Soft tissue knee injuries Flashcards
(133 cards)
1
Q
What is the common cause of meniscal tears in younger patients?
A
In younger patients, the common cause of meniscal tears is usually a sporting injury, often due to a twisting force on a loaded knee.
2
Q
What are the primary symptoms associated with meniscal tears?
A
The primary symptoms of meniscal tears include pain and tenderness localized to the joint line, a feeling of knee instability, and catching or locking sensations.
3
Q
How does an acute locked knee differ from other meniscal tear symptoms?
A
An acute locked knee signifies a displaced bucket handle meniscal tear. This condition involves a large meniscal fragment that flips out of its normal position and obstructs full knee extension.
4
Q
What are the differences in prevalence between medial and lateral meniscal tears?
A
Medial meniscal tears are approximately 9-10 times more common than lateral meniscal tears.
5
Q
What signs might indicate a displaced bucket handle meniscal tear?
A
Signs indicating a displaced bucket handle meniscal tear include a springy block to extension (15°), heel height asymmetry, and a fixed flexion deformity.
6
Q
Why is the healing potential of meniscal tears limited?
A
The meniscus has limited healing potential as it only has an arterial blood supply in its outer third, causing radial tears not to settle.
7
Q
What percentage of ACL ruptures are accompanied by a meniscal tear?
A
Approximately 50% of ACL ruptures are accompanied by a meniscal tear.
8
Q
Which tests are used for meniscal provocation, and why are they unreliable?
A
Meniscal provocation tests like Steinman’s are used, but they are deemed unreliable for diagnosing meniscal tears.
(The Steinmann test, also known as the McMurray test)
9
Q
What type of injury signifies the first stage of knee osteoarthritis?
A
A seemingly innocuous injury in older patients, often in middle age onwards, can lead to atraumatic spontaneous degenerate tears, which probably represent the first stage of knee osteoarthritis.
10
Q
What type of meniscal tears are more prevalent in younger patients, and what treatment might be considered for these tears?
A
Younger patients tend to have a higher proportion of peripheral or bucket handle meniscal tears. Arthroscopic meniscal repair might be considered for these acute traumatic peripheral tears.
11
Q
What is the recommended management for irreparable meniscal tears in younger patients?
A
For irreparable tears in younger patients, consider arthroscopic meniscectomy if the tears result in recurrent pain, effusion, or mechanical symptoms that persist for over 3 months.
12
Q
Why might knees with degenerative changes on X-ray or MRI not benefit from arthroscopic meniscectomy?
A
Knees with degenerative changes on X-ray or MRI might not benefit from arthroscopic meniscectomy because the removal of meniscal tissue could increase stress on already worn or damaged surfaces.
13
Q
How does the healing potential vary with age in cases of meniscal tears?
A
Healing potential decreases with age, with poor healing rates seen in individuals over about 25-30 years old. Additionally, the likelihood of healing decreases with increased time from the injury.
14
Q
What is the role of corticosteroid injections in managing degenerative tears?
A
Corticosteroid injections may help alleviate symptoms in the early stages of degenerative tears.
15
Q
In what situations might arthroscopic meniscectomy be considered ineffective for meniscal tears?
A
Arthroscopic meniscectomy is ineffective for degenerative tears, as it’s only suitable for unstable tears with mechanical symptoms, not for cases involving pain alone.
16
Q
What potential outcome might occur if a bucket handle tear in the knee remains locked?
A
If a knee with a bucket handle tear remains locked, it may lead to the development of a permanent fixed flexion deformity.
17
Q
What interventions might be necessary for irreparable bucket handle tears?
A
Irreparable bucket handle tears may necessitate partial meniscectomy to unlock the knee and prevent further damage.
18
Q
What is the function of the menisci in the knee joint?
A
The menisci in the knee joint act as shock absorbers, help in distributing weight throughout the joint, and facilitate smooth movement between the femur and tibia.
19
Q
How do meniscal tears typically occur in younger patients versus older patients?
