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knee presentations Flashcards

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1
Q

Patellar fx epidemiology

A

1% of all fxs
most common 20-50 yo
Males 2x>F
>50% non-displaced

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2
Q

Patellar fx hx

A

MOI: fall on A. knee
sudden quad activation

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3
Q

Patellar fx sxs

A

pain/inability to extend knee
A. knee pain

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4
Q

Patellar fx exam

A

-palpable gap at fx site (may or not)
-local tenderness
-painful RT> AROM for ext
-painful end range flex ROM
-antalgic gait

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5
Q

Pittsburgh knee decision rule

A
  1. hx blunt trauma/fall
  2. inability to WB x4 steps immediately and in ED
  3. age <12 y/o OR >50
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6
Q

Ottawa knee decision rule

A

TTP head of fibula
inability to WB x4 steps immediately or in ED
Age >/= 55
inability to flex knee 90
isolated TTP patella

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7
Q

Tendon rupture: patellar and quad epidemiology

A

patellar: <40 yo commonly
quad: >40 yo commonly
quad: M 4-8x>F

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8
Q

Patellar and quad tendon rupture rfs

A

-local steroid injection
-prolonged corticosteroid use
-RA
-lupus
-connective tissue diseases
-infectious diseases
-arteriosclerosis
-DM
-hyperthyroidism

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9
Q

Patellar and quad tendon rupture hx

A

-eccentric overload extensor mechanism/trauma
-sudden onset from fall, hemarthrosis common
—-quad: related to regaining balance/rapid quad contraction
—-patellar: jump landing common
-hx degen. tendinopathy
-hx TKA
-ACL reconstruction (patellar tendon graft)

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10
Q

Patellar and quad tendon rupture sxs

A

anterior knee pain

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11
Q

Tendon rupture exam

A

-absent active knee ext OR painful active knee ext (complete/ partial)
-painful knee flexion ROM
-palpable defect
-antalgic gait OR unable to ambulate

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12
Q

Osgood Schlatter disease

A

apophysitis of tibial tubercle
M>F
ages: M: 10-15, F: 8-13
repetitive loading of knee into flexion
radiology: calcification of tibial tubercle

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13
Q

Osgood Schlatter hx

A

adolescent athlete
common bilaterally

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14
Q

Osgood Schlatter sxs

A

anterior knee pain
aggravated w/ activity/ resisted knee ext

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15
Q

Osgood Schlatter exam

A

-local TTP
-prominent tibial tubercle observed visually
-pain end-range knee flex ROM
-painful RT w/ knee ext>AROM
-possibly pain w/ tuning fork

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16
Q

Articular cartilage deficits

A

lesion prevalence: 60-70%
32-58% non-contact trauma MOI

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17
Q

Articular cartilage healing

A

Loss of proteoglycans: matrix reaches loss that is irreversible (matrix cannot replenish)
Mechanical: blunt trauma, penetrating injury, friction abrasion, sharp concentration of joint forces
-Healing depends on extent: chondral, chondral/subchondral, subchondral, cystic

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18
Q

Articular cartilage healing: Chondral vs subchondral

A

Chondral: limited response bc no inflammatory response
Subchondral: extends to blood supply, fills in w/ fibrocartilage, fibrin clot at 48hrs, 2 months kinda looks like normal cartilage, erosive changes at 6 months

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19
Q

Osteochondritis Dissecans

A

-articular cartilage defect
-separation of cartilage from subchondral bone
-juveniles

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20
Q

Osteochondritis dissecans rfs

A

lateral aspect of medial condyle most common
-M>W
greatest 10-20 yo
active individuals
commonly bilat

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21
Q

Osteochondritis dissecans hx

A

-traumatic MOI vs insidious
-hemarthrosis w/in 2 hrs

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22
Q

Osteochondritis dissecans sxs

A

non-specific knee pain
aggravated w/ activity, improves w/ rest
stiff/swell with activities
grinding, locking, catching

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23
Q

Osteochondritis dissecans exam

A

TTP femoral condyle/ medial or lateral joint lines
antalgic gait
knee effusion
limited/ painful knee ROM

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24
Q

Articular cartilage defects -surgery interventions

A

-arthroscopic lavage and debride
-microfracture
-autologous osteochondral mosaicplasty grafting
-ACI (implant)
-OAT procedure (autograft transfer)
-Allograft transplantation
-post op mx

