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MSK > Disorders Of The Knee > Flashcards

Disorders Of The Knee Flashcards

1
Q

Why do knee disorders have a massive impact on patients?

A

Major weight bearing joint needed for walking

Injury reduces mobility (reduces activity, leading to weight gain)

Cant work
Depressions
Socially isolated (cant participate in activities)

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2
Q

What sort of energy is required for a femoral shaft fracture?

A

High energy injuries

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3
Q

What type of incidents can lead to femoral shaft fractures?

A

RTA (Road traffic accidents)
Falls from height

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4
Q

Why are femoral shaft fractures dangerous?

A

Can lose immense amounts of blood leading to Hypovolaemic shock

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5
Q

How are femoral shaft fractures usually treated?

A

Traction splint
Surgical fixation

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6
Q

How do Tibial Plateau fractures usually occur?

A

Axial loading (falling from height landing on the feet)

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7
Q

What type of energy injury is a Tibial Plateau fracture?

A

High energy injury

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8
Q

What is usually damaged in Tibial Plateau fractures?

A

Tibial condyle(s)
Articular cartilage

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9
Q

What do Tibial Plateau fractures cause?

A

Instability in the joint (reduced accurate join surface)

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10
Q

How is a Tibial Plateau fracture fixed?

A

Fix articular segment to shaft in surgery

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11
Q

What is a patient at increased risk of with a Tibial Plateau fracture?

A

Post traumatic Osteoarthritis

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12
Q

What is a Bipartite patella?

A

A patella that functions normally but is in 2 parts

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13
Q

What test can you do to check if the patella is fractured?

A

Straight leg raise to see if the extensor mechanism is in tact

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14
Q

How is a displaced patella fracture fixed?

A

Reduced then surgically fixed

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15
Q

How is an undisplaced fracture of the patella fixed?

A

Splint
Protect

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16
Q

What do all fractures at joints put you at risk of?

A

Post traumatic osteoarthritis

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17
Q

What is the definition of a dislocation?

A

Loss of congruity of joints

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18
Q

What is Subluxation?

A

Partial loss of congruity of joint

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19
Q

Why does the knee tend to move laterally and therefore likely to laterally dislocate?

A

Q angle = The force of the pull of the quadriceps pulls the patella laterally strongly

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20
Q

What muscle pulls the patella medially helping prevent lateral patella dislocations?

A

Vastus medialis

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21
Q

What is the Q angle?

A

Angle between Quadriceps tendon and the patella tendon

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22
Q

How does size of the Q angle affect the patella?

A

The larger the Q angle, the more likely lateral dislocation is to occur

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23
Q

How is a dislocated or subluxated patella fixed?

A

Reduce it
Immobilise it

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24
Q

What type of cartilage is the menisci?

A

Fibrocartilage

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25
Q

How do meniscal injuries occur?

A

Twisting of knee in high Flexion

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26
Q

What are the signs of a meniscal injury?

A

Locking of the knee
Swelling
Localised pain

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27
Q

Why do meniscal injuries/tears often lead to locking?

A

The torn meniscus acts as an Intra articular foreign body mechanically blocking the space preventing the knee from fully extending

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28
Q

What is a menisectomy?

A

Removal of damaged cartilage

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29
Q

What are the static factors that determine joint stability?

A

Bones and ligaments
(Can not be changed)

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30
Q

What are the dynamic factors which can affect joint stability?

A

Muscles and tendon
(Can be changed by exercise, get stronger)

31
Q

What factors strengthen the knee joint?

A

Menisci
2 Cruciate ligaments
2 collateral ligaments
Joint capsule
Quadriceps
Bones
Tendons

32
Q

What is ValGUS strain?

A

Force that acts medially on the knee
Pushes from lateral to medial

33
Q

What is Varus strain?

A

Force acting laterally pushing knee
From medial to lateral

34
Q

Which ligament resists ValGUS strain?

A

Medial collateral ligament

35
Q

Which ligament resists Varus strain?

A

Lateral collateral ligament

36
Q

How are collateral ligament injuries remedied?

A

Surgical repair/reconstruction

37
Q

How do people usually get collateral ligament injuries?
How are they normally treated?

A

Brace + Rehab
Contact/direct blow usually sport

38
Q

What is the most common Cruciate ligament injury?

A

ACL (Anterior Cruciate Ligament)

39
Q

When do ACL tears/injuries usually happen?

A

Non contact landing or changing direction

40
Q

How are ACL injuries usually treated?

A

Rehab and or surgical reconstruction

41
Q

What do ACL injuries lead to? (What type of movement is there instability with?)

A

Instability with twisting (anterolateral rotation)

42
Q

How are PCL injuries caused?

A

Contact (falls onto knee or hyper extension))

Often the tibia dislocates posteriorly which avulses the PCL

43
Q

How are PCL injuries fixed?

A

Brace + Rehab

44
Q

For the knee joint to dislocate, how many ligaments must be ruptured?

A

At least 3 of 4

45
Q

What is the danger with knee joint dislocations?

A

May damage popliteal arteries

46
Q

How is a knee joint dislocation fixed?