A
In younger patients, meniscal tears often occur during twisting movements while playing sports, whereas in older patients, tears might occur with minor twisting movements during routine activities.
20
Q
What are the symptoms associated with meniscal tears?
A
Symptoms of meniscal tears include pain, swelling, stiffness, restricted range of motion, locking of the knee, and sensations of instability or the knee “giving way.”
21
Q
What are the examination findings commonly observed in individuals with meniscal tears?
A
Examination findings associated with meniscal tears include localized tenderness on the joint line, swelling, and restricted range of motion.
22
Q
What are the traditional special tests for diagnosing meniscal tears, and why are they generally not recommended in clinical practice?
A
The traditional special tests for diagnosing meniscal tears are McMurray’s test and Apley grind test, but they are generally not used in clinical practice due to the potential to cause pain and worsen the meniscal injury.
23
Q
Aside from pain, what other sensations might a patient experience during the initial injury of a meniscal tear?
A
Besides pain, the initial injury of a meniscal tear might be accompanied by a “pop” sound or sensation.
24
Q
What ligaments are present in the knee, and what are their names?
A
The four ligaments in the knee are the anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament, and medial collateral ligament.
25
How do the quadriceps muscles affect knee extension?
Contraction of the quadriceps muscles causes knee extension by pulling through the patella.
26
How is the patella connected to the tibia in the knee joint?
The patella is attached to the tibia by the patellar ligament in the knee joint.
27
How is McMurray's test performed, and what does pain or restriction during the test indicate?
McMurray's test involves flexing the knee and internally or externally rotating the tibia with varus or valgus pressure, respectively. Pain or restriction during the test indicates damage to the lateral or medial meniscus.
28
Describe the procedure for the Apley Grind Test and what a positive result might suggest.
The Apley Grind Test requires the patient to lie prone with the knee flexed to 90 degrees while the tibia is internally and externally rotated, applying downward pressure. Pain indicates meniscal damage and can help localize the area affected (medial or lateral meniscus).
29
What are the Ottawa Knee Rules, and what conditions might indicate the need for a knee x-ray according to these rules?
The Ottawa Knee Rules suggest the need for a knee x-ray if the patient is age 55 or older, presents with patella or fibular head tenderness, is unable to flex the knee to 90 degrees, or cannot weight bear.
30
What imaging investigation is usually the first-line approach for diagnosing a meniscal tear, and what is the gold-standard investigation for this diagnosis?
An MRI scan is usually the first-line imaging investigation for diagnosing a meniscal tear, while arthroscopy is considered the gold-standard investigation for this diagnosis.
31
According to the NICE clinical knowledge summaries on knee pain, what key symptoms suggest an urgent referral for a patient with an acute meniscal tear?
Key symptoms suggesting urgent referral for acute meniscal tear include a "pop," rapid onset swelling, instability or giving way, and locking.
32
What does the RICE mnemonic stand for, and how is it applied in the conservative management of meniscal tears?
The RICE mnemonic stands for Rest, Ice, Compression, and Elevation, used in the conservative management of meniscal tears to manage acute soft tissue injuries.
33
What is the primary analgesic medication usually prescribed for musculoskeletal injuries like meniscal tears?
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are typically used as first-line analgesia for musculoskeletal injuries, including meniscal tears.
34
What is the role of physiotherapy in the management of meniscal tears after the initial pain and swelling have subsided?
Physiotherapy is employed for rehabilitation once the initial pain and swelling have subsided in the management of meniscal tears.
35
What are the surgical options available for treating meniscal tears, and what are the main procedures involved in these options?
Surgical options for treating meniscal tears include repair if feasible or resection of the affected portion of the meniscus, often performed through arthroscopy (keyhole surgery). Resection might result in osteoarthritis.
36
What types of movements in sports activities commonly lead to knee ligament injuries?
Knee ligament injuries often result from rotational movements of the knee joint, such as cutting and pivoting movements in sports.
37
How is the examination of an injured knee often affected in the immediate aftermath of the injury, and when is it recommended to re-examine these patients?