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25
Meniscus lesion epidemiology
-incidence -concomitant ACL injury common
26
Meniscus lesion hx
-contact vs noncontact injury vs degenerative -audible pop in directional change -delayed effusion (6-24 hrs following injury)
27
meniscus lesion sx
catching/ locking/ giving way local knee pain
28
meniscus lesion exam
-pain at end range knee EXT -pain/limited flex ROM -pain/weak flex and ext RT -joint line tenderness +McMurray's, Thessaly, Appley's, dynamic test (lateral meniscus) Varus or valgus test (not for meniscus but may be +)
29
Tissue healing: Ligament
1st degree: minor tear of fibers 2nd: partial tear of structure 3rd: complete rupture
30
Ligament heal P1
acute inflammation and reaction (3 days) hematoma formation
31
Ligament P2
repair and regeneration (2-3 days post injury to ~6 wks) fibroblasts produce collagen matrix disorganized
32
Ligament P3
remodeling and maturation (>=12mnths post injury) collagen fibers more parallel increase tissue concentration and tensile strength
33
Ligament healing requirements
-disrupted tissue must remain in continuity -controlled forces necessary to facilitate collagen synthesis -protection from harmful stresses on tissues
34
ACL lesion epidemiology
VERY common knee OA incidence high following ACL injury increase risk for injury to other stabilizers of knee
35
ACL lesion correlations
-Females 2-9x>M (jump landing mechanics, Q angle, narrower intercondylar notch, hormones and laxity) -decreased hamstring or core strength -duration of activity/fatigue -dry/artificial turf -high BMI
36
ACL lesion hx
-non contact injury (more likely) pivoting w. planted foot and ext knee deceleration and direction change/ cutting jump landing in full knee ext hyperext or hyperflex of knee -contact injury varus or valgus force to knee that imposes shear force on joint
36
ACL lesion sxs
-feeling of instability in knee -c/o severe pain at time of injury -audible pop w/ injury -report of immediate swelling immediately (effusion)
37
ACL lesion exam
-weigh shifted posture when standing -knee joint effusion -antalgic gait -AROM and PROM painful/limited all planes -boggy/guarded end feel -resisted testing weak and painful all planes -excessive laxity w/ KT-1000 test +pivot shift. anterior drawer, Lachman's
38
PCL sprain epidemiology and hx
3-20% of knee injuries (not as common) -audible pop -MOI: posterior force at prox anterior tib violent hyperext fall on flexed knee w/ PF
39
PCL sprain sxs
local posterior knee pain aggravated w/ deceleration and kneeling feelings of LE giving way/ instability
40
PCL sprain exam
gait: limited knee ext in stance effusion +posterior drawer limited/painful knee ext and flex ROM pain w/ RT of ext >90
41
MCL sprain epi
pretty common correlation w/ soccer, football, hockey high grade injuries may lead to chronic knee instability common concomitant knee injuries
42
MCL sparin hx
MOI: valgus force, rotary trauma, younger>older, M 2x>F
43
MCL sprain sxs
medial knee pain aggravated w/ activity, change in direction w/ ambulation, valgus force ay knee
44
MCL sprain exam
swell/bruise antalgic gait potential limited/painful knee ROM local TTP +valgus stress test
45
LCL sprain hx
MOI: varus trauma at knee
46
LCL sprain sxs
lateral knee pain aggravated w. directional change in ambulation
47
LCL sprain exam
local lateral knee effusion TTP LCL +varus stress test ay 0 and 30 knee flex guarded/boggy end feel w/ end range ROM flex and ext
48
Patellofemoral Instability predisposition
-structural: smaller patella, shallow groove (lateral tilt and lateral displacement toward ext (30) -patella alta/baja -quad muscle imbalance proposed (VMO/VL) -generalized ligamentous laxity
49
Patellofemoral instability concerns
concern w/ tracking patella and distribution of loading subsequent dislocations common concomitant osteochondral lesion common
50
Patellofemoral instability hx
sublux/ dislocation of PTF joint
51
PTTF instability sxs
giving way of LE peri-patellar pain
52
PTF instability exam
peripatellar tenderness hypermobility apprehension sign ecchymosis/swelling/effusion in acute stage recurrent instability= sx mx
53
PFPS correlations
-common w/ active individuals and adolescents -altered patellar tracking contributes to aberrant loading patterns of joint -quad weak/ muscle imbalance -lateral retinaculum tightness -increased Q-angle -hip weakness (ABD, ER) -altered foot/ankle kinematics -increased femoral angle of inclination -increased femoral anteversion -limited hip extensor endurance -VMO weakness -Hip ER and ABD weak -subtalar pronation (IR tibia)
