Knee

Question 1

Pain persists + interferes w/ weight bearing
Pain/popping/catching with any twisting or pivoting

Answer 1

meniscus tears

Question 2

History of trauma w/ subsequent knee “locking or catching”
Most common cause of knee joint pain

Answer 2

meniscus tears

Question 3

PE: swelling + loss of extension
Joint line tenderness, effusion
→ McMurray’s test (pain/click = +)
→ Apley’s test (pain = +)

XR, MRI, arthroscopy

Answer 3

meniscus tears

Question 4

meniscus tears tx

Answer 4

Ice
Quadriceps exercises
Crutches
NSAIDs
Analgesics
Referral (locked knee or lack of full extension, persistent pain/swelling, giving way) + arthroscopy

Question 5

Hemarthrosis
“Giving way”

Usually swollen

Answer 5

anterior cruciate injury

Question 6

Traumatic injury and may be associated with injury of meniscus or medial collateral
→ moving backward

Answer 6

anterior cruciate injury

Question 7

PE: swelling, palpation causing effusion + pain, ROM painful

Anterior drawer (tibia sliding forward = +)
Lachman’s
Pivot shift
XR: avulsion
PE is key
MRI

Answer 7

anterior cruciate injury

Question 8

anterior cruciate injury tx

Answer 8

RICE → rest, ice, compression, elevation
Knee immobilizer
Crutches
NSAIDS
Therapy

Surgery

Question 9

Direct trauma to proximal tibia when flexed knee is decelerated rapidly
→ moving forward
Dashboard injury

Answer 9

posterior cruciate injury

Question 10

tibia sag test is helpful for

Answer 10

posterior cruciate injury

Question 11

Tx for posterior cruciate ligament

Answer 11

surgery

Question 12

Able to ambulate
Swelling or stiffness, pain and tenderness
Localized ecchymosis

Answer 12

collateral ligament injuries

Question 13

MCL

Answer 13

valgus force

Question 14

LCL

Answer 14

varus force

Question 15

Evaluate normal knee first
PE: swelling, ecchymosis, with tenderness at origin + insertion of ligament
ROM
Valgus + varus stress tests at full extension and 30 degree flexion
XR: AP + lateral XR (usually negative, but possible avulsion)

Answer 15

collateral ligament injury

Question 16

Grades of collateral ligament injuries

Answer 16

Grade I = localized tenderness over ligament, little or no laxity
Grade II = significant laxity but definite end point reached
Grade III = laxity with no end point

Question 17

How do you treat a collateral ligament injury?

Answer 17

Grade I = RICE + NSAIDS

Grade II = hinged brace 4-6 weeks and crutches

Grade III = hinged brace, gradual return
Rehab, refer for possible surgery

Refer if hemarthrosis or ligamentous instability

Question 18

What is another name for bursitis of the knee

Answer 18

housemaid’s knee

Question 19

worse when first rising, better with motion, worse at night

Answer 19

Tendinous or ligamentous bursitis

Question 20

superficial, lies between skin + patella and with kneeling activities

Answer 20

Prepateller bursitis

Question 21

under conjoined insertion of hamstring on medial flare of knee with localized tenderness

Answer 21

pes anserine bursitis

Question 22

pain on lateral femoral condyle

Answer 22

IT band bursitis

Question 23

warm swollen tender fluid filled mass over patella

Answer 23

prepatellar bursitis

Question 24

How do you treat bursitis of the knee?

Answer 24

NSAIDS
ICE
Modalities (US)
Reduction of activities
Stretching of tendons
Corticosteroids
Drain fluid (prepatellar)

Question 25

Anterior knee pain- inferior to the patella → night pain, pain with sitting, squatting, kneeling Increased with climbing stairs

Answer 25

patella/quadriceps tendonitis

Question 26

Overuse syndrome “jumper’s knee”

Answer 26

patella/quads tendonitis

Question 27

PE: pain Quadriceps atrophy → straight leg raise test to rule out rupture Check ACL + PCL MRI can be helpful

Answer 27

patella/quads tendonitis

Question 28

How do you treat patella/quad tendonitis?

Answer 28

Rest, knee immobilizer, NSAIDs Avoid corticosteroids + fluoroquinolones (cause rupture) Refer all possible tendon ruptures

Question 29

Pain, swelling, and tenderness around tibial tubercle Relieved by rest

Answer 29

osgood-schlatter disease

Question 30

Osgood-schlatter disease is common in

Answer 30

adolescent males

Question 31

Repetitive injury, burst of growth

Answer 31

osgood-schlatter disease

Question 32

XR: irregular ossifications or fragmentation laterally

Answer 32

osgood-schlatter disease

Question 33

How do you treat osgood schlatter disease?

Answer 33

Avoid activity triggering symptoms Ice Immobilization for severe symptoms Parental reassurance

Question 34

Pain + inability to extend knee after direct blow

Answer 34

patella fracture

Question 35

PE: hemarthrosis w/ swelling + unable to extend knee XR: AP + lateral Extensor mechanism usually intact if only 2 main fragments <6mm apart

Answer 35

patella fracture

Question 36

patella fracture Tx

Answer 36

Immobilize in extension for 6 weeks (3-4 weeks ROM) If <5mm separation + <2mm displacement Extension intact Surgery if not

Question 37

knee giving way or popping out

Answer 37

patella dislocation

Question 38

a patella dislocation is often

Answer 38

secondary to an acute injury

Question 39

with a patella dislocation always

Answer 39

evaluate for other injuries + apprehension test

Question 40

How do you treat a patella dislocation?

Answer 40

RICE, immobilization, full weight bearing Quadricep exercises important

Question 41

Pain worse with sitting with knee flexed (+ theatre sign) or going down stairs

Answer 41

patellofemoral pain syndrome

Question 42

patellofemoral pain syndrome is common in

Answer 42

female athletes

Question 43

“Chondromalacia patella” MC anterior knee problem

Answer 43

patellofemoral pain syndrome

Question 44

XR usually negative, sunrise films may show lateral displacement of patella Patellar compression + entrapment signs (weak quads)

Answer 44

patellofemoral pain syndrome

Question 45

How do you treat patellofemoral quad syndrome?

Answer 45

NSAIDS, ice, quad exercises, + avoid triggering activities Surgery if no improvement

Question 46

Aching pain at rest, worse with weight bearing

Answer 46

osteochondritis dissecans

Question 47

Avascular necrosis of subchondral bone → medial femoral condyle usually involved Traumatic

Answer 47

osteochondritis dissecans

Question 48

PE: decreased ROM, may feel loose body XR: AP + lateral Half moon lesion in subchondral bone

Answer 48

osteochondritis dissecans

Question 49

osteochondritis dissecans tx

Answer 49

Refer for possible surgery + lower weight bearing

Question 50

tibial plateau/femoral condyle fractures are called

Answer 50

knee intra-articular fractures

Question 51

How do you treat a knee intra-articular fracture?

Answer 51

ORIF