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Clin Med II - Ortho > Knee > Flashcards

Knee Flashcards

(68 cards)

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1
Q

Medical hx

A 
Hx often leads to correct dx
MOI & associated injuries
Pop
Nature & character of pain
Swelling
Instability
Catching or locking
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2
Q

Meniscus - in general

A

Consists of fibrocartilage
Can’t see on x-ray
Blood supply of peripheral 1/3 only
Peripheral attachment onto capsule at joint line

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3
Q

Meniscus - normal function

A

Takes up space
Disburses synovial fluid
Supports approx. 505 of its compartment weight with posterior horn bearing majority of weight

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4
Q

Meniscus Tear - Clinical feature

A

Medial meniscal injuries most common causes of knee joint pain
Hx of trauma with subsequent knee locking or catching
Pain persists and interferes with weight bearing activity

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5
Q

Meniscus Tear - PE

A 
Inspection
- Swelling 
- Loss of extension
Palpation
- Joint line tenderness
- Effusion
ROM
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6
Q

Meniscus Tear - Tests

A

McMurray’s test

Apley’s test

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7
Q

McMurray’s test

A

Knee fully flexed, leg externally rotated testing for medial tears and internally rotated for lateral
While maintaining rotation extend knee with a firm controlled movement
Painful click “positive” test

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8
Q

Apley’s test

A

Pt prone, knee flex at 90°, axial load on heel while leg is rotated internally and externally
Pain “positive” test

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9
Q

Meniscus Tear - dx

A

X-rays
MRI
ARthroscopy

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10
Q

Meniscus Tear - tx

A 
Ice (acute)
Quadriceps exercises
Crutches
NSAIDS
Analgesics
Arthroscopy
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11
Q

Meniscus Tear - when to refer

A

Locked knee or lack of full extension
Persistent pain and/or swelling
Giving way

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12
Q

Ligamentous injuries

A

Anterior & posterior cruciate

Medial and lateral collateral

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13
Q

Anterior cruciate injury

A

Results from traumatic injury
Torn more commonly than PCL
Primary anterior and rotational stabilizer of knee
May occur with associated injury, meniscal or medial collateral tear

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14
Q

ACL injury - Clinical feature

A

Hx of significacnt twisting injury
Popping sensation at time of injury
Hemarthrosis found 75% - rapid
Giving way - acute or chronic

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15
Q

ACL injury - PE

A

Inspection - swelling
Palpation - effusion & pain
ROM - painful

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16
Q

ACL injury - Tests

A

Lachman’s Test
Anterior Drawer
Pivot Shift

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17
Q

Lachman’s Test

A

More sensitive
Knee flexed 30°
Anterior/posterior translation of tibia

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18
Q

Pivot shift

A

Knee fully extended
Valgus and upward force applied to knee
Tibia subluxes anteriorly on femur
Knee flexed produces reduction of tibia

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19
Q

ACL injury - imaging

A

X-rays - avulsion
Arthrocentesis
MRI - gold standard

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20
Q

ACL injury - tx

A 
RICE
Knee immobilizer
Crutches
NSAIDS
Arthrocentesis
Therapy
Sx
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21
Q

ACL injury - when to refer

A

Acute injury

Presence of effusion secondary to trauma

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22
Q

Posterior cruciate injury - in general

A

Direct trauma to proximal tibia when flexed knee is decelerated rapidly - dashboard injury

