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Flashcards in Knee pain Deck (19):
1

Differential

Osteoarthitis
Meniscal
Ligamentous
RA/inflammatory
Referred pain
Osteochondritis
Bursitis
Septic arthritis
Anterior knee pain/patellofemoral disorders

2

History

Age and occupation
Site:
-Generalised->arthritis, effusion, septic
-Localised-> anterior (patelloF, prepatellar/infrapatellar, anterior knee pain), medial/lateral (arthritis, meniscal, collateral), posterior (bakers cyst, bursitis), down back of knee (spine), front of thigh into knee (hip)
Mode of onset
Pain and stiff in morning, improves in the day-> inflammatory arthritis
Nature of pain->stabbing meniscal, deep gnawing of arthritis, pain not affected by activity in AKP
Aggrevating/releiving
-arthritis worse on activity, releived by rest
-patellofemoral worse on walking up/down stairs
-meniscal -ve in deep flexion or when twisting
-crystals intense, any moveM +++
-kneeling worsens prepatellar
Loss of function
Deformity
Associated
PMHx
Drug history->analgesics

3

Important associated symptoms

Ill health
Injury
Snap
How long to swelling (rapid in ACL)
Play on
Locking in meniscal tear/loose body
Giving way in ligamentous/ACL rupture

4

What must you always examine with the knee

The hip

5

Examination

Inspection->deformity, scar, swelling
Palpation->joint line tender in meniscal
Movement
-Loss of extension in locked knee
-Fixed flexed in osteoarthritis
Special tests

6

Special tests

Collateral ligament tears are apparent on
abnormal opening up of the joint on the
affected side.

Anterior cruciate ligament laxity is
demonstrated by positive Lachmann’s and
anterior drawer tests.

Posterior cruciate ligament laxity is seen as a sag
of the tibia at 90° and can be misdiagnosed as
an ACL tear when performing the anterior
drawer test (the abnormal forward movement
of the tibia is due to its sagging back in the fi rst
place).

Maltracking of the patella can be seen when
observing the knee bending from fl exion to
extension (so-called J sign).

Patella apprehension will be positive in a
patient with previous dislocation

7

Investigations

FBC and CRP/ESR in suspected infectious
Xray->confirm RA, show a fracture, be normal

?MRI->confirm meniscal or ligamentous
Aspiration:
-Straw/yellow->simple effusion, crystal
-Green/dirty->septic
-Blood->haemarthrosis

?Arthroscopy

8

Differential for swollen knee

Haemarthrosis
Patellar dislocation
Meniscus
Collateral
Most commonly ACL
Fracture

9

Anterior knee pain

Patellar tendinopathy
Patellofemoral
OA
Osteonecrosis

10

Locking

Meniscal tear
Torn ACL
Dislocation
Loose bodies

11

Cause of loose bodies

Osteochondritis dissecans
(usually lateral side of
medial femoral condyle)
Retropatellar fragment
(e.g. from dislocation of patella)
Dislodged osteophyte
Osteochondral fracture—post injury
Synovial chondromatosis

12

What is osteochondritis dissecans

small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen.

13

Clicking

Normal
Meniscal
Loose bodies

14

First decade knee pain

Infection
Juvenile chronic arthritis

15

Second decade of life

Second decade
Patellofemoral syndrome
Subluxation/dislocation of patella
Slipped femoral epiphysis (referred)

Hamstrung’ knee
Osteochondritis dissecans
Osgood–Schlatter disorder

Anserinus tendonopathy

16

What is osgood schlatter

inflammation of the patellar ligament at the tibial tuberosity. It is characterized by a painful lump just below the knee and is most often seen in young adolescents.

17

Third decade

Bursitis
Mechanical

18

Fourth and fifth decade

Meniscus

19

Sixth decade

Osteoarthritis
Osteonecrosis
Paget disease (femur, tibia or patella)
Anserinus bursitis
Chondrocalcinosis and gout
Osteoarthritis of hip (referred pain)