Pain and apprehension often limit the examination findings of an injured knee in the immediate aftermath. Patients should be re-examined in 2-7 days to assess the knee properly.
38
What role does an early MRI play in cases of suspected significant knee injuries with potential multiple ligament involvement?
An early MRI is useful for delineating the extent of injury in cases suspected to be significant, especially with a suspicious history and potential multiple ligament injuries.
39
How are knee ligament injuries classified based on severity?
Knee ligament injuries are classified into Grade 1 (sprain), Grade 2 (partial tear), and Grade 3 (complete tear).
40
What instabilities are associated with injuries to the MCL, ACL, PCL, and the posterolateral corner of the knee?
MCL rupture leads to valgus instability, ACL rupture to rotatory instability, PCL rupture to recurrent hyperextension or instability descending stairs, and posterolateral corner rupture to varus and rotatory instability. Multiligament injuries can result in gross instability.
41
What is the typical mechanism of injury for an MCL injury?
The mechanism of injury for an MCL injury typically involves valgus stress with possible external rotation, such as in a rugby tackle from the side.
42
What are the clinical features indicative of an MCL injury?
Clinical features of an MCL injury include knee swelling with ecchymosis, pain, deformity, instability, medial joint line tenderness, medial joint laxity, and pain on valgus stress.
43
What investigations are utilized to diagnose an isolated MCL tear, and what is their primary purpose?
Isolated MCL tear is diagnosed clinically, but x-rays and MRI can be used to rule out associated injuries.
44
How is an isolated MCL tear typically managed, and what is the usual course of pain associated with this injury?
Usually, an isolated MCL tear heals well even if it's a complete tear. Pain associated with this injury can take a few to several months to settle. Acute tears are generally treated with a hinged knee brace.
45
What treatments are available for chronic MCL instability?
Chronic MCL instability can be treated with MCL tightening (advancement) or, in rare cases, reconstruction with a tendon graft.
46
What is the most common mechanism of injury for an ACL (anterior cruciate ligament) injury?
An ACL injury typically occurs due to a twisting sports injury, involving higher rotational force and turning the upper body laterally on a planted foot, commonly seen in activities like football, rugby, and skiing. The ACL primarily stabilizes the internal rotation of the tibia.
47
What are the typical clinical features observed after an ACL injury occurs?
Clinical features of an ACL injury often include an audible pop at the time of injury, followed by immediate deep knee pain and swelling (hemarthrosis) within an hour. Subsequently, pain settles but leaves behind rotatory instability, leading to the knee "giving way" due to excessive internal rotation of the tibia.
48
Which specific tests are used to diagnose an ACL injury, and what indications do these tests show in the case of an ACL tear?
The anterior drawer test and Lachman test are utilized to diagnose an ACL injury. Positive results in these tests indicate excessive anterior translation of the tibia, signifying an ACL tear.
49
What type of fluid accumulation might be observed in the joint after an ACL injury, and what diagnostic tool is often used to confirm the injury?
ACL injuries may result in joint aspiration, revealing hemarthrosis. An MRI is often used to confirm the extent and specifics of the injury.
50
How might an ACL injury manifest in terms of long-term consequences, especially in terms of arthritis?
ACL injuries may cause minimal problems in some individuals, while others may experience substantial functional issues. Most individuals, even those who have had surgery, display radiographic evidence of arthritis within 10 years.
51
What factors might indicate the need for ACL reconstruction with a tendon graft?
ACL reconstruction with a tendon graft is mainly indicated in cases of rotatory instability that do not respond to physiotherapy. Other indications include its use in multi-ligament reconstruction or in professional athletes.
52
What role does intensive rehabilitation play in the management of ACL reconstruction, and how long might it take for an individual to return to high-impact sports after the surgery?
After ACL reconstruction, intensive rehabilitation is essential. It may take up to a year for an individual to return to high-impact sports following the surgery.
53
What injuries are LCL (Lateral Collateral Ligament) injuries often associated with?
LCL injuries often occur in combination with PCL (Posterior Cruciate Ligament) or ACL (Anterior Cruciate Ligament) injuries.
