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Knee conditions Flashcards

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1
Q

Acute swelling around the knee- traumatic synovitis

A

Any moderately severe injury (e.g., torn meniscus_ can precipitate reactive synovitis
Swelling appears after several hours

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2
Q

Acute swelling around the knee- Post traumatic hemarthrosis

A

Swelling immediate after injury, means blood in joint
Pain, warm, tense, tender, restriction
X-ray needed to eliminate fracture, if not suspect tear of ACL

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3
Q

Acute swelling around the knee- non-traumatic hemarthrosis

A

In Pt with clotting disorders, knee is common site for acute bleed
Variety of blood disorders are hereditary, e.g., haemophilia

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4
Q

Chronic joint swelling of entire joint- non-infective arthritis

A

Commonest cause of swelling is OA + RA
Other signs such as deformity, loss of movement or instability may be present
X-ray needed to show features

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5
Q

Swelling anteriorly- pre patellar bursitis

A

Fluctuant swelling confined to front of patella, joint itself is normal
Due to constant friction between skin + bone
Treatment= firm bandaging, and avoiding kneeling

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6
Q

Swelling anteriorly- infra patellar bursitis

A

Swelling below patella
Superficial to patella ligament
Treatment same as prepatellar

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7
Q

Swelling posteriorly- semimembranosus bursa

A

Bursa between semimembranosus + medial head of gastrocnemius may become enlarged
Presents as painful lump behind knee, slightly medial
Most conspicuous when knee is straight
Knee joint is normal
Usually takes a while to heal

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8
Q

Swelling posteriorly- popliteal cyst

A

Bulging of posterior capsule + synovial herniation may produce swelling in popliteal fossa
Usually caused by RA or OA
Occasionally ‘cyst’ ruptures + synovial contents spill into muscle planes causing pain + swelling in calf- can be mistaken for deep vein thrombosis
Reoccurrence is common if underlying condition isn’t treated

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9
Q

Swelling posteriorly- popliteal aneurysm

A

Need to be cautious that popliteal swelling isn’t an aneurysm

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10
Q

Swelling laterally- meniscal cyst

A

Small, tense swelling, usually on lateral side/just below joint line
Can be mistaken for bony lump
Usually tender to pressure

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11
Q

Swelling laterally- calcification of collateral ligament

A

Acute painful swelling may suddenly appear
Usually medial side of joint line
Rubbery and tender

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12
Q

When are bow legs common

A

In babies- considered normal development

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13
Q

When are knock knees common

A

4 year olds- considered normal development

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14
Q

How to measure bilateral bow-legs

A

Measure distance between knees with child standing + heels touching- should be less than 6cm

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15
Q

How to measure knock knees

A

Estimated by measuring distance between medial malleoli when knees are touching with patella facing forward- usually less than 8cm

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16
Q

What to do if deformity is still occurring at age 10

A

Surgery

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17
Q

Pathological bow-legs and knock-knees in children

A

Unilateral deformity likely to be pathological as is severe bilateral deformity

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18
Q

Likely cause of unilateral deformity

A

Eccentric growth from physics of distal femur or proximal tibia
Usually progressive

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19
Q

When should operative treatment be offered for deformity

A

Near end of pubertal growth
By age 10 deformity is often grown out of

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20
Q

Pathological bow-legs and knock knees in adults

A

Angular deformities common in adults
Usually bow-legs in men and knock knees in women

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21
Q

Osteochondritis dissecans

A

Bone underneath cartilage dies due to lack of blood flow
Sometimes separates from femoral condyle and appears as loose body in joint

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22
Q

Epidemiology of Osteochondritis dissecans

A

Trauma, either single impact with edge of patella or repeated contact with adjacent tibial ridge

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23
Q

Age groups affected by Osteochondritis dissecans

A

Adolescents involved in competitive sport and children
Usually male aged 15-20

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24
Q

Clinical presentation of Osteochondritis dissecans

A

Intermittent ache or swelling
Attacks of giving way, knee feels unreliable, may lock
Quadricep muscle wasting
Usually small effusion
Tenderness localised to one femoral condyle
+ve Wilsons test

