Flashcards in knee Deck (37):
______is a fluid filled sack, lined by synovial membrane
This type of film is best at showing patella alta/Baja.
lateral (30 degree flexion)
This type of film is always done while the patient is bearing weight (if possible)
This type of film is looking specifically at the patella
This type of film is an AP view of a knee that is bent at 45 degrees
What should you do when you notice swelling around a joint?
determine if it is intra or extra articular
Your 50 year old male patient comes in c/o a stiff swollen knee after twisting it while doing yard work. He has noticed a locking, catching sensation when he moves the knee. On exam, there's ttp of the medial joint line, a mild effusion, and LROM. The McMurray test is positive.
Medial meniscus tear
What imaging would you get to confirm a medial meniscus tear?
MRI!!! (Plain films will be normal)
What is your threshold for surgical repair of a meniscus tear?
pretty low, especially if patient is young due to increased risk of OA.
This ortho problem is most often caused by overuse, specifically jumping. The onset of this problem is very sudden, and it takes a long time to heal. PE will show point tenderness and painful knee extension.
You suspect either patellar or quadriceps tendonitis, but the patient swears the knee hurts "everywhere". You decide to get a lateral xray. How would this help you determine if the problem is the patellar tendon or the quadriceps tendon?
1) Patella alta = patellar tendon
2) Patella Baja = quadriceps tendon
How would you know if there had been a total rupture of either the patellar or quadriceps tendon?
No extension on exam
This injury is commonly caused by the knee hitting the dashboard in an MVA.
This injury will result in a positive posterior drawer sign
This injury results in sudden pain and the sensation that the knee is "giving way". It is commonly caused by rotation or hyperextension of the knee, and will elicit a positive Lachman test.
These ligaments stabilize the knee against varus and valgus stress
These ligaments keep the tibia in line with the femur
On a plain film, you see an avulsion fx on the lateral tibia, this is called the ________ sign and is associated with injury of the __________
Segond sign, ACL
What is the threshold for surgical repair on the ACL? PCL?
reconstruct ACL if no contraindications! Treat PCL non-operatively if possible (brace)
Your attending tells you that a patient has a valgus tear. What ligament does that indicate?
A tear of the LCL could also be called ___________
What is the cardinal finding on PE for a collateral ligament injury?
joint line opening with either varus/valgus stress (and pain)
This problem is caused by the softening or degeneration of the articular cartilage on the undersurface of the patella
This problem is caused by articular cartilage deterioration, typically most severe in the medial compartment of the knee
This problem is caused by irritation of a bursa, usually due to distance running or distance cycling. PE shows point ttp over the epicondyles
IT friction syndrome
Your 67 yo female pt comes in c/o mild swelling in her left knee. She notices pops, clicks, catches, and grinding with flexion and extension. She can't really point to a specific tender spot, but says her pain/discomfort is much worse after she has been sitting or standing for a prolonged period of time. What is the most likely problem?
How can you tell the difference b/t chondromalacia patellae and OA?
1) OA typically shows up on plain film as MEDIAL joint space narrowing
2) Chondro pat will usually be normal on xray, but MRI will show damage to the articular cartilage of the patella
3) OA = medial
Your 56 year old obese patient tells you that his right knee seems to "buckle" on him, and that it is hard to rise from a seated position and to climb up and downstairs without pain. What do you suspect?
Your 71 year old OA patient has been using NSAIDS, heat/ice, PT, and a cane for 18 months with minimal relief. You tried 2 rounds of steroid injections which were also a disappointment. What is the next option? (PMH also significant for htn, cholesterol, thyroid dz which are all well managed)
2) Consider total knee if ineffective.
How will you treat your distance runner who has developed IT friction syndrome?
2) decrease distance
3) ortho shoes
4) improve stretching
5) steroid injections
This dislocation is most likely to be lateral and results from a direct blow to the knee while it is flexed.
this dislocation can be treated conservatively
This dislocation is often caused by an MVA and is most likely to be anterior/posterior
this dislocation is an emergency (treat surgically)
what structures are at great risk during a knee dislocation? (2)
popliteal artery and peroneal nerve
This dislocation often causes either an ACL or PCL injury