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Medicine II: Orthopedics > Knee > Flashcards

Flashcards in Knee Deck (48)
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1

Chondromalacia patella

Often called anterior knee pain and/or patellofemoral pain syndrome (PFPS).

2

What causes Chondromalacia patella?

It is due to the softening or degeration of the articular cartilage on the under surface of the patella.

3

Symptoms and PE of Chondromalacia patella:

Anterior knee pain that becomes worse after prolonged sitting, climbing, jumping, or running. Also a/w +/- catching sensations. Able to hear/feel grinding "noises" of the knee. Mild swelling, tenderness and crepitus.

4

Labs and Tests for Chondromalacia patella

Initial studies are plain xrays→ most helpful views are standing AP, lateral, and Merchant or sunrise. Xrays and MRI will generally be negative.

5

Treatment of Chondromalacia patella

Treatment can be conservative, include activity modifications, and quadriceps/hamstring muscle strengthening activities. Can also use a knee sleeve/brace, NSAIDs, Ice/heat or do a knee arthroscopy/alignment procedure.

6

Malalignment of Patella

Almost always occurs laterally, Common in females in 20s

7

Mechanism of Malalignment of Patella

Mechanism of direct blow to patella and knee in flexed position or powerful contraction of quadriceps. Causes tearing of the restraining retinacular tissue and patellofemoral ligament. Valgus force and external rotation of tibia applied to flexed leg.

8

Presentation and Treatment of Malalignment of Patella

Patella almost always dislocated laterally. Immediate mobilization, strengthening, immobilization in cast for 6 weeks, rehab, arthroscopy, sx or patellar realignment

9

Pain associated with Malalignment of Patella

Pain and apprehension when patella is pushed, fleck of bone present on medial side

10

Bursae

Bursae lie between the skin and bondy prominences or between tendons, ligaments and bone. They are lined by synovial tissue, which produces a small amount of fluid to decrease friction between adjacent structures.

11

Prepatellar Bursistis

Trauma and/or chronic pressure or friction causes thickening of the synovial lining. Swelling is outside the knee.

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Symptoms and Common Findings of Prepatellar Bursistis

Localized swelling (extraarticular), pain with direct pressure and sometimes with activity. Usually full ROM of knee, +/- tenderness upon palpation.

13

Imaging for Prepatellar Bursistis

Can take but not needed; AP, Lateral, Sunrise

14

Treatment for Prepatellar Bursistis

NSAIDS, Ice, Rest, Compression, Activity modification, Aspiration/corticosteroid injection (increased risk of infection), bursectomy, I&D.

15

Collateral Ligaments

MCL and LCL. Ligaments stabilize the knee against medial and lateral stressors.

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Cause of Collateral Ligament Injuries

Injuries caused by valgus/varus stress w/ or w/out rotation.

17

Symptoms and Exam for Collateral Ligament Injuries

Localized swelling or stiffness w/ tenderness. Pain with ambulation, +/- instability. May have joint line opening with valgus/varus stress test at 0 and/or 30 degress.

18

How is swelling noted in a MCL injury?

Effusion

19

How is swelling noted in a LCL injury?

Extra-articular

20

Tests for Collateral Ligament Injuries

Ap/lateral, usually negative but may show avulsion. +/- MRI depending on degree of injury or to rule out meniscal injury.

21

Treatment for Collateral Ligament Injuries

MCL isolated tears are usually treated non-operatively. Severity of LCL injury determines treatment. Rest, Ice/heat, NSAIDs, possible crutches, knee immobilizer and/or brace. When in combination with other ligament /capsule tear usually requires operative repair.

22

Test for an Isolated MCL Sprain

Valgus Stress Test

23

Cruciate Ligaments

ACL and PCL. ACL keeps tibia from slidding forward too far in relation to femur. PCL keeps the tibia from slidding too far back in relation to the femur.

24

Cause of an ACL injury

Tears usually result from a rotational or hyperextension force

25

Symptoms and Exam for an ACL injury

May report sudden pain and giving way. Decrease in ROM usually inhibiting continued activity. Increase in pain and swelling with in 24 hrs. INTRA-ARTICULAR EFFUSION.

26

Special Tests for an ACL Injury

Anterior Drawer and Lachmans Tests

27

Treatment for and ACL Injury

Initially control pain and swelling. Increase ROM, In young individual, protect the meniscus. Discuss surgical options: ACL- if younger pt, then reconstruct. PCL- try non-operative management.

28

Cause of a PCL Injury

Tears usually result from a posteriorly directed force

29

Symptoms and Exam for a PCL Injury

Pain +/- instability. Decreased ROM. INTRA-ARTICULAR SWELLING with in 24 hrs of injury

30

Which Cruciate Ligament Injury is most common?

ACL