54
PFPS hx
athletes females insidious
55
Osteoarthropathy
Knee is most common Commonly symptomatic, hx of knee injury, obese people Radiography: joint space loss, osteophytes, sclerosis -symp vs asymp: joint pain and func limitation
56
PFPS sxs
-anterior/peri patellar knee pain -aggravated w/ prolonged sitting, stairs, inclined walking, squatting -knee crepitus -catching at knee
57
PFPS exam
-patella alta/baja -abnorm Q-angle -pain squat -possible peri-patellar swelling -antalgic gait -pain/limited knee flex/ext AROM -pain/limit knee flex PROM -pain/weak knee ext -hip ER and ABD weakness -pain/ hyper vs hypomobility PF joint -+clarke's
58
OA hx
-insidious -hx trauma, sx -family hx -obesity -knee hypermobility -joint shape abnorm -extreme physcial activity levels ->50 yo -F>M
59
OA sxs
retropatellar pain aggravated w/b activities, squat, stairs, prolonged sitting crepitus
60
OA exam
-antalgic -swelling/warm at knee -TTP joint lines -pain/limit knee ROM -pain/limit knee RT -maybe + Appley compression test
61
Arthrofibrosis what is it?
-dense proliferative intra and extra-articular scar tissue formation w/ limitations in knee ROM -inflammation present -can lead to degenerative joint changes
62
Arthrofibrosis hx
traumatic injury/ sx progressive increase in pain and knee ROM limits
63
Arthrofibrosis sxs
stiffness (worse in morning) knee swelling crepitus diffuse knee pain
64
Arthrofibrosis exam
-limited knee ext in static stance or stance gait -limit/pain knee ROM (PROM=firm end feel) -hypomobile patellofemoral -knee effusion/swelling -inhibited/weak/pain knee ext
65
Genu recurvatum what is it? epidemiology
hyperext of knee >10 degrees F>M correlated w/ joint laxity, hx knee injury, poor muscular control (CVA) excess stress on posterior knee structures
66
GR may predispose to
-ACL injury -compressive injury anteriomedial tibiofemoral joint -tensile loading posteriolateral joint supporters -posterior corner capsulo-ligametous avulsion injuries
67
GR hx
-forced knee ext injury -jump landing in ext -force to anteriomedial prox tibia -noncontact hyperext w/ planted foot -concomitant PCL injury
68
GR sxs
c/o knee instability anteriomedial knee pain or posteriolateral knee pain
69
GR exam
-postural exam- visually see hyperext (tibial ER, genu varum/valgum, tibial varum, excess pronation) (impaired proprio) -edema, ecchymosis -TTP locally -NV screen necessary -antalgic -hypermobility P. glide w/ posteriolateral bias
70
Patellar Tendinopathy
Jumper's knee eccentric overload microtrauma (failed healing response) avg. 32 mnths pain/limitations lot's of athletes quit
71
PT hx
BB and volleyball players
72
PT sxs
anterior knee pain aggravated w/ jumping/ extensor mechanism
73
PT exam
TTP patellar tendon/ inferior pole of patella pain squat pain end range flex ROM pain RT>AROM knee ext
74
ITB friction syndrome
Knee: increased compression on soft tissues between lateral femoral condyle and ITB (~30 knee flex) thickening of bursa correlations: prominent femoral epicondyle, LLD
75
ITB FS hx
long distance runners downhill skiers, jumping sports, weight lifters, cycling insidious/progressive
76
ITBFS sxs
lateral knee pain aggravated w/ activity/ repetitive knee flex/ ext and stairs
77
ITBFS exam
local TTP (distal ITB, gerdy's, lateral femoral condyle) +Ober Hip ROM painful end range ADD Potentially painful hip ABD RT
78
Baker's Cyst
swelling at P. knee' painful w/ synovial effusion may rupture
79
Baker's cyst hx
Intra-articular effusion
80
Baker's cyst sxs
posterior knee pain
81
Baker's cyst exam
-local swelling prox to popliteal fossa -pain knee flex/ext ROM -prominence of cyst increases w/ resisted knee flex
82
Bursitis: Knee
-superficial and deep infrapatellar (nun's knee) (direct mechanical irritation) -prepatellar (recurrent A. knee trauma) -superficial Pes anserine (structures between MCL/pes)(swimmers/distance runners)
83
Bursitis knee exam
Local TTP local swelling
84
Superficial Fibular Nerve (SFN) potential areas of compression
Trauma posteriolateral knee, compartment syndrome
85
SFN motor distr
fibularis longus and brevis
86
SFN sensory distr
distal 2/3 lateral leg/ankle/dorsal foot
87
SFN clin indics
-hx direct trauma/ iatrogenic -neurodynamic tension test, sensitized w/ supination

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