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Knee Differential Diagnosis Course - Coggle Diagram
Knee Differential Diagnosis Course
Traumatic
Fracture
Ottawa Rules
age over 55 or tend at patel, tend pain at fib head, can't flex knee to 90, unable to take 4 WB steps at injury time and at ED.
Extensor Mechanism Injury
Mechanism: Quads tendon, patella, patellar tendon
Can they do a SLR???
MOI: fall dir on patella, or fall with hyperflexed (tendon rupture). Also Steroid use (Tendon rupture - chronic steroid user - weakens tendons).
if patella moves up (Patella Alta) -> patellar tendon tear, ...
Patella Instability
J tracking sign: extend the knee -> patella moves into a J curve moving laterally.
Insufficiency Fracture
Meniscal Root tear cause. CAN BE INSIDIOUS.
Ligament Injury
MCL
More common than LCL. MOI: Valgus mechanism trauma. 50 50 ball
ALOT of instability - medial side collapse. PAIN along line of ligament. OBJ - Valgus stress test.
ACL
70% non-contact injuries.
Pivoting injury, Cutting, twisting, decelerating. Hyperextension.
Couldn't control anterior tibial translation.
Swelling within an hour
Tests:
Lachman's: 20-30 deg - move tibial anterior
Anterior Drawer (sit on foot)
PCL
PLC
Posterior Lateral Corner 0 LCL, Poplitofibular ligament, Popliteus tendon
works to stabilize tibial rotation ER, varus tiibal translation, posterior tibial translation
MOI: anteromedial blow to tibia, sig ER tib. FEELS UNSTSABLE.
OBJECTIVE: Post lateral swelling, bruising post- popliteal vein/artery, lateral genic vein artery. TEST: DIAL TEST: Flex knee to 90 and 30 - turn feet ER - compare healthy.
Trauma, Pain and swelling. Can't play on. INSTABILITY.
LCL
Varus mechanism, pain along line of lig. VARUS stress test. DONT often happen in isolation. PLCCCCC
Meniscal Tear
MOI: WB, twisting with flexion.
Swelling - less likely, common next day. NOT conclusive to meniscal injury.
Locking: can't extend the knee.
OBJ: Pinpoint joint line pain.
Osteochondral Defect
Focal area of damage to art cart or subchonddral bone
Most common in medial femoral condyle. AND also retropatellar
sensation of catching during ROM.
These DONT get better with PT.
OBJ: Palpate for the focal pain.
Trauma patient
What happened? I ACT it out. Did you have XRAY? (VERY imp if SWELLING!) ---- Have you inj tthis knee before.
Sweep test (up medial down lateral -> LOOK for swelling medial side re-inflates) Grading 0-3
Atraumatic
PFP
SUBJ: younger- female>male, Pain around Patella. Aggravated by? Knee flexion - squatting, lunging, sitting for long periods (Cinema Sign)
Contact positions: pos of knee flexion where patella contacts trochlea of femur.
Obj: Clarke's test, crepitus around patella, patella tracking issues when extending knee - painful. Quads and or gluteal weakness.
DX of exclusion. Patella doesn't react well to quad weakness - less control.
Patellar Tendinopathy
Sub: Younger males > fem. Focal pain around patella tendon. Aggrav: explosive movements, jumpers knee.
Warmup response
unlike PFP which gets worse with more activity, PT improves.
Objective: Pain on palpation of tendon, may or may worsen with quad resisted testing, likely to worsen with hopping or jumping
Hoffa's Fat Bad
SUBJ: pain really irritable, location - either side of patellar tendon. --- pain aggravted by extension as compressed pad --- standing walking, ----- eased by FLEXION
OBJ: pain on palpation either side of Patellar tendon.
SWELLING
Fat pad compr test: passively extend knee with pressure on fat pad
Bursitis
Suprapatella
Prepatellar
Superficial Infraptella Bursa
Deep infraptella
Pes Anserine
pain over medial tibial condyle, WORSE with knee flexion. SGT
Subj: Overuse. Pain rep directly at bursa. ___ palpation pain over bursa. Swelling, pain, gristling sensation.
OA
Subj: morning stiffness that doesn't last more than 30.
Joint related
Degen Meninscus
Can go hand in hand with OA.
SUBJ: hx of knee issues. grumbly knee, Catching or jamming sensation, small effusion may
OBJ: Pain on JOINT line palpation - often pinpoint. Pain limiting their active ROM. ------------feeling of giving way functional activity. Catching or jamming during ROM. Small effusion comes and goes.
Inflammatory Arthritis
RA
Psoriatic Arth
Psoriasis
Presents over extensor compartment. (rather than eczema over flexion compartment)
Activity tends to get better with activity