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23
Q

PCL injury - tests

A

Posterior drawer test

Tibia sag test

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24
Q

Posterior drawer test

A

Posterior displacement of tibia on femur

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25
Collateral ligament injury - in general
``` Medial & lateral stabilizer Medial collateral (MCL) Lateral Collateral (LCL) Traumatic partial or complete tear May occur with meniscal, ACL, PCL injury ```
26
Collateral ligament injury - clinical features
``` Able to ambulate C/o swelling or stiffness Pain Tenderness Localized ecchymosis Swelling possible ```
27
MCL injury - MOI
Valgus force
28
LCL injury - MOI
Varus force (less common)
29
Collateral ligament injury - PE
``` Examine normal knee first Inspection - swelling - ecchymosis Palpation - tenderness about origin & insertion of ligament ROM ```
30
Collateral ligament injury - tests
Valgus and varus stress tests | Perform with knee in full extension and 30° flexion
31
Collateral ligament injury - dx
Radiographs usually negative - possible avulsion
32
Collateral ligament injury - Grade I
Localized tenderness over ligament Little or no laxity Tx with RICE & NSAIDs short term
33
Collateral ligament injury - Grade II
Significant laxity, but definite end point reached | Tx with hinged brace 4-6w & allow WBAT
34
Collateral ligament injury - Grade III
Laxity with no end point Hinged brace, gradual return to FWB Rehab - early ROM & quad strengthening Refer for possible sx
35
Collateral ligament injury - when to refer
Hemarthrosis | Ligamentous instability
36
Tendinitis
Overuse syndrome
37
Quadriceps tendon & Tendinitis
At insertion on superior pole of patella
38
Patellar tendon & Tendinitis
At inferior pole of patella or insertion at tibial tubercle (jumper's knee)
39
Tendinitis - clinical symptoms
Anterior knee pain Night pain Pain with sitting, squatting or kneeling Increased with climbing stairs
40
Tendinitis - PE
Palpation - pain Quadriceps atrophy Check straight leg raise to r/o rupture Check ACL & PCL
41
Tendinitis - Dx
MRI is helpful if conservative tx fails
42
Tendinitis - tx
``` Rest Knee immobilizer intermittently NSAIDs - short term AVOID STEROIDS Strength and pain free motion Refer all possible tendon ruptures ```
43
Osgood-Schlatter dz - in general
Seen in adolescents (12-14yo) Repetitive injury Occurs at bone tendon junction-patellar tendon & tibia tubercle
44
Osgood-Schlatter dz - clinical features
``` Pain Swelling Tenderness Relieved by rest irregular ossifications or fragmentation of tibial tubercle on lateral x-ray ```
45
Osgood-Schlatter dz - tx
``` Avoid activity triggering s/s Ice Immobilization for severe s/s Parental reassurance Sx rare ```
46
Patellar fx - in general
Direct blow while quadriceps is under tension
47
Patellar fx - clinical features
Pain | Inability to extend knee
48
Patellar fx - PE
Hemarthrosis with swelling Unable to extend knee Open fx common due to direct blow
49
Patellar fx - dx
AP & lat s-rays | Extensor mechanism usually intact if two main fragments <6mm apart
50
Patellar fx - tx
immobilize in extension 6 weeks (3-4 weeks ROM) - if < 5mm separation & <2 mm displacement - extension intact Sx
51
Dislocations - in general
``` C/o knee giving way or popping out May occur secondary to acute injury May spontaneously reduce with gradual extension Evaluate for other injuries F>M ```
52
Patellar Dislocations - tests
Positive Apprehension test
53
Patellar Dislocations - Tx
Aspirate tens hemarthrosis Immobilization (2-6 wks) Full weight bearing Quadriceps exercises important!!!
54
Patellofemoral Pain Syndrome - in general
Chondromalacia pateleae Most common anterior knee problem Worse with sitting with knee flexed (theatre sign) or going down stairs
55
Patellofemoral Pain Syndrome - dx
X-ray usually show negative, sunrise films may show lateral displacement of patella
56
Patellofemoral Pain Syndrome - tests
Positive patellar compression | Entrapment signs
57
Entrapment sign
Weak quadriceps
58
Patellofemoral Pain Syndrome - tx
``` NSAIDs Ice Quadriceps exercise Avoid triggering activities Sx if conservative tx fails ```
59
Fx of the knee joint
``` May are intra-articular Tibial plateau & femoral condyles - MOI Clinical feature Tx ```
60
OA - in general
Common cause of knee pain Progressive breakdown of cartilage and joint (synovial fluid) Breakdown causes a loss of the cushioning and lubrication that cartilage and joint fluid give to the knee joint
61
OA - s/s
``` Pain Stiffness Functional impairment Swelling Grating & catching when knee is bent ```
62
OA - RF
``` Increasing Age Excessive weight Overuse of the knee Injury to the knee A FHx of OA ```
63
Healthy knee
Bone ends are protected by healthy cartilage | The space between bones is well lubricated with healthy joint fluid
64
Cartilage
A cusiony substance that keeps bones from rubbing together
65
Mild OA
Cartilage surface stats to break down
66
Moderate OA
Cartilage continues to break down and is more easily damaged by everyday ear and tear or injury Joint fluid starts to lose its lubrication and shock-absorbing ability
67
Severe OA
Large amounts of cartilage have worn away, allowing bones to rub against each other Bone spurs form on the ends of bones
68
Treating OA knee pain summary
Non-drug therapies include - exercise, weight loss, heat & cold & PT Drug therapies include - acetaminophen, NSAIDs topical therapies, injectable corticosteroids & viscosupplements Viscosupplements replace dzed joint fluid

Clin Med II - Ortho (13 decks)

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