Knee main focus Flashcards
Deformities of the knee
Bow legs - legs that curve outwards at the knee
Knock knees - legs that curve inwards at the knee
Can be caused by Rickets, Injury, Infection or an Inherent growth disorder
Lesions of the meinsci
Medial less mobile than lateral, more liable to tearing when subjected to abnormal stresses
Grinding forces split the fibres of the meniscus
P usually young who sustains a twisting injury to knee
Or elderly - Horizontal tears usually degenerative or due to repetitive minor trauma
- Swelling appears after a few hours or the following day
- Sometimes knee gives way spontaneously and is followed by pain and swelling
- Ps over 40 may not remember original injury, main complaint will be giving way and locking
- On examination joint may be held slightly flexed
- Quads wasted
- Tenderness on joint line, on medial side in vast majority
Osteochondritis dissecans
A piece of the bone partially or fully separates from the end of the bone that forms a joint. As the piece of the bone dies, the cartilage covering it cracks, and both may break loose.
- lack of blood supply to the area.
- Trauma, either singular impact with the edge of the patella or repeated contact with an adjacent tibial ridge
- Intermittent ache or swelling
- Later attacks of giving way and the knee feels unreliable
- Quads wasted
- Joint slightly swollen
- Limited ROM
- Tenderness localised to femoral condyle
Loose bodies
Small fragments of articular cartilage that break off in the knee joint as a result of a knee injury or degeneration.
Loose bodies float around within the knee joint and cause pain, catching, locking, or swelling depending upon where the fragments migrate.
Behind the patella
- Injury – chip of bone or cartilage
- Osteochondritis dissecans – may produce one or two fragments
- Osteoarthritis – pieces of cartilage or osteophytes
Recurrent dislocation of the patella
Due to disruption/stretching of surrounding ligaments, which normally stabilise the joint.
Repeated dislocation damages articular surfaces of the patella and femoral condyle
This may result in further flattening the condyle and therefore further dislocations
- Generalised ligamentous laxity
- Valgus deformity of the knees
- External tibial torsion
- From time to time knee gives way and P falls
- May be accompanied by pain and knee stays in flexion
- Dislocation almost always to the lateral side
- Usually tenderness on the medial side of the joint
- Later the joint becomes swollen
Chondromalacia of the patella
Breakdown of cartilage on the underside of the kneecap - * Repetitive mechanical overload of the patellofemoral joint
- Anterior knee pain (pain under knee-cap)
- Symptoms aggravated by activity, climbing stairs or when sitting or standing for a long period of time
- Quads wasted
- Patella femoral pain is elicited by pressing the patella against the femur and asking P to contract the quads
Tibial tubercle ‘apophysitis’
- Pain and swelling of tibial tubercle
- Tibial tuberosity unusually prominent and tender
- Sometimes active extension of the knee against resistance is also painful
- X-rays show displacement of tibial apophysis
Chronic ligamentous instability
3 types of tibiofemoral instability: 1. sideways tilt, varus or valgus 2. Excessive glid, forwards or backwards 3. Unstable rotation.
* Ligament injury, from strain to ruptures
Patellar tendinopathy
Common soft tissue injury which can cause pain in the patellar tendon. It can also cause stiffness and weakness around the knee.
* Overuse injury, which means it can develop after repeated stress on your patellar tendon.
Prepatella Bursitis
Inflammation of the bursa in the front of the patella. Occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the adjacent parts of the knee.
Can result from frequent kneeling or from acute trauma to the anterior knee. E.g. Plumbers, roofers, carpet layers and gardeners.
Medial / Lateral Collateral Ligament Strain
Ligaments are stretched but not torn. The MCL is the most commonly injured knee ligament.
* Following trauma - Contact sports
* Report of history of twisting injury with pop or snap
Medial knee pain after trauma to the lateral side of the knee or lower leg or a fall with a valgus moment.
* Pain may be worse with weight bearing, and an effusion may be present.
* There may be a sense of knee instability or “giving way” with high-grade MCL sprains.
* Tenderness on medial side of the knee
* Most painful when knee is in 20-30deg of flexion
Torn Meniscus
Can be acute or chronic degenerative tears.
Acute - Pt will report a rotational or “twisting” injury to the flexed knee that often results in an audible “pop” with concurrent localised sharp pain.
Chronic - older Pts, result of degenerative changes in the meniscus that are typical of aging.
Knee catching or locking, resulting in difficulties with flexion and extension.
With large tears, the knee can become locked in flexion and the patient may be unable to straighten the knee
Pain when squatting or pivoting.
Tenderness to palpation along the joint line in the area of the tear
Pes Anserine Bursitis
Located on the medial side of the knee at the proximal tibia.
Overuse injury, occasionally trauma involved.
Common in patients aged 50-80 years who have osteoarthritis of the knees
* Medial-sided knee pain
* There is tenderness to palpation at the proximal medial tibia, at the attachment of the pes anserine tendons.
Knee Effusion
Swollen knee - excess fluid collects in or around your knee joint
Bakers Cyst
Fluid-filled growth behind the knee. It causes a bulge and a feeling of tightness
Inflammation of the knee joint, which can occur with various types of arthritis
A knee injury, such as a cartilage tear
Swelling behind the knee, and sometimes in the leg
Knee pain
Stiffness and inability to fully flex the knee
The symptoms may be worse after you’ve been active or if you’ve been standing for a long time.
