Knee Flashcards
(12 cards)
Patellofemoral pain syndrome (PFPS)
The most common type of knee complaint in the general population is patellofemoral pain. This type of mechanical knee pain can effect anyone due to a number of contributing factors:
- The most benign of the patellar diagnosis (a diagnosis of exclusion) short-term insult and overuse of the joint on a weak extensor is the usual cause.
- Generally complain of retropatellar and peripatellar pain on and off for weeks or months
- Mostly a vague diagnostic entity with few clinical orthopaedic findings
- No effusion, no instability and no joint line pain
Iliotibial Band Friction Syndrome
Considered a form of Tendonitis, ITB friction syndrome may develop where the fibrous mass of the ITB runs over the lateral femoral condyle due to the anatomic fact that the ITB is free to glide in a A-P and P-A
fashion. Also although the ITB attaches to the lateral proximal tibia (Gerdy` tubercle), most of the stress from movements occur at the joint line.
Chondromalacia patella
*Paul dont think will come up because came up last year
Is a premature degeneration with softening, fibrillation and roughening of the articular surface (is it simply the sequela of some other syndrome?). The pathological changes occur at the patellofemoral joint and have been divided into 4 stages.
4 stages:
Stage 1 Involves softening or blistering of the cartilage
Stage 2 Reveals fissures in the cartilage
Stage 3 Is reached when fibrilation of the cartilage occurs, causing a “crab meat” appearance
Stage 4 Reveals cartilage defects with subchindral bone exposed
Clinical presentation
* Retropatellar pain - vague and dull
* Aggravated by prolonged sitting, walking, running
riding a bike, going up stairs driving a car
* May have crepitus, clicking, and catching sharp pain
Osgood Schlatter Disease
The growth plate represents a cartilaginous weak link in the growing child’s musculoskeletal system
Children who experience a rapid growth spurt are more susceptible as they can lose flexibility in the muscle-tendon unit around rapidly growing long bones
Presentation
* Average age 12 to18 years
* Athletic adolescent boys
* Repetitive microtrauma and stress within
cartilaginous tibial tuberosity
* Painful bump at tibial tuberosity
* Pain is proportional to activity level Exam findings
* May find mild local swelling and palpable tenderness at tibial tuberosity
Osteochondritis dissecans
Classified as a osteochondroses it involves a defect of the subchondral bone and articular cartilage, which can become separated from the joint surface
The lateral portion of the medial femoral condyle is the most common site
Aetiology
* Anomaly of ossification
* Trauma to anterior knee
Exam findings: Wilsons Test
Anterior cruciate ligament
Mechanism of injury
* Usually occurs in deceleration with valgus twisting with a fixed foot and also sudden hyperextension
Clinical presentation
* An audible ‘snap’ and ‘pop’ when the lower leg is hyperextended or in a rotational strain
* Swelling occurs within 12 hours (75% have blood effusion )
* Patient will feel the leg ‘give way’
* Painful and the knee is kept in loose-packed position
Posterior cruciate ligament
Acute tears are less common than ACL (9x)
* 16-23% of ligament injuries to the knee
Mechanism
* Forces that drive the tibia posteriorly or the femur anteriorly in knee flexion or hyperextension
Presentation
* Symptoms may be vague, with less pain, less laxity and less haemarthrosis than ACL injury
* Effusion present in acute injuries
Exam findings
* Observe for ‘sag’ sign
* Posterior translation in posterior drawer test or reverse Lachman test
Medial collateral ligament
MCL injuries are common
Mechanism
Due to chronic overload or direct valgus force to the knee in full extension
Clinical presentation
* Localized pain and tenderness
* Delayed swelling - 6 hours after injury over medial aspect of knee
Meniscus
Mechanism
* Lateral meniscus tears - hyperextension grinds lateral part, and hyperflexion compresses posterior horn
* Medial meniscus tears - partial flexion and rotation - catch the posterior horn, sudden extension from flexion position - longitudinal tear.
Presentation
* Pain and slow synovial effusion
* Locking and simultaneous unlocking - increased frequency and severity
* Clicking of the knee during activity
Pes Anserine Bursitis
lying between the tendons of gracillis, sartoius and semitendinosus
and the inferior portion of the MCL at the proximal tibia is the bursa.
Aetiology
* Overuse tight hamstrings
* External tibial torsion increase Q angle
Presentation
* Pain under the medial joint margin
* Pain on palpation (2cm distal to joint)
* Most cases in 50 to 80 year olds
* 75% of patients with OA of knee
OA of the Knee
Patella Plica Syndrome
Synovial plica is a shelf-like membrane between the synovium of the patella and the tibiofemoral joint. Plicae essentially consist of mesenchymal tissue which is formed in the knee during the embryological phase of development.
his tissue usually starts to involute (fold inward) at 8-12 weeks of foetal growth, and is eventually resorbed, leaving a single empty area between the distal femoral and proximal tibial epiphysis: a single knee cavity.
Yet, in many individuals the mesenchymal tissue is not fully resorbed and consequently the cavitation of the knee joint remains incomplete. The result is that in these individuals plicae can be observed, which represent inward folds of the synovial membrane in the knee joint