54
What are the typical mechanisms of injury leading to LCL injuries?
LCL injuries usually occur due to varus stress and hyperextension of the knee.
55
What clinical features are commonly observed in individuals with an LCL injury?
Typical clinical features in individuals with LCL injuries include knee swelling with ecchymosis, pain, deformity, instability, lateral joint line tenderness, and laxity identified through the varus stress test.
56
How is an isolated LCL tear diagnosed, and what role do x-rays and MRIs play in this diagnosis?
An isolated LCL tear is primarily a clinical diagnosis, but x-rays and MRI scans are used to rule out associated injuries.
57
What is the urgency of repair for a complete rupture of the LCL if diagnosed early, and what approach is taken if diagnosis occurs later?
In the case of a complete rupture of the LCL diagnosed early (within 2-3 weeks), urgent repair is necessary. However, if the diagnosis is delayed, reconstruction with a tendon graft is typically pursued.
58
What potential complications might arise in the case of an LCL injury, particularly in terms of instability and nerve-related issues?
LCL injuries that don't heal adequately can cause varus and rotatory instability. There's a high incidence of common fibular nerve palsy associated with this injury.
59
What long-term consequence might be observed in individuals with LCL injuries in relation to the knee joint?
Long-term consequences of LCL injuries often include a high incidence of early osteoarthritis of the knee joint.
60
What is the common mechanism of injury for a PCL (Posterior Cruciate Ligament) injury?
PCL injuries tend to occur following a direct blow to the anterior tibia, such as in dashboard injuries or motorcycle accidents.
61
Is an isolated PCL rupture a common occurrence or a rare event? If rare, what is often associated with PCL ruptures?
An isolated PCL rupture is rare. It usually occurs in combination with other knee injuries.
62
What are the typical clinical features observed in individuals with a PCL injury?
Clinical features of a PCL injury often include popliteal knee pain and bruising, a positive posterior drawer test, and a positive sag sign.
63
What are the recommended investigations used to diagnose a PCL injury?
X-rays and MRIs are the recommended investigations used to diagnose a PCL injury.
64
In the management of isolated PCL injuries, when is reconstruction typically considered necessary?
In the management of isolated PCL injuries, reconstruction isn't commonly required. However, if a patient develops instability such as recurrent hyperextension or feeling unstable when going downstairs, reconstruction might be considered.
65
In cases of combined knee ligament ruptures, what usually determines the necessity for surgical reconstruction?
In cases of combined knee ligament ruptures involving multiple ligaments, the degree of instability resulting from higher degrees of force usually necessitates surgical reconstruction due to the level of instability.
66
What are the typical causes of knee dislocation in terms of the energy involved, and is this consistent for all age groups?
Knee dislocations commonly result from serious high-energy injuries but can occasionally occur due to low-energy incidents in the elderly.
67
What are the various directions in which the knee dislocation can occur?
Knee dislocations can occur in various directions, including posterior, anterior, medial, lateral, and even involve rotatory movements.
68
What are the primary clinical features associated with knee dislocation?
Primary clinical features of knee dislocation include pain and instability of the knee joint.
69
What initial assessments and imaging techniques are recommended for investigating knee dislocations?
For investigations, it's essential to check the neurovascular status immediately. Imaging involves X-rays and, if concern exists over the neurovascular status, a CT angiogram might be required. If no concern over neurovascular status, an MRI is recommended.
70
How is the immediate management of a knee dislocation handled?
Immediate management involves emergency reduction under sedation and rechecking of the neurovascular status. Temporary stabilization may be necessary, and emergency fix might be required if the medial femoral condyle is button-holed through the medial capsule.
71
What is the necessity and process of emergency reduction in some severe knee dislocations?
Emergency theatre reduction may be needed if certain conditions are met in severe cases of knee dislocation.
72
What complications might arise following a knee dislocation, particularly in terms of neurovascular and ligamentous injuries?
