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1

Claw vs hammer vs mallet

Claw: MTP extension
Hammer: PIP flexion
Mallet: DIP flexion

2

Important HX questions for knee injuries?

Onset of pain
Location of pain
Injury-associated events (catching/locking, pop etc)

3

What are the degrees of immediate dysfunction

Unable to ambulate
Antalgic gait
Continued to participate (sports)

4

Knee anterior structures

Tibial tubercle
Infrapatellar tendon
Quad insertion
Patellar facets
Crepitus

5

Posterior knee structures

Meniscus
Popliteal fossa
Hamstring tendons

6

Medial knee structures?

MCL
Meniscus
Pes anserine
Tibial plateau
Femoral condyle

7

Lateral knee structures?

LCL
Meniscus
Gerdy’s tubercle
Tibia plateau
Femoral condyle

8

posterior lateral corner of knee injury involves what structures?

Lateral collateral ligament
Popliteus tendon
Popliteofibular ligament
Lateral gastrocnemius

9

Theatre sign?

Prolonged sitting causes patella pain.

Knee is in relaxed flexed position, the patella will ride on one side of the knee and it will cause pain.

10

Noncontact injury with “pop” is probably?

ACL tear

11

Contact injury with “pop” is probably?

MCL, LCL tear
Meniscus tear
Fracture

12

Acute effusion (<12hrs) is probably?

ACL tear
PCL tear
Fracture
Knee dislocation
Patellar dislocation

13

Lateral blow to the knee is probably?

MCL tear

14

Medial blow to the knee is probably?

LCL tear

15

Knee “gave out” or “buckled” is probably?

ACL tear
Patellar dislocation

16

Fall onto flexed knee is probably?

PCL tear

17

Joint injuries and their likelihood of hemarthrosis?

ACL: 65-70%
Meniscus: 12.5-50%
Fracture: 1-20%
Patellar dislocation: 11-20%
W/ osteochondral lesion: 5%
PCL: 1-5%

18

Genu varum vs genu valgum?

Varum: knees out
Valgum: knees in (gum)

19

Diagnostic studies you should get on pts with genu varum and ganu valgum?

Leg length radiographs and hip radiographs

The deformity may be in the hip or legs not the knee

20

Q angle?

ASIS-patella and the plane of the tibial tuberosity (hip form affects the femoral to tibial angle)

21

What is normal Q angle?

Male: 15%
Female: 20%

22

Special tests for knee?

Lachman test
Apley compression test
Anterior drawer test
Lateral pivot shift test
McMurray test

Slide 19 has pics

23

Patellofemoral stability test?

Slide patella back and forth

Normal
- patellar slide: 25-50%
- patellar tilt: 15*

Just compare the knees to look for difference

Slide 20

24

What MOI causes patellar dislocation?

Direct trauma
Rotation over planted foot (softball swing)
Sudden cutting movement
Prior injury

25

What radiography should be ordered for knees, why?

x ray: because its everything

MRI: r/o associated injuries

26

Valgus stress test?

MCL

Pull ankle laterally and push knee medically, look for laxity in MCL

at 0* no laxity
At 30* some laxity

Slide 24

27

MCL tears and rupture prognosis?

Proximal ruptures: heal quickly but are stiff

Complete ruptures: can displace joint

Entire ligament: persistent laxity after non-operative tx

28

Varus stress test?

LCL

Pulling ankle medial and pushing knee lateral

Slide 26

29

Lachman test?

ACL

Stablize thigh and pull leg toward you (w 30* flexion) and laxity = badness

Slide 27

30

Pivot shift test?

ACL

Push knee up and medial looking for laxity

Slide 28