Lecture Skills Workshop November 19 th, 2013 Alexander Austin, PGY3

 Anatomy  Inspection  Etiology of knee Pain  Functional Testing  Palpation/Bony Landmarks  Provocative Testing  Diagnosis

 Arthritis  Chondromalacia  Meniscal Injuries  Cruciate Ligament Injuries  Medial & Lateral Collateral Ligament Injuries  Tendon Injuries  Osgood-Schlatter Disease  Iliotibial Band Syndrome  Osteochondritis Dissecans  Plica Syndrome  Gouty Arthritis / Pseudogout  Rheumatoid Arthritis  Septic Arthritis

Lateral LCL sprain Lateral joint capsule sprain Superior tibiofibular Syndesmosis sprain Lateral patellar retinaculum irritation Biceps femoris strain Biceps femoris tendinopathy Popliteal tendinopathy IT band friction syndrome Lateral meniscus tear Fibular head fracture Osteochondral fracture Osteochondritis dissecans Lateral femoral condyle contusion Lateral tibial plateau Contusion Eipipyseal fracture (pediatric) Medial MCL sprain Medial joint capsule sprain Medial patellar retinaculum irritation Pes anserine bursitis Semitendinous strain Semitendinous tendinopathy Semimembranous strain Medial meniscus tear Osteochondral fracture Osteocondritis dissecans Medial femoral condyle contusion medial tibial plateau Contusion Epiphyseal fracture (pediatric)

Anterior ACL sprain Patellar tendinopathy (Jumpers knee) Patellar tendon rupture Patellar bursitis Patellofemoral join dysfuction Quadriceps contusion Fat pad irriatation Quadriceps tendon rupture Patellar fracture Tibial plateau fracture Osgood-Schlatter disease Patellar dislocation or subluxation Chondromalacia Posterior PCL sprain Posterior capsule sprain Gastrocnemius strain Hamstring strain Popliteus tendinopathy Popliteal cyst (Bakers) Medial/Lateral meniscal tear (posterior horn)

 Alignment (Varus/Valgus, pes planus/cavus)  Functional testing  Joint line palpation  Active vs Passive ROM  Capillary Refill / Pulses (DP/PT)

 ACL: Lachman / Pivot shift  PCL: Posterior drawer / sag  MCL: Valgus Stress test  LCL: Varus Stress Test  Meniscus: McMurray / Thesslays  Patella: Patellofemoral grind / Apprehension  Iliotibial Band: Ober

 Age >55  Isolated Patella bony tenderness  Tenderness at head of fibula  Inability to flex knee to 90 degrees  Inability to bear weight (4 steps) – Unable to transfer weight twice

 Primary criteria (required)  - Blunt trauma or fall type injury  Secondary criteria (one of the following)  - Age 50 yrs  Inability to walk four weight bearing steps in ER

1. Starkey, Chad; Brown Sara,1. Examination of Orthopedic and Athletic injuries Clinical Examinations for Meniscus Tandeter MD, Howard; Shvartzman MD, Pesach. Acute Knee Injuries: Use of Decision Rules for Selective Radiograph Ordering 4. Stiell IG, Greenberg GH, Wells GA. Prospective validation of a decision rule for the use of radiography in acute knee injuries. 5. Lachman Test (Two versions). Physical Theraphy Haven. test-two -versions