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25
Prognosis of Osteochondritis dissecans
Early stages with cartilage still intact= no treatment needed but activities reduced for 6-12 months Small lesions often heal spontaneously
26
Loose bodies epidemiology
Injury- child to bone or cartilage Osteochondritis dissecans OA Charcots disease Synovial chondromatosis
27
Clinical presentation of loose bodies
May be symptomless or complain of sudden locking Joint gets stuck in position Pt can usually wriggle knee to unlock May be aware of something 'popping in and out' May swell
28
Prognosis of loose bodies
If loose body causing symptom removed, treatment is successful
29
Tuberculosis epidemiology
Coughing Sneezing
30
Age groups affected by TB
Any age but mainly children
31
Clinical presentation of TB
Pain + limp are early symptoms Swollen knee or low-grade fever Thigh muscle wastage Knee feels warm Restriction
32
Prognosis of TB
Active synovitis- knee is rested in bed-splint, exercise intermittently for short spells Healing stage- wear weight relieving calliper Aftermath- if joint is painful, arthrodesis recommended
33
RA epidemiology
May start as synovitis in knee
34
Age groups affected by RA
40-60 Bit older for men
35
RA risk factors
Genetics Obesity Sex- women
36
Clinical presentation of RA
Valgus- knees in Early stage- pain + swelling, may be large effusion + wasting of thigh muscle, restricted ROM Advancing- joint becomes unstable, muscle wasting and restriction increases, x-ray shows loss of joint space, complete absence of osteophytes Later stage- joint becomes increasingly deformed
37
Prognosis of RA
Anti-inflammatory drugs Once bone destruction is present, joint is unstable and total joint replacement advised
38
OA epidemiology
Knees most common site Injury to articular surface, torn meniscus, instability/pre-existing deformity In many cases no obvious cause can be found Tend to be overweight + have long standing bow legged deformity
39
Age groups affected by OA
Usually over 50
40
Clinical presentation of OA
Pain, worse after activity After rest joint feels stiff and hurts to 'get going' Swelling, giving way, locking Quadricep wastage
41
Prognosis of OA
If not severe, treatment is conservative Analgesics can be prescribed for the pain Quadricep exercises + heat Joint loading lessened (walking stick) If unresponsive to conservative treatment, operative options may be necessary
42
Recurrent dislocation of patella epidemiology
Stretching of ligaments which normally stabilise Initial episode thought to have occurred spontaneously
43
Risk factors of recurrent patella dislocation
Generalised ligament laxity Under-development of lateral femoral coddle + flattening of intercondylar groove Maldevelopment of patella Valgus deformity of knee
44
Clinical presentation of recurrent patella dislocation
Girls affected more commonly Condition often bilateral Knee suddenly gives way + Pt falls Patella always dislocates laterally Tenderness on medial side Swelling
45
Prognosis of patella dislocation
Quadricep strengthening exercises, in particular vests medialis
46
Tibial tubercle apophysitis
An inflammation or stress injury to the areas on or around growth plates in children and adolescent
47
Tibial tubercle apophysitis epidemiology
Traction injury
48
Age groups affected by tibial tubercle apophysitis
Fairly common in adolescents, particularly those engaged in sports
49
Risk factors of Tibial tubercle ‘apophysitis’
Sport
50
Clinical presentation of Tibial tubercle ‘apophysitis’
Pain Swelling of tibial tubercle Extension against resistance is often painful
51
Prognosis of Tibial tubercle ‘apophysitis’
Spontaneous recovery is usual, but it takes time RICE
52
Chronic ligamentous instability epidemiology
Sports injury
53
Chronic ligamentous instability clinical presentation
Giving way during weight bearing activities, sometimes accompanied by pain Joint looks normal apart from slight wasting, rarely tenderness Observe gait and knee posture in standing
54
Prognosis of Chronic ligamentous instability
Most cases operation is not required Some Pt will accept the use of knee brace
55
Patella tendinopathy
