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Musculoskeletal 2 > Knee Clinical Presentations Cont. > Flashcards

Knee Clinical Presentations Cont. Flashcards

1
Q

CPG PFPS

What is A level evidence for reproducing peri or retropatellar pain?

What is B level evidence for making a diagnosis?

What is C level evidence for supporting diagnosis?

A
  1. A → use reproduction of retropatellar/peri-patellar pain during squat as diagnostic test for PFPS
  2. B → make the diagnosis of PFPS using the 3 criteria of:
    • presence of retropatellar or peri-paterllar pain
    • reproduction of pain with squatting, stair climbing, prolonged sitting, or other functional activities loading PFJ in flexed position
    • exclusion of all other conditions
  3. C → use of patellar tilt test in presence of hypomobility to support diagnosis
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2
Q

What joint is most commonly affected by OA?

What is the lifetime risk of developping symptomatic knee OA? What is that risk if you’ve had a knee injury?

What increases risk of having knee OA in general?

What 3 things will be observed on a radiograph?

A
  1. Joint most commonly affected by OA
  2. Murphy et al., 2008
    • lifetime risk of symptomatic knee OA = 44.7%
    • hx of knee injury increases lifetime risk to 56.8%
    • incidence increased to 2/3 among obese
  3. Radiography
    • joint space loss
    • osteophytes
    • sclerosis
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3
Q

Hx of Knee osteoarthropathy (9)

A
  1. Insidious onset
  2. Hx of trauma/prior knee surgery
  3. family hx
  4. obesity
  5. knee hypermobility
  6. joint shape abnormality
  7. extreme physical activity levels
  8. age > 50 yrs
  9. female
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4
Q

symptomology of knee osteoarthropathy (3)

where is the pain?

What is it aggravated by?

What else will you see with it? (1)

A
  1. retropatellar pain
  2. aggravated by
    • w/b activities
    • squatting
    • stairs
    • prolonged sitting
  3. crepitus
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5
Q

physical exam findings for knee osteoarthropathy (5)

  • where is it TTP?*
  • What is limited ROM?*
  • What is limited strength?*
  • What two other things will you see?*
A
  1. antalgic gait
  2. swelling/warmth at knee
  3. TTP joint lines
  4. painful/limited knee ROM (flexion, extension)
  5. painful/limited MMT
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6
Q

what is arthrofibrosis?

A
  1. dense proliferative intra-articular and extra-articular scar tissue formation with related limitations in knee ROM
    • inflammation present
    • may lead to degenerative joint changes
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7
Q

Hx for arthrofibrosis (2)

  • past _______*
  • pain and knee ROM limitations has been ______*
A
  1. traumatic injury/knee surgery
  2. progressive increase in pain and knee ROM limitations
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8
Q

symptomology for arthrofibrosis

  • where is the pain?*
  • 3 other symptoms*
A
  1. stiffness (worse in morning)
  2. knee swelling
  3. creptius
  4. diffuse knee pain
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9
Q

physical exam findings for arthrofibrosis

  • what ROM is limited?*
  • What will joint mobility look like?*
  • What will MMT look like?*
  • 1 other symptom*
A
  1. limited knee ext in static stance or stance phases of gait
  2. limited/painful knee ROM
    • PROM with firm end-feel
  3. hypomobile patellofemoral glides (multi-directional)
  4. knee effusion/swelling
  5. inhibited/weak/painful knee ext
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10
Q

what is genu recurvatum?

A

hyperextension of the knees (>10º)

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11
Q

epidemiology of genu recurvatum

  • what gender is it more common in?*
  • What 3 things is it correlated with?*
  • What does it cause excessive stress of?*
A
  1. females > males
  2. correlated with:
    • joint laxity
    • hx knee injury
    • poor muscular control (CVA)
  3. excessive stress on posterior knee structures
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12
Q

genu recurvatum may predispose someone to ______ injury, compressive injury________________ joint, tensile ________________, and posterior ________________injuries.