Complications of knee dislocation include a high incidence of neurovascular injury (such as popliteal artery injury, common peroneal nerve injury), ligamentous injury, arthrofibrosis, stiffness, and ligament laxity. Reperfusion after prolonged ischaemia might lead to compartment syndrome, requiring fasciotomies.
73
What are the common causes or mechanisms that lead to patellar dislocation?
Patellar dislocation can occur due to a direct blow or sudden quadriceps contraction with a flexing knee.
74
Which demographic group often experiences patellar dislocation, and is there a notable gender difference in incidence?
Patellar dislocation is more common in teenagers, with a higher incidence in females.
75
How does the patella typically dislocate, in terms of direction?
The patella always dislocates laterally.
76
What risk factors contribute to the likelihood of experiencing patellar dislocation?
Risk factors for patellar dislocation include ligamentous laxity/hypermobility, increased Q-angle (genu valgum, femoral neck anteversion), high riding patella, hypoplastic lateral femoral condyle, and lateral quads insertions or weak vastus medialis.
77
What symptoms are commonly reported by individuals experiencing patellar dislocation?
Patients with patellar dislocation commonly report a clear history of the patella dislocating laterally, often self-relocating.
78
What clinical signs are observed in patients with patellar dislocation?
Clinical signs in patellar dislocation include pain medially (from torn medial patella retinaculum tendon), effusion (haemarthrosis), and a positive patella apprehension test.
79
What is the characteristic X-ray appearance associated with patellar dislocation, and what might an X-ray reveal?
The characteristic X-ray appearance associated with patellar dislocation is lipo‐haemarthrosis. A small opacification on X-ray may suggest an osteochondral fracture.
80
How is patellar dislocation managed, especially concerning reduction and subsequent treatment?
Patellar dislocations may spontaneously reduce when the knee is straightened or may require manual manipulation back into position (reduction with knee extension). Management involves aspiration (rarely), braces, and physiotherapy.
81
What complications are associated with patellar dislocation, and what is the risk of recurrent dislocation after the first instance?
Complications of patellar dislocation include tears in the medial patellofemoral ligament and osteochondral fracture. The risk of recurrent dislocation after the first instance is approximately 10%. Physiotherapy to strengthen the quadriceps may help reduce the risk. Patients with recurrent dislocations may benefit from surgical interventions such as lateral release or medial patellofemoral ligament (MPFL) reconstruction, and the risk of recurrent instability decreases with age.
82
What are the synonymous terms used to describe disorders of the patellofemoral articulation resulting in anterior knee pain?
Disorders of the patellofemoral articulation causing anterior knee pain encompass several diagnoses, such as chondromalacia patellae, adolescent anterior knee pain, and lateral patellar compression syndrome.
83
Who is more commonly affected by these conditions, and are there any particular age and gender tendencies?
These conditions are common in adolescence, especially affecting girls.
84
What factors might contribute to the development of disorders in the patellofemoral articulation?
The exact cause is unclear, but factors such as muscle imbalance, ligamentous laxity, and subtle skeletal predispositions (such as genu valgum, wide hips, femoral neck anteversion, internal rotation) might contribute.
85
What typical symptoms are associated with these conditions?
Typical symptoms include anterior knee pain that worsens when descending hills, a grinding or clicking sensation in the front of the knee, and stiffness after prolonged sitting leading to 'pseudolocking' of the knee.
86
How are these conditions diagnosed?
Diagnosing these conditions is primarily clinical.
87
What is the primary approach to managing such conditions, especially in cases that are often self-limiting?
The majority of cases are self-limiting, and physiotherapy is the mainstay of treatment, aimed at rebalancing the quadriceps muscles.
88
What specific focus does physiotherapy have in treating these conditions, and what muscle group is particularly targeted?
Physiotherapy primarily focuses on rebalancing the quadriceps, particularly by strengthening the vastus medialis obliqus (VMO).
89
Is there a typical pattern of resolution in younger patients with these conditions, and what interventions might be considered for resistant cases?