Patella ligament strain or partial rupture may lead to traction tendonitis
56
Epidemiology of patellar tendinopathy
Repeated stress on patella tendon Obesity Sudden increase in body weight
57
Age groups affected by patella tendinopathy
Adolescents- particularly athletes
58
Risk factors of patella tendinopathy
Sport Tight leg muscles Muscular imbalance
59
Clinical presentation of patella tendinopathy
Repeated episodes of pain and local tenderness
60
Prognosis of patella tendinopathy
If persistent, may lead to calcification within ligament Usually resolves spontaneously
61
Chondromalacia Patella
Softening and degeneration of articular cartilage of patella
62
Chondromalacia Patella epidemiology
Post-traumatic injury Microtrauma- wear + tear
63
Age groups affected by Chondromalacia Patella
Young females
64
Risk factors of Chondromalacia Patella
Patella Alta (high rising) High Q angle that may lead to malt racking
65
Clinical presentation of Chondromalacia Patella
Tenderness of inferior angle of patella Crepitation Anterior pain following flexion and prolonged pain Increased Q angle Potential hyper mobility of patella Pt should be able to extend knee
66
Prognosis of Chondromalacia Patella
Once it starts its irreversible Involves breakdown of surface layer of cartilage surface, which is progressive Can be treated with isometric exercises and activity modification Patella taping may be useful
67
Prepatella bursitis
Inflammation, swelling and enlargement of prepatellar bursitis
68
Prepatellar bursitis epidemiology
As a result of frequent kneeling Acute trauma to anterior knee
69
Risk factors of prepatellar bursitis
Occupation- e.g., carpet laying
70
Clinical presentation of pre patella bursitis
Pain when directly kneeling on it Swelling, tenderness, and redness of tissues overlying patella
71
Prognosis of pre patella bursitis
Infectious (pyogenic) bursitis may develop Occasionally resolves with rest, icing, NSAIDs, compression wraps, and avoidance of kneeling Very rarely is surgery necessary Pyogenic bursitis may require drainage
72
Overuse syndromes
Refers to musculoskeletal pain or dysfunction following physical activity that exceeds strength of musculoskeletal tissues such as bones, tendons, ligaments, joints and bursa
73
Epidemiology of overuse syndrome
Vigorous physical activity with no distinct history of trauma Exercise may cause microtrauma to structures
74
Clinical presentation of overuse syndrome
Symptoms are variable Pain often achy and most pronounced 1-2 days after intense physical activity, especially when Pt has not warmed up/stretched Pain may be vague and poorly localised Structures that have suffered microtrauma will be tender and inflamed Stretching will elicit pain
75
Prognosis of overuse syndrome
Can cause tendonitis Should heal with elimination of offending activity Time frame resolution is variable, often within 8 weeks If symptoms last longer than this, reconsider diagnosis
76
DDX of overuse syndrome
Patella tendon rupture Tibial stress fracture Patella fracture ACL rupture Meniscal tear
77
Medial/lateral collateral ligament strain epidemiology
Following trauma Report of history of twisting injury with 'pop' or 'snap'
78
M/LCL strain age groups
20-34 and 55-65
79
Risk factors of M/LCL strain
Contact sports
80
Clinical presentation of M/LCL strain
Pain may be worsened with weight bearing Tenderness of medial/lateral side of knee Compare to symptomatic
81
Grade 1 M/LCL strain symptoms
Tenderness, minimal swelling, and ecchymosis
82
Grade 2 M/LCL strain symptoms
More pain and tenderness that can be localised to tibia or femoral insertion of MCL
83
Grade 3 M/LCL strain symptoms
Complete rupture of MCL, knee joint swelling and effusion will be minimal as much of haemorrhage diffuses into surrounding soft tissue
84
Prognosis of M/LCL strain
Grade 1- no specific treatment 2+3 should be protected for 6 weeks 3 or severe instability should be evaluated for reconstruction pf possible associated ligament injury
85
Importance of meniscus
Improve articular cartilage congruency + stability Control complex rolling + gliding actions of the joint Distributing load during weight bearing
86
