MSK Final exam (barf)
- knee OA
Knee pain with mobility deficits
- Meniscal derangment
what type of carilage lines the knee joint hyaline
what type of cartilage are the menisci composed
fibrocartilage
of
false:
- inner portion: white
t/f the inner portion of the menisci is
zone: avascular
vascularized, but the outer is not
- outer portion: red zone:
vascularized
What red flags should you consider for knee - fracture
pain with mobility deficits -Deep vein thrombosis (DVT)
If any of the below are present, refer out to rule
out fracture:
- patient is 55+
- unable to weight bear immediately after or in
List the Ottawa knee rules the ER
- tender at the fibular head
- tender at the patella
- cannot flex the knee ast 90deg
what is used to classify if DVT is present? Well's criteria
<2: DVT is unlikely
interpret a score from the Wells criteria
2 or more: DVT is likely
- LEFS
Outcome measures for knee pain with mobility
- KOOS
deficits
- IKDC 2000
What is the most common location for articular
the medial demoral condyle
cartilage changes in the knee
ACR criteria Must meet 3/5 to diagnose OA
, - patient is at least 50
- morning stiffness lasting <30 minutes
- Crepitus with AROM
- bone tenderness
- Bone enlargment
- aching pain that is worse with WB
- stiffness after prolonged positions
- limited ROM
List some things you would find in the OA
- hypomobility
subjective/objective exam
- Varus angle of the tibiofemoral joint
- swelling
- palpable deformity
What knee motion is most limited with knee OA Flexion is more limited than extension
What are the meniscal derangement
acute and degenerative
classifications
- trauma (plant and twist, or hyperflexion)
Acute meniscal derangement is associated with: - younger populations
- lateral meniscus
- older people
degenerative meniscal derangement is
- insideous onset
associated with
- medial meniscus
which meniscus is more commonly injured medial meniscus
Which meniscus is more mobile? the lateral meniscus
t/f the LCL is continuous with the lateral false.
meniscus The MCL is continuous with the medial meniscus
explain the screw home mechanism for open
- tibia externally rotates on femur
chain movements
explain the screw home mechanism for closed
- femur internally rotates on tibia
chain movements
- joint line tenderness
- limited AROM/PROM
List the subjective/objective findings for
- hypomobility
meniscal derangement
- report of clicking or popping
- swelling
, What is used to diagnose meniscal derangement meniscus composite score
thessaly
Special tests for meniscal derangement apley
McMurray
Patient is in supine
- maximally flex the knee
- internally rotate to test the lateral meniscus
How would you perform a McMurrays?
- externally rotate to test the medial meniscus
Clicking, popping, pain, or symptom
reproduction is a positive test
- patient stands on
affected leg, using your
shoulders for support as
they internally and
How would you perform a Thessaly externally rotate
Clicking, popping, pain, or
symptom reproduction is
a positive test
patient is in prone
- flex the knee 90 deg
- apply axial compression
How would you perform an Apleys - internally and externally
rotate the knee
Clicking, popping, pain, or
symptom reproduction is
a positive test
- Gait training
- Glides I-II
- Soft tissue
- Trigger point dry needling
Patient presents to the clinic with an acute - Unloading braces
meniscal tear after a trauma yesterday. How
would you address the swelling and pain? - Shoe insoles
- OTC meds/ Topical NSAIDs
- Corticosteroid injection
- Visco-supplmentation
- Surgery
How would you treat Knee OA? - Glides to address hypomobility
- knee OA
Knee pain with mobility deficits
- Meniscal derangment
what type of carilage lines the knee joint hyaline
what type of cartilage are the menisci composed
fibrocartilage
of
false:
- inner portion: white
t/f the inner portion of the menisci is
zone: avascular
vascularized, but the outer is not
- outer portion: red zone:
vascularized
What red flags should you consider for knee - fracture
pain with mobility deficits -Deep vein thrombosis (DVT)
If any of the below are present, refer out to rule
out fracture:
- patient is 55+
- unable to weight bear immediately after or in
List the Ottawa knee rules the ER
- tender at the fibular head
- tender at the patella
- cannot flex the knee ast 90deg
what is used to classify if DVT is present? Well's criteria
<2: DVT is unlikely
interpret a score from the Wells criteria
2 or more: DVT is likely
- LEFS
Outcome measures for knee pain with mobility
- KOOS
deficits
- IKDC 2000
What is the most common location for articular
the medial demoral condyle
cartilage changes in the knee
ACR criteria Must meet 3/5 to diagnose OA
, - patient is at least 50
- morning stiffness lasting <30 minutes
- Crepitus with AROM
- bone tenderness
- Bone enlargment
- aching pain that is worse with WB
- stiffness after prolonged positions
- limited ROM
List some things you would find in the OA
- hypomobility
subjective/objective exam
- Varus angle of the tibiofemoral joint
- swelling
- palpable deformity
What knee motion is most limited with knee OA Flexion is more limited than extension
What are the meniscal derangement
acute and degenerative
classifications
- trauma (plant and twist, or hyperflexion)
Acute meniscal derangement is associated with: - younger populations
- lateral meniscus
- older people
degenerative meniscal derangement is
- insideous onset
associated with
- medial meniscus
which meniscus is more commonly injured medial meniscus
Which meniscus is more mobile? the lateral meniscus
t/f the LCL is continuous with the lateral false.
meniscus The MCL is continuous with the medial meniscus
explain the screw home mechanism for open
- tibia externally rotates on femur
chain movements
explain the screw home mechanism for closed
- femur internally rotates on tibia
chain movements
- joint line tenderness
- limited AROM/PROM
List the subjective/objective findings for
- hypomobility
meniscal derangement
- report of clicking or popping
- swelling
, What is used to diagnose meniscal derangement meniscus composite score
thessaly
Special tests for meniscal derangement apley
McMurray
Patient is in supine
- maximally flex the knee
- internally rotate to test the lateral meniscus
How would you perform a McMurrays?
- externally rotate to test the medial meniscus
Clicking, popping, pain, or symptom
reproduction is a positive test
- patient stands on
affected leg, using your
shoulders for support as
they internally and
How would you perform a Thessaly externally rotate
Clicking, popping, pain, or
symptom reproduction is
a positive test
patient is in prone
- flex the knee 90 deg
- apply axial compression
How would you perform an Apleys - internally and externally
rotate the knee
Clicking, popping, pain, or
symptom reproduction is
a positive test
- Gait training
- Glides I-II
- Soft tissue
- Trigger point dry needling
Patient presents to the clinic with an acute - Unloading braces
meniscal tear after a trauma yesterday. How
would you address the swelling and pain? - Shoe insoles
- OTC meds/ Topical NSAIDs
- Corticosteroid injection
- Visco-supplmentation
- Surgery
How would you treat Knee OA? - Glides to address hypomobility
