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NMS3 Final
Knee
| Question | Answer |
|---|---|
| What is the condition that is the softening of the patella? | Chondromalacia Patella |
| What are the 3 categories of Chondromalacia patella? | Primary Idopathic, Secondary adolescent, Adult DJD. |
| What are the signs and symptoms of primary idopathic chondromalacia patella? | Movie sign! Diffuse ache in knee, over patella. Pain increases with activity, stair climbing, full extension of the knee. Crepitus and some effusion in and around patella. |
| What is the etiology of primary idiopathic Chondromalacia patella | Degenerative process that involves the softening and fissuring of the patellar articular cartilage. |
| How common is primary idiopathic chondromalacia patella? | 30% 10-20. 40% 45-50. |
| How is primary idiopathic chondromalacia patella evaluated? | pain over margin of the aptella. Pain when patella is forced into trochlear groove. |
| What orthos are used to identify chondromalacia patella? | Perkins, and Fouchet's |
| How would primary idiopathic chondromalacia patella be seen on xray? | initially negative. subchondral bone erosion, joint space narrowing, spurring at the lower pole. |
| Whats the best imagine way of diganosis primary idiopathic chondromalacia patella? | MRI |
| What is the prognosis for primary idiopathic chondromalacia patella? | Continue for years, may get worse or better. Most improve spontaneously and do not progress to DJD. |
| How are all kinds of chondromalacia patella treated? | Conservative care, improve the tracking by exercise. Stretch lateralis and strenthen the medialis. Orthotics. Adjust knee, hip, foot ankle, and LB. Ice, US, Stim, laser. nutrition for inflam and cartilage support. |
| What is secondary adolescent chordromalacia patella? | Softening of cartilage secondary to trauma in adolescents and young adults. |
| What is the etiology of secondary adolescent chordromalacia patella? | Direct trauma or indirect trauma. Increased Q angle or elongated patellar tendon. Repetitive smaller injuries to the patella. Ltered mechanics from sprains with disruption of ligamentous tissue of patella. |
| What are signs and symptoms for secondary adolescent chordromalacia patella | Lesion is more laterally over the lateral aspect of patella, buckling. |
| What is adult DJD chondromalacia patella (AKA patellofemoral syndrome)? | In middle age and beyond. signs of DJD prior to symptoms and by at 30, 40-50% are subjected to this process. |
| What is the etiology of adult DJD chondromalacia patella? | Age, wear and tear. Softening involves the entire patella. usually insidious. |
| What are signs and symptoms of adult DJD chondromalacia patella? | Typical DJD symptoms such as pain with activity that is relieved with rest and followed by stiffness. May have limited motion and some joint effusion. crepitation from knee. |
| What is Patella Alta? | Congenital problem with a long patellar tendon. Which causes the patella to ride superior to trochlear grove. May lead to chondromalacia patella. |
| What is Osgood Schlatter's Disease? | common cause of knee pain in active adolescents. Disturbance at teh junction of patellar tendon and tibial tubercle apophysis. Jumping and cutting sports. Bilater 20%. |
| What causes Osgood Schlatter's Disease? | unknown. may be repetitive micro avulsion of chondro-fibro-osseous tibial tubercle. |
| What are signs and symptoms of Osgood Schlatter's Disease? | pain at tibial tubercle. May have swelling. Happens with activity, resolves with rest. Insidious. Pain localized over tubercle. Full ROM, no effusion, instability, or meniscal signs. |
| What are the grades of Osgood Schlatter's Disease? | 1- pain after activity that resolves in 24 hours. 2-pain during and after activity that does not limit activity and resovles within 24 hours. 3-constant pain that limits activity. |
| Osgood Schlatter's Disease is self limititing and usually takes____ to run its course? | 12-24 months |
| Pain of Osgood Schlatter's Disease usually remits on skeletal maturity, but a small percentage of patients develop a ____ | painful ossicle. |
