Term
|
Definition
| stretching or partial tear of a ligament |
|
|
Term
| What are the most commonly sprained ligaments in the knee? |
|
Definition
MCL
LCL
ACL (often complete tear)
PCL (often complete tear) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| The ______ gives valgus stability to the knee. |
|
Definition
|
|
Term
| The ______ gives varus stability to the knee. |
|
Definition
|
|
Term
| What type of stress affects the MCL? |
|
Definition
|
|
Term
| What type of stress affects the LCL? |
|
Definition
|
|
Term
| What suggests a sprain/tear of the MCL? |
|
Definition
| valgus stress produces pain and/or laxity |
|
|
Term
| What suggests a LCL sprain/tear? |
|
Definition
| varus stress produces pain and/or laxity |
|
|
Term
| What should you be thinking about in addition to a ligament tear if the pt. has tenderness to palpation centrally over the ligament? |
|
Definition
| meniscal tear (especially with MCL) |
|
|
Term
| When doing stress tests for knee ligament tears, what positions should the knee be tested in? |
|
Definition
| both 0 degrees of extension and 30 degrees of flexion |
|
|
Term
| What knee position isolates the ligament in question when testing for knee ligament sprains/tears? |
|
Definition
|
|
Term
| What is the treatment for MCL and LCL sprains? |
|
Definition
-weight bear as tolerated (DO NOT immobilize!)
-crutches for comfort
-hinge knee brace if laxity and/or increased pain
-work on PROM and AROM
-refer to ortho to make sure no concomitant problems (ie. meniscal tear) |
|
|
Term
| What does the ACL prevent? |
|
Definition
| anterior translation of the tibia |
|
|
Term
| What does the PCL prevent? |
|
Definition
| posterior translation of the tibia |
|
|
Term
| Which tear is more likely to require surgery, ACL or PCL? Why? |
|
Definition
ACL
There are other ligaments that can provide support with a PCL tear. |
|
|
Term
| What special tests are used to check for knee ligament tears? |
|
Definition
Lachman's
anterior/posterior drawer |
|
|
Term
| What do cruciate ligament tears predisposed you to in the future no matter what age you are? |
|
Definition
|
|
Term
| Which are more common, ACL tears or PCL tears? |
|
Definition
|
|
Term
| What is the most common mechanism of injury associated with cruciate ligament tears? |
|
Definition
pivoting on a planted foot with flexion or extension of the knee
sometimes with valgus or varus stress applied |
|
|
Term
| What will the patient typically complain of with a cruciate ligament tear? |
|
Definition
'pop'
sometimes immediate swelling
giving way episodes |
|
|
Term
| What is the major problem athletes have with an untreated cruciate ligament tear that they thought was just a sprain? |
|
Definition
| instability (knee gives way) |
|
|
Term
| What is the best test for definitive diagnosis of a cruciate ligament tear, short of arthroscopy? |
|
Definition
| MRI with contrast of affected joint |
|
|
Term
| What is the difference between Lachman's test and anterior/posterior drawer tests? |
|
Definition
Lachman's--knee extended
drawers--knee flexed at 90 degrees |
|
|
Term
| What sign may be seen with a PCL tear? |
|
Definition
|
|
Term
| What type of sports are most affected by an ACL tear? |
|
Definition
cutting/pivoting sports
straight away activities, such as running, are not affected |
|
|
Term
| Who should have their ACL reconstructed? |
|
Definition
-young active person (<40)
-athlete involved in cutting/pivoting sport (even if they are >40) |
|
|
Term
| What muscles can give anterior translocation stability to the knee in the absence of an ACL (although not fully)? |
|
Definition
|
|
Term
| How long is the rehab process for cruciate ligament tear surgery? |
|
Definition
at least 6 months
returning the sports too soon can lead to complications and the ligament can be torn again |
|
|
Term
| How many months out from surgery are patients typically not cleared to run after ACL repair? |
|
Definition
|
|
Term
| What is the most important aspect of healing with an ACL tear? |