A
  1. ACL injury
  2. compressive injury anteriomedial tibiofemoral joint
  3. tensile loading posteriolateral joint supporters
  4. posterior corner capsulo-ligamentous avulsion injuries
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13
Q

Hx for genu recurvatum (5)

what 4 types of MOIs are there and what is a common concomitant injury?

A
  1. forced knee extension injury
  2. jump landing in extension
  3. force to anteriomedial proximal tibia
  4. noncontact hyperextension with planted foot
  5. concomitant PCL injury
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14
Q

symptomology of genu recurvatum (2)

  • what do they complain of?*
  • What are the two places they may have pain?*
A
  1. C/O knee instability
  2. anteriomedial knee pain vs posteriolateral knee pain
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15
Q

physical exam findings for genu recurvatum

  • what will be seen on the postural exam/visual inspection? (5)*
  • Where is it TTP?*
  • What will joint mobility look like?*
  • What 2 other things will be seen?*
  • What type of screen is necessary?*
A
  1. postural exam (visual inspection) → knee hyperextension
    • tibial ER
    • genu varum/valgum
    • tibial varum
    • excessive pronatio n
    • impaired propioception at knee
  2. edema, ecchymosis
  3. TTP locally
  4. Neurovascular screening, exam necessary
  5. antalgic gait
  6. hypermobility posterior glide with posteriolateral bias (with ER of tibia)
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16
Q

Patellar Tendinopathy

  • what is it’s nickname?*
  • What is is caused by? (2 things)*
  • What is the average amount of time that there is pain/functional limitations?*
  • How does this affect an athlete if it happens to them?*
A
  1. aka Jumper’s knee
  2. caused by an eccentric overload
  3. microtrauma
    • failed healing response
  4. average 32 months pain/functional limitations
  5. 53% of affected athletes quit sport
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17
Q

What two sports would commonly experience patellar tendinopathy?

A
  1. basketball and volleyball players
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18
Q

symptomology of patellar tendinopathy

  • where is the pain located?*
  • what activity bothers it the most?*
A
  1. anterior knee pain
  2. aggravated with jumping/extensor mechanism
19
Q

physical exam findings for patellar tendinopathy

  • Where is it TTP?*
  • What functional movement is painful?*
  • What ROM is painful?*
  • What resistive testing is weak/painful?*
A
  1. TTP patellar tendon/inferior pole of patella
  2. painful squat
  3. pain end-range flexion ROM
  4. pain resisted > active knee extension
20
Q

what is ITB Friction syndrome (at the knee)?

A
  1. increased compression on soft tissue structures between lateral femoral condyle and IT Band
  2. thickening of burase
21
Q

ITB friction syndrome correlates (2)

A
  1. prominent femoral epicondyle
  2. leg length discrepancy
22
Q

ITB friction syndrome Hx

(5 sports)

Is the onset insidious or acute?

A
  1. long distance runners
  2. downhill skiers,
  3. Jumping sports
  4. weight lifters
  5. cycling
  6. Insidious/progressive onset
23
Q

Symptomology of ITB friction syndrome

  • Where is the pain?*
  • What motions aggravate it?*
A
  1. lateral knee pain
  2. aggravated with activity/repetitive knee flexion/extension and stairs
24
Q

physical exam findings for ITB friction syndrome

  • Where is it TTP? (3)*
  • What muscle length test is positve?*
  • What MMT may be painful?*
A
  1. local TTP
    • distal ITB
    • Gerdy’s tubercle
    • lateral femoral condyle
  2. (+) Ober test
  3. Potentially painful hip ABD MMT
25
Q

what is Hoffa’s syndrome?

Where is the site of impingement?