Then meniscus epidemiology Acute + chronic
Acute- rotational or twisting injury to flexed knee resulting in audible pop with concurrent localised sharp pain Chronic- degenerative changes to menisci, often no discrete history of trauma
87
Age groups affected by torn menisci
Acute 20-40 Chronic older Usually younger person who sustains twisting injury
88
Risk factors of menisci tear
Pivoting sports
89
Clinical presentation of torn menisci
Acute- effusion, moderate pain, may describe mechanical symptoms (catching, locking) resulting in difficulty with flex/ext Large tears- knee can become locked in flexion, severe pain caused from squatting/pivoting Chronic- symptoms exacrberated by activity and improved with rest Effusion may be relevant to recent activity Tenderness with palpation along joint line
90
Prognosis of meniscal tears
McMurray test will identify tear Treatment based on side of tear, as well as Pt age and activity level Small tears- RICE, NSAIDs, activity modification, stretching + strengthening
91
Degenerative joint disease
Most common cause of knee pain in elderly Pt Knee most commonly affected by OA
92
Epidemiology of DJD
Rarely evidence of history or trauma May present after aggravating knee with minimal twist or contusion Younger Pt with previous knee trauma at increased risk at an early age due to post traumatic arthritis May be in occurrence with chronic metabolic conditions (gout) and obesity
93
Age groups affected by DJD
50-80
94
Clinical presentation of DJD
Pain, swelling and stiffness that gradually becomes worse Pain may be worse on cold days Often exacerbated by activity and relieved with rest Common to have night pain after day of activity, severe shoulder wise alternate diagnosis Observe gait (antalgic gait) Bowed legs (genus vacuum), or knocked knees (genus valium) Tenderness to palpation is unlikely Crepitus with flex/ext
95
Prognosis of DJD
Initial treatment involves weight loss, activity modification, and NSAIDs High impact activities such as running should be avoided Swimming is beneficial End-stage OA requires total knee replacement
96
Pes anserine bursitis
Pes anserine bursa located on medial side of knee at proximal tibia Provides cushioning to tendons during activity
97
Epidemiology of pes anserine bursitis
Pain often insidious on onset, no history of trauma (unlike MCL sprain) Report of history of overuse, commonly in sports such as breastroke- repetitive strain on tendons -->bursitis
98
Risk factors of pes anserine bursitis
Sports involving reparative strain on medial tendons
99
Clinical presentation of pes anserine bursitis
Medial knee pain Tenderness to palpation of proximal medial tibia at attachment of pes anserine tendon
100
Prognosis of pes anserine bursitis
RICE and NSAIDs initially Identify stress aetiology Often resolution of symptoms, however occasionally becomes chronic Refer after 6 weeks of rest, NSAIDs and activity modification
101
ACL tear Hx
Direct trauma with valgus hyperextension Audible pop Playing sport with quick stops or sharp cutting on non slip surafces
102
ACL tear SSx
Severe Jt effusion +ve ant drawer Feeling of instability
103
PCL tear Hx
Direct trauma with posterior to anterior stress Audible pop
104
PCL SSx
Effusion in popliteal fossa Reduced ROM Instability/feeling of giving way
105
Chrondromalacia patella
Prior trauma Retropatellar P Worse with prolonged walking Going down stairs
106
Chrondro SSx
Knee tenderness Worse after prolonged sitting P going upstairs
107
Meniscus tear
Painful clicking or snapping Deep Jt line P Jt locking Local tenderness to palpation
108
Osgood Schlatters
Active preteen/teem Insidious onset or after intense activity Local tenderness Swelling Red P with PROM P brought on by activity
109
Osgood DDX
Osteochondroma- an overgrowth of cartilage and bone that happens at the end of the bone near the growth plate
110
ITB friction rub
Recent inc inc running distance, intensity, frequency Lateral knee P Local tenderness, +ve Nobles
111
Plica syndrome
P over lateral or medial condyle Snapping sensation Tender band or cord from patella to condyle

Orthopaedic Conditions (11 decks)

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