A

Reduce
Stabilise

47
Q

What is Osgood-Schlatters Disease?

A

Where you get bony swelling and inflammation around the knee at the tibial tuberosity (where the patella tendon inserts)

48
Q

What is Grimers law?

A

Anything bigger than a golf ball and painful is likely a soft tissue Sarcoma

49
Q

What is a soft tissue sarcoma?

A

Cancers that start in soft tissue

50
Q

What is knee effusion??

A

When fluid fills the knee joint

51
Q

What are 2 types of Acute Knee effusions?

A

Haemarthrosis
Lipo-haemarthrosis

52
Q

What happens during haemarthrosis?

A

Bleeding into the knee joint causes swelling

53
Q

What is Lip-haemarthosis and what does it usually indicate?

A

When fat has filled in the joint
Fat usually comes from a fractured bone

54
Q

What does a pop while playing sports indicate?

A

Torn ACL
(Until proven otherwise)

55
Q

What are Bursae?

A

Fluid filled sacks protecting bony prominences

56
Q

What is bursitis?

A

Inflammation and fibrosis of a bursa

57
Q

What is prepatellar bursitis also called?
Where is the prepatellar bursa?

A

Housemaids knee
Imagine kneeling and scrubbing floors far away

In front of the patella

58
Q

What is a Semimembranosus bursitis also called?

Where is the Semimembranosus bursa?

A

Popliteal cyst/bakers cyst

Behind the patella deep to the popliteal fossa

59
Q

What is osteoarthritis?

A

The wear and tear damage caused to joints
Articular cartilage wears away leading to the damage of the bones too

60
Q

What may indicate Knee arthritis?

A

Synovitis
Pain and stiffness
Deformity (Varus or ValGUS)

61
Q

How is knee osteoarthritis treated?

A

Strengthening exercises for the muscles
Analgesia (pain reduction)
Weight loss
Activity modification

62
Q

What 4 things indicate osteoarthritis on a radiograph?

A

LOSS

Loss of Joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

63
Q

What is sclerosis?

A

More dense bone indicated by increased whiteness

64
Q

Why is it thought that osteophytes form in osteoarthritis?

A

Trying to increase the SA of the bone when it gets damaged
Trying to repair and replace the damaged bone and cartilage

65
Q

What are the signs of septic arthritis?

What is the triad of signs patients present with in septic arthritis?

A

Pain
Swelling (MOST have this))
Redness and warmth
Recent surgery
Knee effusion bacterial infection

Triad:
-Fever
-Pain
-Reduced range of motion

66
Q

What should be immediately done if septic arthritis is suspected?

A

Aspirate to confirm diagnosis of infection by sending aspirate for microscopy, culture and sensitivities
IV Antibiotics and surgical wash out

67
Q

SEPSIS Pneumonic

A

Slurred speech or confusion
Extreme shivering or muscle pain
Passing no urine in the day
Severe breathlessness
I’m going to die
Skin mottled or discoloured

68
Q

Where is the suprapatellar bursa?

What is suprapatellar bursitis a sign of and why?

A

Above the patellar

The suprapatellar bursa is an extension of the synovial cavity of the knee joint. So a KNEE EFFUSION often presents with swelling in the suprapatellar pouch

69
Q

What are some possible pathologies causing knee effusion?

A

Osteoarthritis
Rheumatoid arthritis
Infection/septic arthritis
Gout

70
Q

Which of the 2 infrapatellar bursae are most commonly involved in bursitis?

Where is this bursa?

What is this bursitis also called and why is it called this?

A

Superficial infrapatellar bursa

Just below the patella

Clergyman’s knee (injury caused by the repetitive upright kneeling a religious clergyman would do)

71
Q

What is damaged in septic arthritis ?

How is this damaged?

A

Articular cartilage damaged

Bacterial invasion and their virulence factors like proteases break it down

Or

Host immune response
Neutrophils make cytokines and other inflammatory products resulting in hydrolysis of collagen and Proteoglycans

72
Q

Where is the bipartite part of the patella always visible?

What causes it?

A

Superolateral aspect

Failure of union of a secondary ossification centre

73
Q

What is the mnemonic to remembering how the ACL and PCL ligaments run?

Using this mnemonic how are they orientated?

What is another way of remembering it?

A

PAMs APpLes (orientation from the bottom of the ligament up, so distal to proximal)

Posterior (PCL) passes to the Anterior inserting Medially

Anterior (ACL) passes to the Posterior inserting Laterally

Or think of the ACL running the same way as when you put your hands in your pockets

74
Q

What is the mnemonic use to categories the potential pathology of a knee effusion?

What does this stand for?

A

VITAMIN C&D

Vascular (haemarthrosis)
Inflammatory/infective (bursitis, septic arthritis)
Trauma (meniscal tear)
Autoimmune (rheumatoid arthritis)
Metabolic (Gout)
Iatrogenic (infected prosthetic joint, infection following injection but this is septic arthritis)
Neoplasia (rare)

Congential (rare)
&
Degenerative (osteoarthritis)

MSK (36 decks)

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