|
Definition
|
|
Term
|
Definition
| stretching or partial tear of a muscle |
|
|
Term
| What muscles of the knee are commonly strained? |
|
Definition
anterior thigh musculature (rectus femoris, VMO, vastus lateralis)
posterior thigh musculature (biceps femoris) |
|
|
Term
| How are strains of the knee diagnosed? |
|
Definition
-tender to palpation
-sometimes local swelling
-hematoma/bruising may occur |
|
|
Term
| What is the treatment for knee strains? |
|
Definition
-rest
-ice for first 72 hours
-after 72 hours, do heat/ice
-gentle AROM, then PROM once it improves
-gradual return to activities as tolerated |
|
|
Term
|
Definition
| blunt force to the soft tissue or bone |
|
|
Term
| What type of contusion is often more painful than a fracture? |
|
Definition
|
|
Term
| What should you suspect if you get fatty deposits in an aspirate of a knee in which you thought only had a contusion? |
|
Definition
|
|
Term
| If you get fatty deposits in the aspirate of a knee and therefore send the pt. for an x-ray which comes back negative, what should you do? |
|
Definition
make pt. non weight bearing and immobilize
send for MRI/CT |
|
|
Term
| If you get fatty deposits in the aspirate of a knee and therefore send the pt. for an x-ray which comes back negative, then send for an MRI/CT which also comes back negative, what should you do? |
|
Definition
| make pt. weight bearing again and work on ROM |
|
|
Term
| How are contusions diagnosed? |
|
Definition
-tender to palpation at site of complaint
-swelling
-ecchymosis
-xrays negative |
|
|
Term
| What is the treatment for contusions? |
|
Definition
similar to strains
may need aspiration |
|
|
Term
| What types of tendonitis can occur at the knee? |
|
Definition
quadriceps tendonitis
iliotibial band (IT band) tendonitis
patella tendonitis |
|
|
Term
| What is the mechanism of injury for tendonitis in the knee? |
|
Definition
|
|
Term
| What is the common presentation of quadriceps and patella tendonitis? |
|
Definition
-tender at specific tendon
-may c/o pain with explosive activities
-pain with flexion (especially AROM)
-increased pain with eccentric motion |
|
|
Term
| If you can palpate a defect at the knee and the patient can't extend the knee, what should you suspect? |
|
Definition
|
|
Term
| What is the risk of continued activity without rest or pushing your way through the pain with tendonitis? |
|
Definition
|
|
Term
| What is a common mechanism of injury for quadriceps or patella tendon rupture? |
|
Definition
| falling onto flexed knee (stairs) |
|
|
Term
| What is a key history component that you need to ask about if a patient presents with tendon rupture? |
|
Definition
|
|
Term
| What is IT band tendonitis most commonly seen in? |
|
Definition
|
|
Term
| What actually causes IT band tendonitis? |
|
Definition
| bursa just behind the IT band gets swollen, red, and painful |
|
|
Term
| What can sometimes be palpated at the IT band with ROM in a patient with IT band tendonitis? |
|
Definition
|
|
Term
| How is IT band tendonitis diagnosed? |
|
Definition
-tender to palpation at the tendon
-sometimes swelling
-pain with stretching or movement of the tendon |
|
|
Term
| How is IT band tendonitis treated? |
|
Definition
-similar to strains
-steroid shots can be used (inject bursa only, NOT the tendon itself!) |
|
|
Term
| What type of knee tendonitis can be treated with steroid shots? |
|
Definition
IT band ONLY (inject bursa)
quadriceps and patella tendons cannot be injected--can cause rupture |
|
|
Term
| What is patellofemoral pain syndrome? |
|
Definition
-peripatellar, or retropatellar, pain secondary to physical and biomechanical changes in the patellofemoral joint
-inflammation behind and around the patella |
|
|
Term
| What exacerbates the pain associated with patellofemoral pain syndrome? |
|
Definition
-bending, especially with weight bearing activities
-increased periods of sitting with knees bent and then move to standing position |
|
|
Term