| Long term follow up of Osgood Schlatter's Disease ____ have limitations of activities, and ____ have discomfort with kneeling. | 24%, 60% |
| Osgood Schlatter's Disease could leave to a ___. | large bump on anterior knee. |
| Treatment of Osgood Schlatter's Disease is.. | Decrease stress on tubricle, limit activities of the quads especially with a flexed knee. Cho-Pat is a strap that goes below the patella to take the stress off the tubercle. Adjust. PRICE. |
| What is sinding-Larsen-Johansson disease? | Caused by contusion leading to a subsequent tendonitis in the proximal patellar tendon attachment. Can lead to calification, ossification or inferior pole avulsion fractures that produce ossicles. |
| What are symptoms of sinding-Larsen-Johansson disease? | Tenderness and soft tissue swelling over the lower pole of patella that is aggravated by activity |
| What does sinding-Larsen-Johansson disease show on xrays? | fragmentation of patella. |
| What is the a high cause of disability due to knee issues? | Osteoarthritis of the knee. |
| What are early symptoms of Osteoarthritis of the knee? | Painful cracking or grinding while climbing stairs, standing from seated, kneeling. |
| What are some late symptoms of Osteoarthritis of the knee? | Attacks of synovitis (swelling). Muscle atrophy of quads (usually medial side goes first) |
| Causes of bursitis of the knee? | Direct trauma, chronic irritation. |
| Signs and symptoms of bursitis? | Localized tenderness over patella, reddening, swelling, effusion, ROM is painfree. |
| Which bursa is subcutaneous anterior to patella. Protect from blow to patella, or kneeling. extracapsular. associated with housemaids knee? | Prepatellar |
| Which bursa is Superior to patella, beneath the quad. Decreases friction between quad and femur. extension of the synovial membrane (contains fluid). Intrasynovial. | Suprapatellar bursa |
| Which bursa is subcutaneous anterior to patellar tendon but below patella. Inflammation causes rounded swelling. | Superficial infrapatellar bursa |
| Which bursa is deep to infrapatellar tendon, somtimes is continuous with synovial space. INflammation causes dumbbell swelling. | Deep infrapatellar bursa. |
| which bursa protects the patellar tendon from rubbing against the tibia? | Deep infrapatellar bursa. |
| Which bursa are associated with Parson's knees? | Deep infrapatellar bursa. Superficial infrapatellar bursa. |
| Which bursa lies between the medial collateral ligament/tibia and the muscles that attach there? | Pes Anserine Bursa. |
| How do you treat acute bursitis of the knee? | ice 20 mins 4x a day within first 48 hours. Compression bandage, protect, crutches. |
| How is subacute/chronic bursitis of the knee treated? | Pulsed ultrasound, gental manipulation, padding in athletes. |
| What is runners knee? | Iliotibial band syndrome |
| What is the classic presentation of IT band syndrome? | pain and inflammation on the alteral side of the knee. Lateral epicondyle. usually after repetitive use. Common cause of lateral knee pain in runners. |
| What are the causes of IT Band syndrome? | Repetitive irritation of the IT band over the lateral tibial tubercle. Or with increased pressure over the area, like weight lifters doing squats. |
| What are pre-disposing factors to IT band syndrome? | Conditions, or postural alterations that change the friction of the ITB over the lateral knee. Genu Varum(bowed knees), Pronation of foot. leg length. week knee flexors and extensors bilaterally. Running on a sloped road. |
| HOw is IT Band syndrome evaluated? | Point tenderness over lateral epicondyle. Ober's test. |
| What is treatment of IT band syndrome? | Remove irritating factors. Decrease or stop running. NO hill, stair, sloped road running. orthotics. Stretch ITB before and after running. |
| In office care for ITB syndrome? | Ice 20 mins every 2 hours. Electrical stim, Pulsed US. Orthotics, adjust leg. |
| Another name for Patellar tendonitis? | Jumper's Knee |
| Who tends to have patellar tendonitis? | Athletes that require explosive quads contraction. |
