - Superficial Pes Anserine = Swimmers/ distance runners
109
Bursitis Physical Examination: | -Local ____/__________
Local TTP/swelling
110
PART 19: NERVE ENTRAPMENTS
PART 19: NERVE ENTRAPMENTS

S6- MSK 2 (21 decks)

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