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MS of the Kneee

Clinical Medicine II-Spring 2012

What is the largest joint in the body The knee joint: mostly hinge but complex
What are the two joints within the knee? tibiofemoral and patellofemoral joints
What provides static stability of the knee MCL, LCL, ACL and PCL, ligaments
What provides dynamic stability Quads/Hamstrings
What are the cushions b/w bones of the knee Menisci, medial and lateral
What are articular surfaces covered with cartilage
What are the medial and lateral condyles also called? Serve as? plateaus, recepticles for femeral condyles
What is the attachment for the patellar tendon tibial tuberosity
Is the fibula part of the knee joint no! doesn’t articulate w/ femur or patella
What is the fxn of the fibula biceps femoris and LCL attachment
What is a sesamoid bone to the quads femoris patella: articulates w/ femur
Where is the patella located in quadriceps and patellar tendons imbedded in
What is gerdy’s tubercle lat tib con
Where does the synovial cavity lie b/w surfaces of tibia & femer
What is post. Of paterllar tenson infrapatellar fat pad
Fxn of knee bursae “shock absorbers” decrease friction
Frontal knee bursae suprapatellar, prepatellar, deep infrapatellar, pretibial
Lateral knee bursae gastrocnemius, Fibular, Fibulopopliteal, subpopliteal
Medial knee bursae medial gastroc, anserine bursa-foot of goose, semimebranosa
Knee extensors and innervation rectus femoris, vastus intermedius, vastus lateralis, vastus medidalsis: Femoral n.
Knee flexors Tibial n: semitendinosus, semimembranosus, biceps femoris (long head), Common peroneal n. short head biceps femoris
What is the blood supply to the knee extensors LCFA lateral circumflex femoral artery (ascending, transveres, descending)
What is the blood supply to the knee joint medial genicular arterys
What is the “Big Red One” that supplies the knee Popliteal artery
How are CT’s usually sliced transverse or axial from caudal to cranial
How are MRI’s USUALLY sliced sagittally or looking like lateral on a view of a slice of a MRI
What has to be done to the knee joint in order to internally or externally rotate the leg flexed 20-30degrees
What does cruciate mean cross
How are the PCL and ACL ligaments named origination on the tibia
What are the 4 types of meniscal tear? Bucket handle, horizontal, longitudinal, radial
Which menisci is more common to tear? medially, common w/ ACL tear→knee locking
What is a sign on a MRI that may signify a menisci tear? double PCL sign means bucket handle menisci tear
Tx Bucket handle closed reduction: temporary, arthroscopic resection
MC football and basketball injuries in younger pts ACL’s
MOI of an ACL tear result of a shearing force on acl, quad contracting, with knee at 0-30degrees
What are the main forces causing an ACL injury hyperextension, internal rotation of tibia on femur
What is present in 70% of ACL injuries, what should we try to do first? Hemoarthrosis, PE before this helps exam
What PE tests are used to examine the ACL Lachman and ant. Drawer test
Tx for partial and complete ACL tears Partial: conservative, PT for quad and hamstring strengthening, Full: usually surgery w/ auto or allograft reconstruction
What is the MOI of a PCL injury MC: hyperflexion for isolated PCL, fall on flexed knee w/ foot plantarflexed, or knee into dashboard in MVA
What should we look for in MVA/MCAs soft tissue injuries: posterior drawer test, post sag sign
Tx of a PCL Conservative if isolated PCL injury, especially if older less active, operative in acute, usually young/active
Herniation of synovial membrane through joint capsule, common where Baker’s Cyst, M>F, Med>Lat, in popliteal fossa
DDx and how to diagnose a Baker’s Cyst lipoma, xanthoma, vascular tumor, US Dx
Popliteal cyst baker’s cyst
What can a ruptured baker’s cyst present as thrombophlebitis as fluid flows into calf, looks dramatic: very painful, redl, swollen, hot: mimic an infx
Tx of Baker’s cyst conservative 1st, steroid injection, PT for compression/wrapping and exercises, surgery only w/ highly symptomatic
Inflamed synovial fluid, locations? Bursitis, prepatellar, infrapatella, pes anserine
If acute onset bursitis, what should we be aware of? trauma and ifx:septic rare! Sick?, rarely drug allergy
Tx of bursitis I&D for infx, cultures, compression, ice, activity modification, SOMETIMES steroid injx to supercharge healing process
Cause of patellar fracture and view to detect? direct trauma, Lateral, can do 3rd view, MRI if suspect other ST damage
Tx patellar frx non operative if <3mm, not transverse, extension preserved
If patellar frx >3mm what do we suspect? Tx patellar tendon rupture, Surgery
What is OCD osteochondroitin dissecans loss of blood supply causes articular cartilage separates from bone
Cause of OCD trauma, blockage of tiny arteries to necrosing bone
Abnormally high patella patella alta
ASIS to middle of patella to tibial tuberosity q angle
RF’s for patellar sublux Patella alta, laxity of ligaments, increased q angle, femoral anteversion (varus or valgus)
Tx patellar sublux sedation, reduction, immobilize, post reduction XR, CT in f/u if OCD suspect
With an ankle break external rotation injury→fibula fracture maisonneuve fracture
Pain on inside or outside part meniscus or collateral ligament tear/arthritis
Pain above patella quadriceps tendon or swelling
Pain behind the knee Baker’s cyst or arthritis
Pain in front of knee ocd, patella tracking, bursitis
3 compartments of the knee medial, lateral, patellofemoral
Tx of osteroarthritis conservative until nothing else works: NSAIDS steroids, bracing, exercise, wt loss, surgical replacement
What do we evaluate in a knee XR with OA joint space narrowing, osteophytes, subchondral sclerosis, subchondral cysts
MC organisms of a knee joint infection MRSA, MSSA, Gram neg bacilli
Created by: streetsmarts
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