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50 Cards in this Set
- Front
- Back
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Give a differential diagnosis for knee pain.
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BONY INJURY
-fracture (femur, tibial plateau, patella) -osteonecrosis -osteomyelitis -neoplasm Arthritis: -osteoarthritis -rheumatoid arthritis -septic arthritis -reactive arthritis -crystalline arthritis Ligamentous injury -ACL, PCL, MCL, LCL Meniscal injury -medial, lateral |
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• What 5 associated symptoms should be asked about when taking a history for the knee?
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CLIPS
Clicking, locking, instability, pain, swelling Also ask about functionality: DEATH ..., eating, ambulating, transferring, hygiene |
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• What is meant by “locking”?
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o Mechanical block to extension
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• What type of injury does a history of locking and clicking suggest?
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o Meniscal tear, loose body within joint
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• What type of injury does a history of a “giving way” suggest?
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o May be due to a ligamentous injury OR be pain-related
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• What imaging modalities are typically employed to investigate a knee injury?
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o X-rays
o MRI a useful adjunct |
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• What is the characteristic mechanism of injury for a meniscal tear?
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o Low energy, twisting/rotational, non-contact
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• Which meniscus is most commonly torn?
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o Medial meniscus much more commonly injured than lateral
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• When does swelling typically occur in a meniscal tear?
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o Late (next day)
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• Name the physical exam maneuver used to identify a meniscal tear.
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o McMurray’s test
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• Describe McMurray’s test
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...
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• How is a meniscal tear usually diagnosed?
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o Clinical diagnosis based on history and physical exam
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• What is the ultimate long-term outcome of a meniscal tear?
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o Menisci are shock absorbers, so a non-functional or removed meniscus will lead to early OA.
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• What is the treatment for meniscal tear?
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o Arthroscopic repair if possible
o Arthroscopic meniscectomy if repair not possible |
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• What is the characteristic mechanism of injury for a ligament tear?
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o High-energy impact
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• When does swelling and dysfunction occur with a ligament injury?
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o Right away as opposed to later on with meniscal injury
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• Which is more common, an ACL or a PCL tear?
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o ACL much more common
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• Name the physical exam maneuvers used to identify an intracapsular ligament tear.
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o ACL: Lachmann test, anterior drawer test
o PCL: posterior drawer test |
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• Describe the Lachmann test.
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o With the knee flexed at 20-30 degrees, stabilize the femur with one hand and attempt to sublux the tibia anteriorly with the other
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• At what angle should the knee be flexed for the anterior or posterior drawer test?
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o 90 degrees
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• What is the treatment for an ACL tear?
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o Knee usually unstable, reconstruct if possible
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• What is the treatment for a PCL tear?
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o Knee not always unstable, depends on person
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• Which is more common, an MCL tear or and LCL tear?
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o MCL injury more common
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• Describe the physical exam maneuvers used to identify a collateral ligament injury.
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o Medial collateral ligament stress test (valgus force)
o Lateral collateral ligament stress test (varus force) |
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• In which direction do you apply force to stress the MCL?
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o Valgus
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• In which direction do you apply force to stress the LCL?
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varus
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• What is the major risk with a dislocated knee?
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o Neurovascular damage
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• Which artery can be ruptured with a dislocated knee?
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o Popliteal artery
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• Which nerve may be injured with a dislocated knee?
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o Peroneal (fibular) nerve
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• What is meant by extensor mechanism disruption?
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o Damage to quadriceps tendon, patella, or patellar ligament
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• In which age group does patellar tendon rupture typically occur?
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o Young patient (<40)
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• What is the mechanism of injury leading to patellar tendon rupture?
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o Eccentric loading
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• What is eccentric loading?
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o External force elongating a muscle that is contracting
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• What clinical exam finding is strongly suggestive of patellar tendon rupture?
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o Inability to perform straight leg raise
o Also, palpable defect below patella, high-riding patella |
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• What imaging modality is useful for assessing injury to the patellar ligament?
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o U/S or MRI
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• What is the treatment for a patellar ligament tear?
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o Surgical repair
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• What physical exam finding suggests femoral tendon tear?
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o Low-riding patella
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• What is patellofemoral syndrome?
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o Syndrome characterized by pain or discomfort seemingly originating from the contact of the posterior surface of the patella with the femur
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• What is the technical name for patellofemoral syndrome?
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o Chondromalacia Patellae
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• Which demographic group is most associated with patellofemoral syndrome?
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o Young active females
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• What physical exam finding is virtually pathognomonic for chondromalacia patellae?
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o Positive compression test (pain with firm compression of the patella into the medial femoral groove)
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• What is the cinema sign?
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o The pain of patellofemoral syndrome often worsens when sitting for prolonged periods of time
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• In general, what is a varus deformity?
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o A varus deformity is one in which the distal portion of a limb is turned inward toward the midline of the body
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• What is the etymology of varus?
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o Latin, bow-legged
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• In general, what is a valgus deformity?
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o A valgus deformity is one in which the distal portion of a limb is turned outward away from the midline of the body
o Remember by L (in valgus) for Lateral |
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• What is the etymology of valgus?
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o Latin, knock-kneed
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• A bow-legged person has what type of deformity at the knee?
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o Varus
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• A knock-kneed person has what type of demormity at the knee?
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o Valgus
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• What do you do to place a varus stress on a particular joint?
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o Try and displace the distal end of the limb towards the midline
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• What do you do to place a valgus stress on a particular joint?
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o Try and displace the distal end of the limb away from the midline
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