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Knee.
Orthopedic Tests
| Question | Answer |
|---|---|
| Common causes of knee pain in children and adolescents | Patellar subluxation, Tibial apophysitis (OSgood-Schlatter lesion), Jumper's knee (patellar tendonitis), Referred pain (SCFE), Osteochondritis dissecans |
| Common causes of knee pain in adults | Patellofemoral pain syndrome, medial plica syndrome, pes anserine bursitis, trauma, ligamentous sprains, meniscal tear, RA, Reiter's syndrome, septic arthritis |
| Common causes of knee pain in older adults | Osteoarthritis, crystal induced inflammatory arthropathy, gout, pseudogout, popliteal cyst (Baker's cyst) |
| Anterior knee pain | patellar subluxation, tibial apophysitis (Osgood-Schlatter lesion), Jumper's knee (patellar tendonitis), Patellofemoral pain syndrome (chondromalacia patellae), anterior cruciated ligament injury |
| Medial knee pain | Medial colloteral ligament sprain, medial meniscal tear, pes anserine bursitis, medial plica syndrome |
| Lateral knee pain | Lateral collateral ligament sprain, lateral meniscal tear, Iliotibial band tendonitis |
| Posterior knee pain | Popliteal cyst (Baker's cyst), Posterior cruciate ligament injury |
| Q angle (quadriceps angle) | angle between lines from tibial tubercle to middle of patella and from ASIS to middle of patella |
| Normal Q angles | Q-angle 14 for male, 17 for female (+-3) |
| Increased Q angle indicate? | external tibial torsion, laterally positioned tibial tuberosity, tight lateral retinaculum, genu valgum, (increased peak patellofemoral contact pressures, patella alta) |
| Knee ROM normals | Flex 135, Ext 0, IR 10, ER 10 |
| Knee joint effusion | Limited ROM d/t tissue swelling -May damage meniscus, cruciate ligament, muscle, bursitis, RA, OA, infection |
| Septic arthritis (info, sxs) | Infected joint (orthopedic emergency) -systemic gonococcal infection, puncture into joint, Sxs: rapid onset of joint inflammation after UTI, dental abscess, urethritis |
| Ballotable patellar Test | -passive, supine -knee extended or slightly flexed, apply pressure or tap over patella +: floating patella over knee joint =major synovial joint fluid effusion |
| Bulge Test | -passive, supine, knee extended -apply brushing strokes along medial aspect of patella (inf->sup). Then press on lateral side of patella looking for fluid wave medially +wave=minor synovial fluid effusion |
| Pes anserine bursitis | Local inflammation to pes anserine (sartorius, gracilis, semitendinosis) -associated w/ OA, obesity, jumping sports, rule out MCL injury/meniscal tear |
| Prepatellar bursitis | -housemaid's knee, most common bursitis, -insidious onset of pain, pain w/ direct pressure, full ROM (not in septic) |
| Patellar subluxation/dislocation | -Observed, injury related -increased valgus, Q-angle >15deg, patellar crepitus/apprehension, -hyperlaxity |
| Pes anserine bursitis Tx | Anti-inflammatories, hydrotherapy, hamstring stretching, injection (homeopathic) |
| Patellar subluxation/dislocation Tx | Brace, rehab, taping, PT -Quad/VMO Strengthening -surgical realignment |
| Miserable malalignment syndrome | -femoral anteversion, genu valgum, foot pronation sxs: anterior knee pain, pain w/ stairs |
| Patellar apprehension Test | -passive supine -observe patient's face while extending knee and manually displace patella laterally +pain or apprehension=lateral patella dislocation |
| Chondromalacia apatella (aka anterior knee pain syndrome, patellofemoral stress syndrome) | Anterior knee pain (w/ squatting, kneeling, walking down stairs) -commonly in runners, sports -reversible/no breakdown of articular cartilage |
| Patellar grinding Test (1) | active/resisted, supine 1-tract the patella inferiorly then ask pt to contract quadriceps +pain or crepitus=chondromalacia patella |
| Patellar tendonitis (aka jumper's knee) | anterior knee pain due to patellar tendonitis -pain w/ squatting, kneeling, stairs |
| Patellar grinding Test (2) | Passive, supine -move patella medially and laterally while pressing down +pain under patella=chondro.pat., retropatellar arthritis, +pain over patella=prepatellar bursitis |
| Medial collateral ligament Test (abduction/valgus stress test) | passive, supine -abduct leg (valgus) while stabilizing knee +pain=MCL injury |
| Lateral collateral ligament Test (adduction/varus stress test) | passive, supine -adduct leg (varus) while stabilizing knee +pain=LCL injury |
| Apley's distraction Test | passive, prone -flex knee to 90, stabilize thigh, pull on ankle w/ internal/external rotation +pain=meniscus/ligament injury |
| Plica | remnant of connective tissue from fetus development. thin wall of fibrous tissue extending from synovial capsule. Sxs: medial knee pain, snapping sensation w/ knee flexion, provocative: stairs/squatting, repeated flex/ext movements, painful arc at 30-60 |
| Mediopatella Plica Test | passive, supine -Flex affected leg to 30deg, then move patella medially (pinch plica btw medial femoral condyle and patella +pain=plica adhered to patella and is inflamed |
| Anterior Cruciate Ligament injury | change of direction (non-contact injury), sudden giving way of knee, hearing pop, swelling w/in two hours, effusion (blocks palpation) -concurrent meniscal tear |
| Anterior drawer Test | passive supine -flex knee (P->A pull) +>5 mm of tibial movement on femur=injury/tear of ACL |
| Lachman's test | passive, supine -flex knee slightly, stabilize femur and pull leg P->A +softened feel and anterior translation of tibia=ACL tear |
| Posterior Cruciate Ligament Injury | 70% associate w/ injury Hx: hyperextension, hyperflexion w/ posterior tibial displacement, direct blow to anterior tibia PE: effusion, bruising, |
| Posterior Drawer Test | passive, supine -flex knee (A->P pull) +>5mm tibial movement on femur=injury or tear of PCL |
| Meniscal Tears | -acute injury/degenerative process -age<40: sports w/ twisting, cutting, jumping, rapid deceleration Age>40: injury w/ standing, kneeling, squatting, Baker's cyst -swelling w/in 24 hrs, quads dysfuntion |
| Meniscal Tear TX | PT for ROM, quad strengthening, anti-inflammatories, arthroscopic debridement vs. repair, free bicycling, contrast therapy (not in acute) |
| McMurray's Test | passive, supine -flex hip and knee, 1-externally rotate ft and valgus stress, extend leg, 2-internally rotate ft and varus stress, extend leg +palpate or audible click=meniscal injury/tear |
| Apley's compression Test | passive, prone -flex knee to 90 and press down w/ rotations while stabilizing thigh +pain or crepitus=Meniscal injury |
Created by:
phdinh33
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