Differential Dx
Insidious onset of mild to moderate pain in the popliteal area of the knee. Most common synovial cyst of the knee.
What is popliteal (baker) cyst?
flex knee 20-30 degrees, pull tibia anteriorly assessing firmness of endpoint
What is Lachman's test?
bloody knee aspirate
what is hemarthrosis?
if locking, popping, or joint instability was of concern, to detect meniscal or ligament damage, order (imaging)
what is an MRI?
first line treatment, shown to reduce pain and improve function
what is exercise ?
Abrupt onset of generalized extreme pain and swelling. Arthrocentesis with turbid synovial fluid.
Flex knee to 90 degrees, stabilize foot by sitting on it and push tibia posteriorly
what is the posterior drawer test?
clear, straw-colored transudative fluid
what is simple joint effusion?
patient has no improvement with initial conservative treatment, or you are considering referral for joint replacement, order (imaging)
what is an x-ray?
first line for patients >65 to reduce pain (based on side effect profile)
what is acetaminophen?
Generalized or joint line tenderness; pain aggravated by weight-bearing activities, relieved by rest. Crepitus on exam.
what is osteoarthritis?
abduct hip, flex knee to 30 degrees, with one hand at lateral joint apply pressure inward to test integrity of MCL.
What is valgus stress test?
partial or incomplete dislocation of the kneecap
what is patellar subluxation ?
considering rheumatoid arthritis, check (blood work)
what is rheumatoid factor?
may be the most effective NSAID at reducing pain due to osteoarthritis
what is diclofenac?
Immediate onset of moderate to severe joint effusion- swelling within two hours of "pop"
what is anterior cruciate ligament sprain?
abduct hip, flex knee to 30 degrees, place hand at the medial joint, and apply pressure outward to assess the integrity of LCL.
What is the varus stress test?
inflammation of the tibial tubercle at the site of the patellar tendon attachment
What is tibial apophysitis (Osgood-Schlatter)?
If concerned about septic arthritis or an acute inflammatory arthropathy, check: (blood work)
What are CBC w/ differential, ESR and/or CRP?
reduces pain, limits the need for other medications, and improves function, but does not improve overall quality of life. Has fewer associated side effects than NSAIDs or opiates.
what is intra-articular corticosteroid injections?
presents with mild to moderate anterior knee pain, worse after prolonged sitting
What is patellofemoral pain syndrome?
Patient stands flat-footed on the affected leg, with the knee at 20 degrees flexion, while holding the clinician's hands for stability. The other knee should be flexed to avoid contact with the floor. The patient internally and externally rotates the knee three times.
what is the Thessaly test?
to evaluate knee pain following trauma, this is used to decide whether or not to order an x-ray
what is the Ottawa knee rules?
The work-up of arthrocentesis fluid includes
What is cell count w/ differential, glucose, protein, bacterial cultures, and polarized light microscopy?
centrally acting agent that has efficacy in the treatment of OA when used alone or in combination with NSAIDs; improves chronic pain
what is duloxetine?