Most younger patients tend to "grow out" of the condition. For resistant cases, taping might help, while surgery, such as tibial tubercle transfer, may be considered in some cases where the forces on the patella need to be shifted. However, results from surgery can be unpredictable.
90
What age groups are more susceptible to patellar tendon versus quadriceps tendon ruptures, and what activities or sports might contribute to these injuries?
Patellar tendon ruptures tend to occur in individuals younger than 40, often engaged in running or jumping sports, while quadriceps tendon ruptures are more common in individuals over 40 involved in similar activities.
91
What events or actions can lead to patellar or quadriceps tendon ruptures, and are there differences in the typical causes for each tendon rupture?
The rapid contractile force on the tendons, such as after lifting a heavy weight, falling, or degenerate tendon structures, can lead to patellar or quadriceps tendon ruptures. These injuries might also be associated with blunt or penetrating trauma.
92
What are the common risk factors associated with tendon ruptures of the extensor mechanism of the knee?
Risk factors for tendon ruptures of the extensor mechanism of the knee include previous tendonitis, steroid use/abuse, chronic renal failure, the use of quinolone antibiotics like Ciprofloxacin, diabetes, and rheumatoid arthritis.
93
What symptoms and signs are typically seen in individuals with a patellar or quadriceps tendon rupture?
Common symptoms include knee pain and weakness. Signs observed in individuals with these ruptures include the inability to perform a straight leg raise, a palpable gap in the extensor mechanism, and in partial tears, reduced extensor mechanism function with decreased power.
94
What imaging techniques are used for diagnosing these tendon ruptures, and how does imaging aid in diagnosis, especially in obese patients?
X-rays may display effusion or abnormal patellar positioning, which differs for patellar and quadriceps ruptures. Ultrasound or MRI is useful for visualizing partial or complete tears. In obese patients, ultrasound may be crucial due to the lack of obvious gaps in X-rays.
95
What is the recommended approach for managing patellar or quadriceps tendon ruptures, and what does post-surgical management typically involve?
Urgent surgical repair is typically required for patellar or quadriceps tendon ruptures, followed by physiotherapy to gradually increase range of motion. Small partial tears of the quadriceps may be managed with immobilization and physiotherapy.
96
What is the suggested treatment for small partial tears of the quadriceps, and what precaution should be taken in individuals with tendonitis of the knee extensor mechanism?
Steroid injections for extensor mechanism knee tendonitis should be avoided due to the high risk of tendon rupture.
97
What causes bone bruising, particularly in the context of joint injuries?
Bone bruising occurs due to the impact on the articular surface, resulting in a microscopic fracture of the trabecular bone, leading to bleeding and inflammation.
98
In what scenarios is bone bruising commonly observed, especially concerning other joint injuries?
Bone bruising is a significant source of pain following meniscal tears and ligament injuries.
99
Which imaging modality is typically used to diagnose bone bruising?
MRI is the standard imaging modality used to diagnose bone bruising.
100
How long does it usually take for bone bruising to resolve, and is there any known treatment to expedite the recovery process?
Bone bruising typically settles with time, usually within around 3 months, although it can take over a year to completely resolve. There is no known treatment that expedites the resolution of bone bruising.
101
What potential consequence might occur over time with the hyaline cartilage in the area affected by bone bruising?
Over time, the hyaline cartilage over the area affected by bone bruising may deteriorate, potentially leading to a full-thickness chondral defect.
102
What causes the formation of loose bodies within the knee joint, and what conditions or injuries might contribute to their development?
Loose bodies within the knee joint can be caused by trauma, osteochondritis dissecans, or joint degeneration, which results in detached fragments of cartilage or bone in the joint.
103
How do loose bodies within the knee joint evolve over time, and what complications might they cause?
Over time, loose bodies can grow and obtain nutrition from synovial fluid, potentially leading to painful locking or catching. Some may adhere to the synovium or fat pad, no longer being "loose."
104
What are the typical clinical manifestations that suggest the presence of a loose body in the knee joint?
A history of a mobile lump, occasional sharp pain, and episodes of locking or catching in the knee suggests the presence of a loose body. Constant, generalized, or severe pain is not typically associated with loose bodies.
