Knee Flashcards
(58 cards)
1
Q
What are traumatic causes of knee problems?
A
Fracture Tear Sprain (ligaments) Strain (tendons) Dislocation
2
Q
What are non-traumatic causes of knee problems?
A
Arthritis PF syndrome Infection Nerve irritation Gout Lesion/tumor OA Osgood schlatters Tendonitis Bursitis
3
Q
What should you look for in HPI?
A
WB status Swelling/effusion Constant/intermittent Mechanical sx Prior problems Timing Instability Tx
4
Q
Common traumatic dxs of knee
A
ACL/PCL tear MCL/LCL strain or tear Meniscus tear Fxs Contusions
5
Q
Pt hx of ACL injury
A
"Popping" sound at the time of injury Rapid swelling +++ Pain Instability Non WB
6
Q
PE of ACL
A
Effusion Pain Decreased ROM Uncomfortable -Lachman's test -Anterior drawer
7
Q
Lachman’s test
A
Best for ACL Bend about 25 degrees Grasp thigh Shuck tibia anterior Pos test= no end point/laxity
8
Q
Anterior drawer test
A
Knee at 90 degrees
Stabilize foot
Pull tibia forward
If over 6 mm anterior translation = pos
9
Q
Diagnostic for ACL injury
A
Xrays usually neg
MRI ****
10
Q
Tx for ACL injury
A
Refer -Most full tears need sx intervention NSAIDs/ice Elevation Immobilizer \+/- crutches
11
Q
PCL characteristics
A
Much less common
Usually MVA
Dashboard injury
12
Q
Collateral ligament injuries
A
MCL tears more common than LCL Direct blow Lower leg is forced sideways Swelling Pain Instability
13
Q
Varus stress
A
Rupture of lateral collateral ligament
This is rare but can occur when a motorcycle fall on the medial side of the knee
14
Q
Valgus stress
A
Rupture of medial collateral ligament. This shifts the forces to the lateral condyles and leads to a torn meniscus and torn ACL impaction of the lateral femoral condyle or wedge fracture of the lateral tibial plateau
15
Q
Type I MCL/LCL injury
A
Microscopic tear
16
Q
Type II MCL/LCL injury
A
Partial tear
17
Q
Type III MCL/LCL injury
A
Complete- may require surgery
18
Q
Meniscus injury
A
Usually twisting type injury
C/o mechanical sx
Swelling
Pain c WB
19
Q
Meniscus function
A
Load distribution
Joint stability
Shock absorption
20
Q
PE of meniscus injury
A
Effusion Pain Decreased ROM Joint line tenderness Pos McMurrays test
21
Q
Dx and tx of meniscus injury
A
X-rays usually neg MRI is diagnostic test Look for "bowtie" in nl meniscus Refer -Can give symptomatic tx but need referral
22
Q
Fractures
A
Associated with trauma NWB or painful WB Depends on involvement/severity etc Dx via X-ray Stress fracture may only be seen on MRI
23
Q
When to get an Xray
A
Age 55 or older Isolated pain over patella Pain over fibular head Unable to WB 4 steps Only use for injuries <7 days only Only one of these criteria makes Xray necessary
24
Q
RF of OA
A
Age Obesity Hx of trauma FHx Decreased strength
25
HPI of OA
```
Pain
Stiffness or decreased ROM
Creaking/popping
"Theater" sign (hurts when standing after sitting for a long time)
Usually no significant swelling
```
26
Dx of OA
```
Dx is made by Xray (WB AP view a must)
Joint space narrowing
Osteophytes
Sclerosis
Cysts
Any one of these 4 things is pos sign
```
27
OA tx
```
Weight reduction
PT
OTC
Bracing
Steroid injections
Visco-supplementation
TKA
```
28
Tendonitis
Quad, Achilles, patellar, etc
Over use injury
Recurring pain c activity
Improves with rest
29
PE of tendonitis
Pain with palpation over tendon
Possible swelling
Possible heat
Nl motion (pain)
30
Tx of tendonitis
```
Rest
Ice
NSAIDs
Rehab
Compression/bracing
PRP
```
31
Osgood Schlatter
```
Overuse injury (only in children)
Apophysitis of tibial tubercle
Running/jumping type sports
```
32
HPI of Osgood Schlatter
During growth spurt
Worse with activity
Better with rest
Often bilateral
33
PE of Osgood Schlatter
```
Pain over tubercle
Swelling
Stable
Good ROM (+/- pain)
If there are no other PE abnormalities but decreased ROM, then think something else
No need for Xray but to r/o fx
```
34
TX for Osgood Schlatter
```
Activity modification
Rest
NSAIDs
Ice with activity
Bracing
PT/stretching
Reassurance
```
35
Bursitis
```
Bursa- fluid filled sac
Overuse or trauma
Pain c activity, swelling
Bursa's job is to decrease friction
Found throughout the body
```
36
PE of bursitis
Pain over bursa
Swelling
+/- redness
37
Tx for bursitis
```
+/- aspiration
NSAIDs
Compression therapy
Activity modification
Refer for sx
```
38
Patella Femoral Syndrome
Anterior knee pain
Increases with activities
Worse c sitting/squatting, inclines/stairs
Associated c changes in activity levels
39
PE of patella femoral syndrome
J sign
Pain with patellar grind
No effusion
Crepitus
40
Tx of patella femoral syndrome
```
Activity modification
PT- VMO strengthening
Bracing
NSAIDs
Weight loss
```
41
What are the four leg compartments?
Anterior
Lateral
Deep posterior
Superficial posterior
42
Compartment syndrome
Elevated intracompartmental pressures
Compromised nerves and blood flow
Crush injury
43
HPI of compartment syndrome
Pain out of proportion ***
Pain with passive stretch
Swelling
***Can also be exertional
44
Osteomyelitis
Infection in the bone
Infection leads to inflammatory response leads to abscess leads to bone destruction
Hematogenous spread/contact c infected tissue/direct spread by fx, bite wound, puncture, etc.
MC agent is S. aureus
45
S/sx of osteomyelitis
```
Fever
Pain
Redness/swelling
Draining
Ulcers/recent infection
```
46
Dx of osteomyelitis
```
Early X-rays will be nl
Bone scan if needed confirmation
Wound culture
CBC/CMP
ESR
CRP
Blood culture
```
47
Tx for osteomyelitis
IV abx
-Start Abx right away...do NOT wait for cultures
Surgical debridement
-Most need I and D
48
Septic arthritis
Sudden severe pain (often no trauma)
Swelling
Redness
Warmth
49
RF for septic arthritis
STI
Illness
TKA
Surgery
50
PE of septic arthritis
```
Look for source of infection
-Tooth abscess
-STD
-Wound
Effusion
Pain c AROM and PROM
Erythema
```
51
H. influenzae in septic arthritis
Peak age of incidence in children
| Gram neg coccobacilli
52
N. gonorrheae in septic arthritis
Peak age of incidence in young adults
| Gram neg diplococci
53
Salmonella in septic arthritis
Peak age of incidence in young with sickle cell anemia
| Gram neg rods
54
S. aureus in septic arthritis
Peak age incidence in adults
| Gram pos cocci in clusters
55
E. coli in septic arthritis
Peak age incidence in adults
| Gram neg rods
56
Pseudomonas in septic arthritis
Peak age incidence in adults
| Gram neg rods
57
Aspiration for septic arthritis
```
CBC
ESR
CRP
Blood cultures
UA
```
58
Tx for septic arthritis
IV abx
| I and D
