Knee Joint conditions MSK

Patellofemoral syndrome (runner’s knee)

• Condition: Age 20-50, MOI: trauma, tight ITB, gmax & TFL

• Examination:

  • Worsening s/s after prolonged sitting (moviegoer’s sign), stairs, kneeling

  • end-range knee flexion is painful

  • Tenderness on anterior knee, especially with patella compression

  • Swelling may occur on anterior knee

• Special tests: Clarke’s test

Patellar tendinopathy (jumper’s knee)

• Condition: age 15-30, inflammation of patellar tendon, gradual onset, MOI: gradual (repeated eccentric overloading during deceleration activities)

• Examination:

  • Pain increases with squatting and jumping

  • End range knee flexion painful

  • Tenderness over patellar tendon (inferior or superior to patella)

• Special tests

  • Patellar grind test

  • SL hop test

  • High step up test

Prepatellar bursitis

• Condition: Age: 15-50, inflammation of bursa due to recurrent minor trauma of anterior knee, MOI: direct trauma to the anterior aspect of the knee

• Examination:

  • pain increases with kneeling

  • Local swelling, fluctuation

Quadriceps muscle tear

• Condition: age 20-40, MOI: sudden eccentric overload

• Examination

  • Squatting increases s/s

  • Bruising and/ or swelling can occur over the anterior thigh/ knee

  • Knee flexion is limited

  • Combined hip extension and knee flexion is painful

  • Resisted hip flexion and knee extension is painful

  • Tenderness over anterior thigh

Osgood Schlatter disease

• Condition: age 8-13 in females, 10-15 in males, onset: sudden, traction apophysitis of tibial tubercle

• Examination

  • Visible lump over the site

  • Pain with activities (jumping, running, squatting, kneeling, acute knee impact and ascending or descending stairs)

  • Knee extension against resistance or stressing quads increased s/s

  • Anterior knee pain

Sinding- larsen- johansson syndrome

• Condition: traction apophysitis at inferior pole of patella

• Examination:

  • Pain with activities like cycling, athletics, resisted knee extension

• Special tests:

  • X-ray fragmentation of tibial tubercle or irregular calcification

Anterior cruciate ligament injury

• Condition: Age 14-45, contact & non-contact MOI, Contact > blow to the lateral side of knee- valgus force to knee results in ACL, MCL, medial meniscus injury (terrible triad), non-contact tibia ER on planted foot, forceful hyperextension

• Examination:

  • Immediate swelling of knee and popping sound

  • Feeling of instability

  • Symptoms increase with WB

  • Pain at end ranges

  • Pain with resisted knee rotation

• Special tests

  • Lachman’s test

  • Pivot shift

  • Anterior drawer test

Medial/ lateral collateral ligament

• Examination:

  • Valgus/ varus forces across medial joint line of knee

  • Symptoms increases with varus stress (LCL) and valgus stress (MCL)

• Special tests

  • collateral ligament instability test

Posterior cruciate ligament injury

• Condition: forceful blow to anterior tibia in knee flexed, dashboard or falling onto the flexed knee, hyperflexion

• Examination: popping sound, pain in the posterior aspect of the knee joint which aggravates with kneeling

• Special tests:

  • Posterior sag test

  • posterior drawer test

  • reverse Lachman test

Iliotibial band friction syndrome

• Condition: age 25-55, MOI- overuse

• Examination:

  • Pain with repetitive movements, climbing, or descending stairs

  • Lateral knee pain diffuse & hard to localize

  • Localized tenderness at lateral femoral condyle

• Special test

  • Ober’s test (ITB tightness)

  • Noble compression test

  • Renne test