Disorders of the Knee Flashcards
(29 cards)
what are the specialty tests of the knee:
Ligament Tests:
MCL: Valgus Stress Test LCL: Varus Stress Test ACL: -Anterior Drawer Test -Lachman’s Test -Pivot Shift Test PCL: -Posterior Drawer Test -Sag Test
Meniscal Tests: -McMurray’s Test --->Medial and Lateral Extensor Mechanism Testing --->Patellar Apprehension Test ---->Shrug Test
what is the mechanism of injury for a medial collateral ligament injury?
Valgus force applied to knee with external tibial rotation
Non-contact or from blow to lateral knee
what are the signs of a MCL injury?
Medial knee pain Localized swelling Valgus instability if complete tear Laxity with valgus stress test MRI :Confirm diagnosis and evaluate for other pathology
how do you treat the different grades of an MCL injury?
Grades I and II:
Conservative – rehabilitation, ice, NSAID’s, crutches, functional bracing
Grade III:
Symptomatic immobilization
Conservative – rehabilitation, ice, NSAID’s, crutches, functional bracing
what is the MOI for an LCL injury?
Varus or twisting injury
Contact or non-contact
Hyperextension injury
what are the signs of an LCL injury?
Lateral knee pain
Localized swelling
Varus instability with twisting/pivoting activity
what could your radiographic LCL findings show you?
X-rays:
- Lateral Capsular Sign
- -Avulsion of lateral tibia
- -Associated with ACL injury - Arcuate Sign
- -Avulsion of proximal fibula
- -Associated with posterolateral instability
MRI:
Confirm diagnosis and evaluate for other pathology
how will you do treatment for the different grades of LCLs tears:
Grades I and II
Conservative – rehabilitation, ice, NSAID’s, crutches
Grade III
Acute – primary repair
Chronic - reconstruction
what is the MOI for an ACL tear?
Mechanism of Injury:
Multiple – hyperextension, varus/internal rotation, valgus/external rotation
Contact or Non-contact
What are the signs/symptoms of an ACL tear?
Acute: Hear or feel a pop at injury Large effusion within 2 hours Loss of ROM May get autonomic symptoms (dizziness, sweating, nausea, faintness) - POSITIVE LACHMAN
Chronic:
Instability with cutting, pivoting, twisting activities
- POS. LACHMAN, ANTERIOR DRAWER TEST, PIVOT SHIFT
What radiographic findings are present on X-ray and MRI?
X-rays
Usually normal
Avulsion of tibial spine in young patients
MRI
Confirm diagnosis and evaluate for other pathology
what are the treatments for surgical and non-surgical ACL
Treatment: 1. Non-surgical Acute symptom treatment Rehabilitation (hamstrings) Bracing LIFESTYLE CHANGE 2. Surgical Reconstruction not repair Patellar tendon or hamstring autografts Allograft Rehabilitation Return to twisting activity at 6-7 months
What is the MOI for an PCL injury?
Most commonly a direct blow to anterior proximal tibia
MVA dashboard injury
Fall on hard playing surface
what are the signs and symptoms of a PCL tear?
Acute:
Mild pain and swelling
Mild loss of ROM
Chronic:
Feeling of instability (femur sliding anteriorly off of tibia)
what will you see on PE with a PCL injury?
positive posterior drawer and positive sag test
what is the treatment
Always conservative to start
Ice, NSAID’s, rehabilitation (Quadriceps), +/- bracing
Surgical reconstruction if still having functional instability despite conservative treatment
which is more common a medial or later meniscus tear?
Medial meniscus tears are more common than lateral meniscus tears
Lateral meniscus is more mobile
how does a meniscal tear usually happen, MOI?
Mechanism of injury:
Twisting or squatting
Older patients don’t require a specific “episode” to tear a meniscus
what are the signs of a meniscal injury?
- Mild swelling
- Joint line pain
Mechanical symptoms :
- Locked knee
- Catching sensation over a joint line
positive mcmurray’s test
what is the treatment of a meniscal injury?
- Meniscal tears do not heal
- Arthroscopy
- –>Usually requires meniscectomy
- –>Occasionally can repair a meniscus if the tear is located in the peripheral (vascular) zone
what are extensor mechanism injuries?
Includes quadriceps muscles, patellofemoral joint, and patellar tendon
what are predisposing anatomical findings that cause extensor mechanism malalignment
Rotational abnormalities of femur (usually anteversion) and/or tibia
Increased Q-angle
How does a patellar dislocation typically occur?
Mechanism of injury:
Valgus and/or twisting with strong quadriceps contraction
What physical exam signs do you see with a patellar dislocation?
Physical Examination
Acute: Possibly lateral displacement of patella Effusion Tender patella with manipulation Loss of ROM
Chronic:
Patellar apprehension/laxity
Predisposing anatomic findings