| Causes of patellar tendonitis? | Chronic repetitive stress(sqautting, kicking a ball, broad jumping, jumping from high point, stepping in a hole). Increase in training. Training on ridged surface. Improper mechanics. |
| Signs and symptoms of patellar tendonitis? | Vague insidious onset after competition, pain disappears after rest, knee feels weak and may give out, complete rupture may occur, may feel tendon is squeaking. |
| Exam findings of patellar tendonitis? | tenderness to palpation, forced knee extension against resistance if painful, little or not swelling present. |
| Treatment for patellar tendonitis? | Ice, warm up exercises, stretching, US, correct alignment of feet, knee, and low back. |
| What is baker's cyst? | Synovial herniation in the posterior of the knee. |
| Where do you find a baker's cyst? | Semimenranosus/gastroc bursa. Located under the medial gastroc, Large soft tumor in popliteal space |
| Causes of a traumatic meniscus tear? | Twisting injury, blow to side of knee. |
| Causes of degenerative meniscus tear? | Drying out of the inner center of the menisucs beginning in late 20s and progresses with age. |
| What are the orthos for a meniscus tear? | Bounce home, McMurray, Steinmann, Apley's Compression Test. |
| How is a torn meniscus treated? | If its minor: patient may choose to just avoid aggravating behavior, improved biomechanics. IF major, the only treatment is surgery. |
| Causes of collateral ligament tears? | Varus/valgus knee injuries. |
| What are the signs and symptoms of a collateral ligament tear? | pain over the medial or lateral boarder of the knee joint after injury. unstable feeling of the knee, giving out of the knee. |
| How is a collateral ligament tears examined? | stress of ligaments. Varus and valgus stress will increase pain. Total tears will have little increase in pain to stress. |
| How do you treat Grade 1 and 2 collateral ligament tears? | RICE, pain modalities, activity modification, protection with a hinge brace is standard. |
| How do you treat a grade 3 collateral ligament tears? | Usually require surgery. Rehab starts right away. Return to play is allowed when 90% strength is returned. |
| What are the orthos for a collateral ligament tear? | Adduction and abduction stress, Apply's distraction test. |
| What is a dislocated patella. | Patella dislocates laterally due to a direct blow. |
| What is the etiology of a dislocated patella? | shallow trochlear groove which allows the patella to slide laterally out of the grove. |
| What is the treatment for a dislocated patella? | When dislocated the quads goes into spasm locking the patella to the laterally. Normally to relocate the patella wo damaging the cartilage requires sedation of the patient. |
| What is the most commonly injured ligament of the knee? | ACL |
| HOw does an ACL tear happen? | Knee if forcefully twisted or hyperextended. |
| Chronic ACL deficincy can lead to ... | Significant knee instability, 2ndary damage to other knee structures, possibly early DJD |
| What ligaments limit valgus and varus motion/forces? | Collateral |
| What ligaments limit backward motion of the tibia on the femur, internal rotation of the tibia with hyper extension of the knee | PCL |
| What ligament limits forward motion of the tibia on the femur, internal rotation of the tibia on the femur and hyperextension of the knee. | ACL |
| What are the orthos for ACL tears? | Lachman's Anterior Drawer test, Pivot shift maneuver. |
| What ortho is the most reliable indicator? | Lachman's Test |
| Grading of a ACL tear. | Grade 1: <5mm. Grade 2: 5-10mm. Grade 3 >10mm |
| What are non contact mechanisms of injury for ACL tears? | Planting and cutting. Straight knee landing. One step landing with the knee hyperextended. Pivoting. Sudden deceleration. |
| What are contact mechanisms of injury for ACL tears? | Posterior force. Lateral force. |
| What are signs that it might be ACL tear? | Pop at time of injury. Knee swelling within 6 hours usually sooner. instability and insecurity. Feeling of giving way or coming apart. Pain progressively getting worse. Muscle spasm. unable to return to play. May still be able to walk. |
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