105
Why might the identification of loose bodies be prone to overdiagnosis on X-rays, and what imaging modalities can aid in confirming their presence accurately?
Loose bodies in the knee joint are often overdiagnosed due to an opacification observed on X-rays. A fabella, an accessory ossicle in the lateral head of the gastrocnemius, is commonly misdiagnosed as a loose body. MRI or serial X-rays are better for accurately determining the presence of a loose body.
106
What is the primary approach for managing troublesome symptoms related to loose bodies in the knee joint, and is there any impact on degenerative joint pain?
Arthroscopic removal is the primary method for managing troublesome symptoms caused by loose bodies in the knee joint. However, this procedure won't alleviate degenerative joint pain.
107
What anatomical region does a Baker's cyst occur in, and what structures form the boundaries of this area?
A Baker's cyst occurs in the popliteal fossa, bordered by the tendons of the semimembranosus and semitendinosus (superior and medial), the biceps femoris tendon (superior and lateral), and the medial and lateral heads of the gastrocnemius (inferior and medial/lateral).
108
What is the primary pathophysiological mechanism behind Baker's cysts in adults, and what conditions or injuries are they commonly associated with?
In adults, Baker's cysts are usually secondary to degenerative changes in the knee joint, often associated with conditions such as meniscal tears, osteoarthritis, knee injuries, and inflammatory arthritis, causing synovial fluid to collect in the popliteal fossa.
109
How do patients with Baker's cyst typically present in terms of symptoms, and what is Foucher's sign?
Patients may present with localized symptoms such as pain, discomfort, fullness, pressure, a palpable lump or swelling, and restricted knee motion, while Foucher's sign refers to the reduction in the size of the lump when the knee is flexed to 45 degrees.
110
What complications might arise if a Baker's cyst ruptures, and what critical condition should be considered in differential diagnosis?
Ruptured Baker's cysts can lead to inflammation in surrounding tissues and calf muscles, manifesting as pain, swelling, and erythema. A critical differential diagnosis is a deep vein thrombosis (DVT), and rarely, a ruptured cyst might cause compartment syndrome.
111
What are the key differential diagnoses for a lump in the popliteal fossa aside from a Baker's cyst?
Key differential diagnoses for a lump in the popliteal fossa include DVT, abscess, popliteal artery aneurysm, ganglion cyst, lipoma, varicose veins, and tumors.
112
Which imaging modalities are used for diagnosing Baker's cyst, and what additional information might an MRI provide?
Ultrasound is the primary investigation for confirming the diagnosis and ruling out a DVT. MRI can further evaluate the cyst and underlying knee pathology, such as meniscal tears, particularly before surgical intervention.
113
What are the non-surgical and surgical management approaches for symptomatic Baker's cysts, and what complications might be associated with surgical intervention?
Non-surgical management involves modified activity, analgesia, physiotherapy, ultrasound-guided aspiration, and steroid injections. Surgical management usually involves arthroscopic procedures addressing underlying knee pathology contributing to the cyst, although resection of the cyst is difficult and likely to recur, especially in the presence of other knee pathologies.
114
What anatomical structures are involved in bursitis, and what is the primary function of bursae in the body?
Bursitis involves the inflammation of bursae, which are small sacs lined with synovium located around joints. Bursae serve to reduce friction between tendons, bones, muscles, and skin.
115
What are some common types of bursitis and their associated anatomical locations?
Common types of bursitis include pre-patellar bursitis, olecranon bursitis, and bursitis over the medial 1st metatarsal head in hallux valgus, also known as bunions.
116
How does bursitis typically develop, and what may lead to its secondary infection and formation of an abscess?
Bursitis often develops due to repeated pressure or trauma, leading to soft tissue swelling. In some cases, it may become secondarily infected, forming an abscess typically due to bacterial infections from small wounds on the limb.
117
What is the usual course of inflammatory bursitis, and what issues might arise with persistent thickening of the bursal sac?
