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Flashcards in Knee & Leg Deck (14):
1

What are the important questions in the knee history?

Pain =
- what does it stop you from doing?
- what analgesia have you had?
- location: inside or outside, referred from groin
- timing: rest (biological pain), activity (mechanical pain)
- progression: acute (traumatic), gradual (degenerative)
- night pain

Stiffness =
- start-up
- flexion e.g. low chair, toilet, squatting
- occupation

Instability = actual or threatened, with what activities

Swelling = subjective, small effusions easily detectable

Locking = physical block to flexion/extension caused by loose body jamming the articular surfaces

Red flags =
- severe night pain
- inability to bear weight on limb
- Hx of malignancy
- rapid deterioration of knee symptoms

2

What are the important features of a knee exam?

LOOK
- wasting (esp. quads)
- alignment: foot everted so you see more toes on that side than the other
- gait: varus thrust, stiff knee gait, bow-legged, knock-kneed
- scars: minor trauma, knee replacement, arthroscopy
- varicosities
- walking aids
- foot orientation and perfusion

FEEL (flexion and extension)
- swelling: sweep test, patellar test
- bony landmarks
- joints: femur, tibia, patella, fibula
- osteophytes
- pulses
- patellar grind

MOVE

SPECIAL TESTS

3

What are the special tests of the knee exam?

Striaght leg raise = extensor mechanism tested (quads, patellar ligament and tendon ---> tibial tuberosity)

Stability of medial and lateral collateral ligaments = flex knee to 90 degrees and push knee medially and laterally

Mobile or fixed varus/valgus deformities = try to correct

Anterior/posterior drawer test = flex knee to 90 degrees (check hamstrings are flexed) and put thumbs on front whilst fixing foot and rocking knee back and forth

Lachman's test = more senstive than anterior drawer test; knee flexed to 30 degrees, encircle femur with one hand and tibia with the other

Pivot shift test = put thumb behind fibula and use other hand to flex and pivot knee into valgus, tests for ACL tear (tibia moves with when flexed with varus movement)

McMurray's test = tests for meniscal tears, place hand between femur and tibia on both sides whilst flexing and extending knee (meniscus pinched ---> pain)

4

What are the investigations in the acute, traumatic knee?

Swelling, instability, joint line tenderness

X-ray to rule out fracture/dislocation

MRI

Splint and re-examine at 3wks

5

What are the key features of anterior knee pain?

Occurs when going downstairs

Gives way

Crepitus

Swelling

Pseudo-locking

Patellar tracking (patella shifts out of place)

6

What are the key features of a meniscal tear?

Twisting/hyperflexion injury

Locking

Swelling

Joint line tenderness

Arthroscopy to repair/excise meniscus

7

What are the key features of an ACL tear?

Body thrown over planted foot

Acute swelling

Giving way

Positive Lachmann test/anterior draw test/pivot shift test

8

What is osteochondritis dissecans?

Separation of articular cartilage and subchondral bone fragment from joint surface ---> fragment becomes avascular and exists as loose body within joint

e.g. genetic, ischaemia, repetitive trauma

9

What are the key features of septic arthritis?

Unwell

Pain

Tense effusion

Very stiff

Aspirate for culture and washout

10

What is a Segond fracture?

Avulsion fracture of knee involving lat. aspect of tibial plateau (freq. associated with ACL tear)

11

What is the management of a tibial plateau fracture?

ORIF OR external fixation

12

What is a high tibial osteotomy?

Correct valgus/varus deformity by sawing through tibia and hinging it with plate and screws/inserting a bone graft to correct the angle of weight distribution to the knee

13

What is Hoffa's fat pad?

Infra-patellar fat pad

Can become impinged between patella and femur, causing significant effusion

14

What is Osgood-Schlatter disease?

Inflammation of patellar ligament at tibial tuberosity characterised by painful lump just below knee (tibial tubercle)

Caused by osteochondritis or traction apophysitis of tibial tubercle