| What is the best treatment for patellofemoral pain syndrome? |
|
Definition
| rehab (keep quads strong) |
|
|
Term
| Most patients with severe patellofemoral pain syndrome have some ________ to their knees. |
|
Definition
|
|
Term
| What are pertinent negatives in the history of a patient with patellofemoral pain syndrome? |
|
Definition
| denies swelling, locking, instability, injury |
|
|
Term
| What are potential causes of patellofemoral pain syndrome? |
|
Definition
-overuse/overload (overweight, repetitive activities)
-biomechanical (increased valgus, laterally tilted patella, pes planus at the foot)
-muscular dysfunction (atrophy/weakness of the vastus medialis oblique (VMO)) |
|
|
Term
| What is the most commonly diagnosed knee problem? |
|
Definition
| patellofemoral pain syndrome |
|
|
Term
| What is Osgood-Schlatters? |
|
Definition
| apothysitis (occurs at the growth plate in a growing child) at the insertion of the patella tendon on the tibial tubercle |
|
|
Term
| What is the pathophysiology behind Osgood-Schlatters? |
|
Definition
bone grows faster than the tendon, causing the tendon to pull on the tibial tubercle which causes pain at its insertion
often occurs bilaterally |
|
|
Term
| What type of child is usually most affected by Osgood-Schlatters? |
|
Definition
| athlete that performs repetitive jumping and flexion activities with the knees |
|
|
Term
| Where will a patient be tender to palpation if they have Osgood-Schlatters? |
|
Definition
|
|
Term
| What is the treatment for Osgood-Schlatters? |
|
Definition
-avoid aggravating activities
-ice
-gentle stretching
-generally resolves when the patient stops growing
-rarely have pain into adulthood |
|
|
Term
| If a patient diagnosed with Osgood-Schlatters continues to have pain into adulthood, what do they probably have? |
|
Definition
|
|
Term
| What is prepatellar bursitis? |
|
Definition
| inflammation of the bursa anterior to the patella |
|
|
Term
| What usually causes prepatellar bursitis? |
|
Definition
-repetitive kneeling or pressure on the anterior knee (plumbers)
-contusion of the knee |
|
|
Term
| What is the common presentation of prepatellar bursitis? |
|
Definition
may present only with swelling
sometimes increased warmth, erythema, pain to palpation (rule out infection--look for entry wounds, bug bites, etc.) |
|
|
Term
| What should you do for a patient that comes to your primary care facility who has an infection with perpatellar bursitis? |
|
Definition
send them to orthopedist THAT DAY!
will aspirate and determine organism so they know what antibiotic to use |
|
|
Term
| What is the treatment for non-infected prepatellar bursitis? |
|
Definition
-avoid kneeling and repetitive bending
-only pressure recommended is a sleeve (not one with donut hole) or wrap to reduce swelling
-usually resolves on its own
-if significant swelling, aspiration can help |
|
|
Term
| What is the treatment for infected prepatellar bursitis? |
|
Definition
-still avoid kneeling and repetitive bending
-if cellulitis, treat with oral abx (may need IV if worse)
-NO wrap/sleeve
-aspirate to determine best antibiotic
-REFER to ortho for I&D |
|
|
Term
| What is the mechanism of injury for meniscal tears? |
|
Definition
pivoting on a planted foot with hyperextension or flexion of the knee
also with valgus or varus force |
|
|
Term
| What meniscus is most commonly torn? |
|
Definition
|
|
Term
| What other condition, beside an ACL tear, is a 'pop' common with? |
|
Definition
|
|
Term
| What do patients typically complain of with a meniscal tear? |
|
Definition
-immediate swelling and pain with pivoting motions
-sometimes they can't extend knee fully
-will point to either the medial joint line or lateral joint line of the knee as their source of pain |
|
|
Term
| How soon do patients with meniscus tears need to be surgically treated? |
|
Definition
| within the first few weeks |
|
|
Term
| What are patients with meniscal tears predisposed to? |
|
Definition
|
|
Term
| How are meniscal tears diagnosed? |
|
Definition
