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MS of the Kneee
Clinical Medicine II-Spring 2012
| Question | Answer |
|---|---|
| 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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