Disorders of the Knee Flashcards Preview

MED: Ortho/Rheum > Disorders of the Knee > Flashcards

Flashcards in Disorders of the Knee Deck (29):
1

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

2

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

3

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

4

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

5

what is the MOI for an LCL injury?

Varus or twisting injury
Contact or non-contact
Hyperextension injury

6

what are the signs of an LCL injury?

Lateral knee pain
Localized swelling
Varus instability with twisting/pivoting activity

7

what could your radiographic LCL findings show you?

X-rays:
1. Lateral Capsular Sign
--Avulsion of lateral tibia
--Associated with ACL injury
2. Arcuate Sign
--Avulsion of proximal fibula
--Associated with posterolateral instability

MRI:
Confirm diagnosis and evaluate for other pathology

8

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

9

what is the MOI for an ACL tear?

Mechanism of Injury:
Multiple – hyperextension, varus/internal rotation, valgus/external rotation
Contact or Non-contact

10

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

11

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

12

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

13

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

14

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)

15

what will you see on PE with a PCL injury?

positive posterior drawer and positive sag test

16

what is the treatment

Always conservative to start
Ice, NSAID’s, rehabilitation (Quadriceps), +/- bracing

Surgical reconstruction if still having functional instability despite conservative treatment

17

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

18

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

19

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

20

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

21

what are extensor mechanism injuries?

Includes quadriceps muscles, patellofemoral joint, and patellar tendon

22

what are predisposing anatomical findings that cause extensor mechanism malalignment

Rotational abnormalities of femur (usually anteversion) and/or tibia
Increased Q-angle

23

How does a patellar dislocation typically occur?

Mechanism of injury:
Valgus and/or twisting with strong quadriceps contraction

24

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

25

How do you treat a patellar dislocation?

1. Extend knee if still dislocated
2. Symptom treatment after acute episode
3. Rehabilitation focused on patellar control
4. Patellofemoral bracing
5. 50% chance of recurrence
Extensor mechanism reconstruction if becomes chronic and functionally disabling

26

What is Patellofemoral Pain Syndrome?

Anterior knee pain that is not explained by a definable cause (i.e. patellar tendonitis…)
- usually do to overuse
- treatment is conservative: ice, NSAIDs
sometimes surgery needed

27

What is the patellar tendonitis?

“Jumper’s knee”
Most commonly at tendon insertion to patella
Occasionally at patellar tendon insertion to tibia
usually due to overuse
treatment is conservative.

28

What is Osgood-Schlatter’s Disease?

-Painful enlargement of tibial tuberosity at distal patellar tendon insertion
-Due to mechanical stress on growing tibial tuberosity apophysis
-Occurs in preadolescence and early adolescence, usually during rapid growth period
- painful enlargement, normally seen in overuse in kids

29

What is the treatment for Osgood-Schlatter’s Disease?

Symptom treatment with ice, NSAID’s, activity modification, localized padding

Rehabilitation including simple modalities

Emphasis on stretching

Occasional surgical excision of loose ossicle