|
|
Term
| What is a positive McMurray test? |
|
Definition
pain produced at the joint line while preforming the test
AND
feel/hear a 'clunk/click' underneath your finger tip at the joint line of the meniscus in question |
|
|
Term
| What is the radiographic test of choice for diagnosing meniscal tears? |
|
Definition
|
|
Term
| How do you isolate a mediat meniscus tear? |
|
Definition
| bring the knee to 90 degrees and rotate is with a VARUS stress (McMurray's) |
|
|
Term
| How do you isolate a lateral meniscus tear? |
|
Definition
| bring the knee to 90 degrees and rotate it with a VALGUS stress (McMurray's) |
|
|
Term
| How is Apley test done and what is it used for? |
|
Definition
meniscal tears
pt. is prone and knee is flexed to 90 degrees
rotate the tibia with compressive force downward |
|
|
Term
| What is the best way to determine the extent of meniscal injury? |
|
Definition
| arthroscopy (although MRI can help) |
|
|
Term
| If a patient has a locked knee due to a meniscal tear, what do you need to do? |
|
Definition
| immediate referral to orthopedic surgeon |
|
|
Term
| How are meniscal tears treated? |
|
Definition
| usually surgery (especially if locking/catching) |
|
|
Term
| In an older patient (>40) who sustains a meniscal tear, what do you need to think about? |
|
Definition
|
|
Term
| If a patient has osteoarthritis, what do they probably also have? |
|
Definition
|
|
Term
| What is another name for osteoarthritis? |
|
Definition
| degenerative joint disease (DJD) |
|
|
Term
|
Definition
| degeneration of joint cartilage and the underlying bone |
|
|
Term
| What do patients typically complain of with osteoarthritis? |
|
Definition
-increasing pain in the knee that is gradually getting worse
-generally comes and goes with activity and weather
-diffuse, dull ache in the knee
-may swell intermittently
-as it gets worse, pain with most activities |
|
|
Term
| Who are the best candidates for knee replacement for osteoarthritis? |
|
Definition
-65 or older
-minimal medical problems
-already weight bearing
-emotionally, socially, mentally ready and education about the procedure
-c/o pain while sleeping and it's affected ADLs |
|
|
Term
| What are the 4 radiograph views that should be ordered for a knee complaint? |
|
Definition
AP standing
lateral
sunrise/merchant
PA standing at 30-40 degrees of flexion |
|
|
Term
| Why are standing views important in diagnosing OA? |
|
Definition
| accentuate the loss of joint space |
|
|
Term
| In a patient with varus deformity of the knee, where would you expect the osteoarthritis to be? |
|
Definition
|
|
Term
| In a patient with valgus deformity of the knee, where would you expect the osteoarthritis to be? |
|
Definition
|
|
Term
| What measure of joint space is considered advanced OA? |
|
Definition
|
|
Term
| What conservative treatment options are there for OA of the knee? |
|
Definition
-do nothing and watch and wait
-oral anti-inflammatories
-physical/aquatic therapy
-steroid shots
-viscosupplementation injections |
|
|
Term
| What do you need to check in a patient you are wanting to put on oral anti-inflammatories for their OA? |
|
Definition
|
|
Term
| What do you need to check in a patient you want to do steroid shots for their OA? |
|
Definition
| INR (needs to be less than 2.5) |
|
|
Term
| What is a contraindication for viscosupplementation injections for OA of the knee? |
|
Definition
| allergy to chicken or eggs |
|
|
Term
| What is another name for AVN? |
|
Definition
|
|
Term
|
Definition
| blood is no longer supplied to the ends of the long bones, which leads to bone death |
|
|
Term
| Where can AVN occur in the knee? |
|
Definition
| distal femur, proximal tibia, or both |
|
|
Term
| What condition is often not seen early on with x-ray? |
|
Definition
|
|
Term
| What is the radiographic image of choice if you suspect AVN? |
|
Definition
|
|
Term
| What are early radiographic findings of AVN? |
|
Definition
| subchondral lucency and surrounding sclerosis |
|
|
Term