In cases of inflammatory bursitis, the fluid component of the swelling usually subsides, but it may leave a thickened bursal sac. Recurrence might occur, and a thickened bursal sac can lead to persisting problems.
118
In what circumstances might excision be considered for managing bursitis, and what potential complications or challenges can arise from this procedure?
Excision may be considered for managing bursitis if recurrence is an issue, but complications can arise due to scarring and potential challenges with scarring after the procedure.
119
What is the definition of olecranon bursitis, and how is it typically related to the olecranon and the underlying bone?
Olecranon bursitis refers to the inflammation and swelling of the bursa over the elbow, particularly the bony lump known as the olecranon, which is part of the ulna bone.
120
What are bursae, and what role do they play in the body?
Bursae are small sacs lined with synovial membranes and filled with synovial fluid, found at bony prominences in the body. They reduce friction between bones and soft tissues during movement.
121
What are the primary causes of bursitis in the context of the olecranon, and how might these causes lead to the inflammation of the bursa?
The primary causes of olecranon bursitis include repetitive movements, trauma, inflammatory conditions like rheumatoid arthritis or gout, and in some cases, infection leading to septic bursitis.
122
Why might olecranon bursitis be termed "student's elbow," and what occupations or behaviors could contribute to its development?
The term "student's elbow" is used due to students leaning on their elbows for extended periods while studying, leading to mild trauma and friction causing bursitis. Occupations such as plumbing or driving that involve leaning on the elbow can also contribute to its development.
123
What are the common presentations of olecranon bursitis, and how can one differentiate between aseptic bursitis and infected (septic) bursitis?
Olecranon bursitis typically presents as a swollen, warm, tender, and fluctuant (fluid-filled) elbow. Distinguishing features between aseptic bursitis and infected bursitis include signs of infection like warmth, increased tenderness, spreading erythema, fever, and systemic symptoms such as tachycardia, hypotension, and confusion. Septic arthritis may be considered if swelling is primarily within the joint and is associated with painful, reduced elbow motion.
124
What is olecranon bursitis, and what is another term for it?
Olecranon bursitis refers to inflammation and swelling of the bursa over the elbow. Another term for it is "student's elbow".
125
What are the common causes of olecranon bursitis?
Common causes of olecranon bursitis include friction from repetitive movements, trauma, inflammatory conditions (like rheumatoid arthritis or gout), and infection.
126
What is the typical presentation of a person with olecranon bursitis?
A typical presentation of a person with olecranon bursitis includes a swollen, warm, tender, and fluid-filled elbow.
127
What are the signs that indicate an infection in olecranon bursitis?
Signs indicating infection in olecranon bursitis include the affected area being hot to touch, more tender, erythema spreading to the surrounding skin, fever, and features of sepsis.
128
What differential diagnosis should be considered for a swollen joint in the elbow?
Septic arthritis should be considered as a differential diagnosis for a swollen joint in the elbow.
129
What does aspiration of fluid from the bursa reveal, and how does it help in diagnosis?
Aspiration of fluid from the bursa provides clues for diagnosis. Pus indicates infection, straw-colored fluid suggests infection is less likely, blood-stained fluid may indicate trauma, and milky fluid indicates gout or pseudogout.
130
What are the management options for olecranon bursitis?
Management options for olecranon bursitis include rest, ice, compression, analgesia, protecting the elbow, fluid aspiration, and sometimes steroid injections.
131
What antibiotics are recommended for treating olecranon bursitis suspected to be infectious?
Flucloxacillin is recommended as the first-line antibiotic for treating infectious olecranon bursitis, with clarithromycin as an alternative.
132
What steps are recommended for managing a patient with olecranon bursitis if they are systemically unwell?
Systemically unwell patients with olecranon bursitis need hospital admission for further management, including blood tests, IV antibiotics, and fluids.
133
What is the significance of fluid appearance during aspiration in olecranon bursitis?
The appearance of fluid during aspiration in olecranon bursitis provides information that helps identify the underlying cause, aiding in appropriate treatment.
