Knee: Other Dx

Question 1

Repetitive extension irritates the knee, most common in gymnasts. Pain behind the patellar tendon and to deep palpation at the joint line behind patellar tendon. Pain with forced knee extension. What’s dx

Answer 1

Infrapatellar fat pad irritation or Hoffa’s fat pad

Question 2

This is common in runners usually due to hilly terrain or increase load. Can also come with biking at 20-40* of knee flexion. Pain at lateral epicondyle and positive noble compression test.

Answer 2

IT band friction syndrome

Question 3

What muscles attach to the pes Anserine?

Answer 3

Satorious, semitendinosus, gracilis

Question 4

This dx comes with repetitive activities, sporting activities and is very common with knee OA

Answer 4

Pes Anserine bursitis

Question 5

This presents with swelling above the knee cap. This looks like quad tendinopathy but will have swelling and bogginess

Answer 5

Suprapatellar bursitis

Question 6

This presents with swelling on top of the patella between bone and skin.

Answer 6

Prepatellar bursitis (housemaid or carpenters knee)

Question 7

Pain close to the distal attachment of the patellar tendon. Due to kneeling but sitting back on your feet.

Answer 7

Infrapatellar bursitis or clergyman’s knee

Question 8

This is a traction apophysitis of the growth plate located at the tibial tubercle

Answer 8

Osgood schlatter disease

Question 9

What age for boys and what age for girls for osgood schlatter and Sinding Larsen Johansson?

Answer 9

Girls: 8-13
Boys: 10-15

Question 10

This is a traction apophysitis that occurs at the patellar growth plate. Pain at the inferior pole of the patella

Answer 10

Sinding Larson Johansson

Question 11

What are tx for SLJ and OSD

Answer 11

More frequent with sport specialization, warm up phenomenon. In the acute phase; rest and off loading. Then address motor control, strength, flexibility deficits

Question 12

What test helps dx patellar instability?

Answer 12

Patellar apprehension test: patella pushed laterally, looking for apprehension, quad contraction, pain, normal glide is 25-50% of the patella

Question 13

What is the tx for patellar instability?

Answer 13

Bracing and PT unless loose body or trochlea dysplasia

Question 14

This is dx with pain at the inferior pole of the patella or along the length of the patellar tendon that is provoked with activities that activate the extensor mechanism.

Answer 14

Patella tendinopathy or jumpers knee

Question 15

What are three differences between patellar tendinitis and PFP

Answer 15

1. Location
2. Pain at rest? None with Patellar tendinitis
3. Gender: males more common with patellar tendinitis

Question 16

What are the four tx stages to patella tendinopathy?

Answer 16

1. Analgesic techniques
2. Pain monitoring
3. Progressive tendon loading
4. The rest of the tx

Question 17

How is isometric loading prescribed for patellar tendinopathy?

Answer 17

Midrange hold 5x45 seconds

Question 18

Pain is allowed to reach _/10 but should not _ from week to week

Answer 18

5
Increase

Question 19

How do you progress patellar tendinopathy patient?

Answer 19

Start with isometrics, then do isometrics on first day then isotonics every 2nd day starting with 4x15 then increasing weight to 4x6, then progress to every third day adding polymeric then progressing to sport specific training with isometrics on off days

Question 20

What should you do differently with quad tendinopathy tx?

Answer 20

Avoid loading in deep squat at first then load in deep squat and varying degrees of hip extension

Question 21

What is the ACR criteria for knee OA?

Answer 21

Pain in the knee then 3 of the following
1. Age over 50
2. Less than 30 min of morning stiffness
3. Crepitus on AROM
4. Bony tenderness
5. Bony enlargement
6. No palpable warmth of the synovium

Question 22

What are the 5 kellgren Lawrence classifications?

Answer 22

Grade 0 no changes on x ray
Grade 1: little joint space change osteophytic lipping
Grade 2: definite osteocytes possible joint space narrowing
Grade 3: multiple osteophytes definite joint space narrowing, possible sclerosis
Grade IV: large osteophytes, marked joint space narrowing, severe sclerosis and bone deformity

Question 23

Yes/no lateral heel wedge for knee OA

Answer 23

No

Question 24

Y/N: Valgus brace for medial joint OA

Answer 24

Yes

Question 25

PT tx for knee OA

Answer 25

Exercise is good, doesn’t matter type, NMR is ok, manual therapy for short term relief, laser is good, tens had mixed results, ECSW and dry needling mixed results, education on medication compliance, pain management, joint protection, use of cane

Question 26

What medications are effective for knee OA

Answer 26

Topical NSAIDs, oral NSAIDs then acetaminophen. Corticosteroid injection lasts 3 months. No narcotics

Question 27

What is the CPR for hip mobilizations. What criteria would a patient have to meet? (5)

Answer 27

1. Hip, groin pain, or paresthesia
2. Anterior thigh pain
3. Passive knee flexion <122*
4. Passive hip IR <17
   5: pain with hip distraction
   Need one for 92% and 2 for 97% success rate