| If AVN is obvious on an x-ray, do you need to get and MRI to confirm? |
|
Definition
|
|
Term
| What can be done for AVN if caught early by MRI? |
|
Definition
| micro-fracturing surgery to improve blood flow to the area |
|
|
Term
| How does a patient with AVN typically present? |
|
Definition
|
|
Term
| What is the treatment for advanced AVN? |
|
Definition
|
|
Term
| What are the causes of AVN? |
|
Definition
-50% no known reason
-hx of increased EtOH use
-hx or HIV more susceptible
-long term steroid use |
|
|
Term
| What should you always ask patients about, especially if AVN is suspected? |
|
Definition
| hx or steroid or EtOH use |
|
|
Term
| If a patient has been diagnosed with AVN in one joint and are c/o pain in another joint, what should you suspect? |
|
Definition
| AVN in that joint as well |
|
|
Term
| What joints are most commonly affected by AVN? |
|
Definition
hips and knees
can occur in shoulders, wrists, ankles |
|
|
Term
| What is osteochondirits dissecans (OCD)? |
|
Definition
| death of subchondral bone causing fragmentation of bone and cartilage, which may become a loose body in the joint |
|
|
Term
| What age group is more commonly affected by osteochrondritis dissecans? |
|
Definition
|
|
Term
| What do patients with OCD typically complain of? |
|
Definition
point tenderness at the lesion
recurrent effusions |
|
|
Term
| Where is the lesion usually located with OCD? |
|
Definition
| lateral aspect of medial condyle |
|
|
Term
| What is the treatment for osteochondritis dissecans? |
|
Definition
-avoid activities that increase symptoms
-protective weight bearing
-sometimes will heal with time (3 months) with conservative measures |
|
|
Term
| When can a patient with OCD return to normal activities? |
|
Definition
-no pain
-negative PE findings
-lesion is healed on x-rays |
|
|
Term
| What is the difference in healing of OCD between younger and older patients? |
|
Definition
| older patients generally require surgery |
|
|
Term
| Who is susceptible to sepsis of the knee? |
|
Definition
-s/p total knee replacement
-other knee surgeries
-trauma
-HIV
-autoimmune disorders
-concomitant comorbidities
-open wounds
-hx of gonorrhea |
|
|
Term
| What should you do if sepsis of the knee is suspected in a patient in your primary care clinic? |
|
Definition
| refer to orthopedist immediately |
|
|
Term
| What are the signs and symptoms of a septic knee? |
|
Definition
-diffuse pain, usually with swelling
-erythema, calor
-may or may not have fever |
|
|
Term
| What has to be done for a septic knee? |
|
Definition
run labs
aspirate the knee |
|
|
Term
| What labs need to be run for a septic knee? |
|
Definition
CBC w/diff
sed rate
CRP
fungal
acid fast bacilli (TB)
anaerobic and aerobic
gram stain
gonorrhea (esp. if sexually active)
uric acid level (r/o gout) |
|
|
Term
| What is the most common organism with septic knee? |
|
Definition
|
|
Term
| What is the treatment for septic knee? |
|
Definition
IV antibiotics to cover isolated organism
I&D with arthroscopy |
|
|
Term
| When is an open procedure used to I&D a septic knee? |
|
Definition
| pt. with infected prosthetic knee |
|
|
Term
| Where is the most common site of gout? |
|
Definition
|
|
Term
| What are the signs of acute gouty knee? |
|
Definition
hot to palpation
swollen
painful to touch
painful with any ROM |
|
|
Term
| How can OA and gout be differentiated in the knee? |
|
Definition
| OA does not present as sudden severe pain |
|
|
Term
| What is the treatment for gout? |
|
Definition
-generally through PCP or rheumatologist
-indomethocin, conchicine, and/or pain meds
-preventative meds (allopurinol) |
|
|
Term
| When are the only times you should immobilize the knee? |
|
Definition
suspected fracture
tendon rupture
pt. needs immediate referral in these cases! |
|
|
Term
| With regard to ligament and meniscal tears in the knee, what is the only situation in which you want to immobilize the knee prior to surgery? |
|
Definition
| locking due to a meniscal tear |
|
|