What action causes further impingment? (flexion or extension)

A
  1. hypertrophy/inflammation of infrapatellar fat pad
  2. impingement between femoral condyles and tibial plateau (knee extension)
26
Q

MOI for Hoffa’s syndrome

A
  1. trauma or repetitive extension microtrauma
27
Q

Hoffa’s syndrome symptomology

A
  1. anterior (infrapatellar) knee pain
  2. aggravated by activities that require (repetitive) knee extension
28
Q

physical exam findings for Hoffa’s syndrome

  • What motion is painful?*
  • Where is it TTP?*
A
  1. pain knee extension ROM
  2. Local TTP
    • medial and lateral patellar tendon
29
Q

what is Plica Syndrome?

  • What is irritated? (3 things)*
  • When are plica normal? What happens to cause the syndrome?*
A
  1. irritated suprapatellar, mediopatellar infrapatellar and lateral patellar plicae
  2. Normal structures; inflammation and hypertrophy in pathologic situations
    • during development synovial folds compartmentalize the knee
    • typically resorbs during month 3-4 of embryonic development; plica remains if this does not occur
30
Q

suggested clinical diagnosis for plica syndrome (4)

A
  1. Supportive hx
  2. failure with conservative management
  3. arthroscopic observation of fibrotic plica with impingement in patellofemoral joint during knee flexion
  4. no other likely diagnostic hypothesis (Dx of exclusion)
31
Q

is Plica syndrome common?

A

symptomatic Plica syndrome is controversial over whether or not it’s common or non-existent.

32
Q

Hx for plica syndrome

  • Is it traumatic or insidious?*
  • What is the common age and greatest risk age?*
A
  1. microtrauma; usually an initial injury with secondary inflammation to the Plica
  2. any age but greatest risk at adolescence
33
Q

symptomology of plica syndrome

  • where does it hurt?*
  • What aggravates it? (3)*
  • 1 other symptom*
A
  1. anterior knee pain
  2. clicking/catching/locking/giving way
  3. aggravated with
    • activity
    • prolonged standing and sitting
    • squatting
34
Q

physical exam findings for plica syndrome

  • Where is it TTP?*
  • What ROM is painful? Less painful?*
  • What PROM will likely be painless?*
A
  1. hypertrophied plica without effusion
  2. TTP (local)
  3. painful knee flexion ROM
    • less pain with active extension
  4. painless extension PROM (likely)
35
Q

what is a Baker’s cyst?

A

swelling at posterior knee

painful with synovial effusion

may rupture

36
Q

Hx for Baker’s cyst

A
  1. intra-articular effusion
37
Q

Symptomology of Baker’s cyst

where is the pain?

A
  1. posterior knee pain
38
Q

physical exam findings for Baker’s cyst

  • Where is the swelling?*
  • What ROM is painful?*
  • What increases the prominence of the cyst?*
A
  1. local swelling proximal to popliteal fossa
  2. pain knee flexion/extension ROM
  3. prominence of cyst increases with resisted knee flexion
39
Q

List the types of bursitis possible at the knee (3)

what causes each type?

A
  1. superficial and deep infrapatellar (nun’s knee)
    • direct mechanical irritation
  2. prepatellar
    • recurrent anterior knee trauma
  3. superficial pes anserine
    • structures between MCL/pes anserine
    • swimmers/distance runners
40
Q

physical exam findings for bursitis at the knee (2)

A

local TTP

local swelling

41
Q

potential area for entrapment of the superficial fibular nerve (2)

A
  1. trauma posteriolateral knee (fibrosis)
  2. compartment syndrome
42
Q

motor distribution of the superficial fibular nerve

A
  1. fibularis longus and brevis
43
Q

sensory distribution of the superificial fibular nerve

A
  1. distal 2/3 lateral leg/ankle/dorsal foot
44
Q

other clinical indicators for the superficial fibular nerve

A
  1. hx direct trauma/iatrogenic
  2. neurodynamic tension test, sensitized with supination

Musculoskeletal 2 (7 decks)

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