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Knee.

Orthopedic Tests

QuestionAnswer
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