Knee

Question 1

What is a common overuse fracture present at the knee?

Answer 1

Tibial stress fracture

Question 2

What are important PMH factors when considering likelihood of a fracture?

Answer 2

Mechanism, Osteoporosis, REDS, long-term steroid use, cancer

Question 3

What would the pain characteristics of a lower-limb fracture be?

Answer 3

Worse when WB, pain relieved when non-WB.

Question 4

What would the characteristics of an Osteosarcoma be?

Answer 4

• Constant pain, worse at night.

- More common in children/young people. (most common site is distal femur followed by pros. tib.

Question 5

What likely pathology would the following factors indicate;

Interview;

• Very active child
• Complaints of Px after sport or activity
• Lump over tibial tuberosity (localised Px and swelling)

Examination;
- Px on isometric quads

Answer 5

Osgood Slatters Disease Apophysitis

Question 6

What are the main pathological features of RA and OA, respectively?

Answer 6

RA - invasion and erosion of underlying bone (autoimmune condition)

Destruction of cartilage.

OA - Bony sclerosis and thickening.

Osteophyte (spur) development at joint margins

Irregular thinning/loss of cartilage

Question 7

What are the additional pathological features of RA in relation to the synovial membrane?

Answer 7

• Non-specific inflammatory synovitis
• Exudate into joint cavity
• Proliferation of synovial tissue

Question 8

If you were given this subjective interview information, what pathology would you hypothesise?

• Gradual onset
• > 45 years age
• Joint Px related to WB
• Mild swelling
• Crepitus
• No EMS or EMS <30mins
• Exclusion of RA, SA and malignancy.

Answer 8

Osteoarthritis.

Question 9

If you were given this subjective interview information, what pathology would you hypothesise?

• EMS > 30 minutes
• Swelling and heat at joint
• Fatigue and low grade fever.
• Hx of Vasculitis, pulmonary fibrosis, carditis or ocular disease.

Answer 9

Rheumatoid arthritis.

Question 10

What are the features of bursitis?

Answer 10

Local tenderness, swelling and/or heat at the bursa.

Question 11

What would you look for especially in suspected pes anserine bursitis?

Answer 11

Observation;

• Wide Q angle
• Valgus

Functional task;

• Single leg squat/step-up (note an excessive values strain.
• Pain on repetitive, active knee flex/ext.

Question 12

Who is most at risk of pre patellar bursitis?

Answer 12

Manual workers (repeated kneeling)

Question 13

Who is most at risk of Infrapatella bursitis?

Answer 13

• People who repeatedly put strain on the patella tendon through jumping activities.
  (look for Px on isometric quads)

Question 14

Who is most at risk of pes anserine bursitis?

Answer 14

• Peoplewho take part in sports that repeatedly use Sartorius, Gracilis and semi-tendinosus.
• Running, cycling, breaststroke and ‘change of direction’ sports.
  (look for Px on repeated, active knee flex/ext.

Question 15

What are the potential mechanisms for supra patellar bursitis?

Answer 15

• Blunt trauma e.g falling onto knee.

- Repetitive oversuse (running)

Question 16

What are the potential mechanisms of plica syndrome?

Answer 16

• Blunt trauma to knee.
• Repetitive bending and straightening
  (in the presence of a plica)

Question 17

What injury(s) would you hypothesise if you were given this subjective? And what would you process of objective examination be?

• Cutting in a football match
• Immediate Px and swelling at knee
• Reduced movement (especially inability to extend knee)
• Gives way on twisting movements

Answer 17

• ACL

Differential
- MCL, meniscus (O’Donoghue’s unhappy triad)

Objective;

• AROM (oxford scale); Knee flex, extension.
• PROM; flex, ext, int/ext rotation.
• Special tests; Anterior draw, McMurrays (also maybe values/varus stress)

Question 18

What are the mechanisms for acute meniscal damage?

Answer 18

• Non-contact: sudden-twisting
• Contact: (Lat. meniscus) foot planted, varus force on flexed knee with ext rot of femur.
• (Med. meniscus) Valgus force, femur int rot.

Question 19

What are the signs and symptoms of acute meniscal damage?

Answer 19

• Localised pain on joint line.
• Localised swelling
• Locking

Question 20

What special questions could you ask in relation to locking/giving way of the knee?

Answer 20

Locking;

Does your knee ever lock in a position that you can not move it?

Explain to me what happened to your knee the last time it happened. (?True locking)

How often?

Giving way;

Does you knee ever give way on you? Do you to fall on the floor?

Explain to me what happened to your knee the last time it happened?

Question 21

What should you be aware of with relation to neurological ‘red flags’?

Answer 21

- Pins and needles
Problems with bowel/bladder control
- Parasthesia in groin
- Night pain
- Burning pain.